Showing papers in "Families, Systems, & Health in 2019"

Couples' treatment preferences for insomnia experienced during pregnancy

Abstract: Introduction Insomnia during pregnancy is prevalent, yet little is known about preferred treatments for the disorder. The current study investigated both pregnant women's and their partners' preferences for treatment of maternal insomnia, comparing the two most empirically supported therapies: cognitive-behavioral therapy for insomnia (CBT-I) and pharmacotherapy. Method We recruited pregnant women and their partners (N = 212) from a low-risk maternity clinic in Calgary, AB, Canada. Participants read expert validated treatment descriptions of pharmacotherapy and CBT-I and indicated their preference for treatment of maternal insomnia. Participants also completed the Insomnia Severity Index and Edinburgh Postnatal Depression Scale. Results The majority of pregnant women (72.6%) and their partners (73.6%) selected CBT-I as their preferred choice for treatment of maternal insomnia, with a high concordance between partners. Correlates of maternal treatment choice included previous use of treatment and partner preference. Discussion Findings suggest that pregnant women and their partners prefer CBT-I to pharmacotherapy as a treatment for maternal insomnia. Partners' preference may be an important consideration for women selecting treatment for insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pediatric palliative care in the medical neighborhood for children with medical complexity.

Abstract: Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Listening to adolescents with uncontrolled diabetes, their parents and medical team.

Abstract: Introduction Few studies have reviewed concurrent perspectives and experiences of parents, health care providers (HCPs), and adolescents themselves, when their Type 1 diabetes (T1D) is uncontrolled. We utilized a qualitative interview approach to explore these feelings and interactions. Method Nine adolescents, age 13-18 years with T1D > 1 year and A1C > 9.0%, their parents, and 10 HCPs participated in semistructured interviews. The 7 girls and 2 boys were interviewed with their parents present and the 10 HCPs participated in separate interviews. Interviews were recorded, transcribed, and reviewed for themes relevant to the uncontrolled diabetes experience. Results Adolescents, parents, and providers shared similar feelings of frustration, guilt, anxiety, and anger related to uncontrolled diabetes, but described very different behavioral responses to these unexpressed feelings. Adolescents tended to rebel and became more nonadherent to diabetes-related tasks. Parents became angry, nagged, threatened, and often blamed and shamed their teen. Health care providers became less patient-focused, distancing themselves from patients and their parents. This resulted in misunderstandings, conflict, and often disengagement from diabetes. Discussion Adolescents with poorly controlled T1D, their parents, and HCPs, while attempting to do their best, often respond to their frustrations with visible behaviors "out of sync" with their unexpressed feelings. This resulted in conflict, continued poor blood sugars, and disengagement. Interventions to improve diabetes-related care and communication between adolescents, parents, and HCPs may result in improved diabetes self-management. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Youth self-reported health and their experience of parental incarceration.

Abstract: Introduction Mass incarceration is becoming one of this country's most detrimental public health problems. Children are particularly affected by this phenomenon, as parental incarceration is associated with a host of adverse outcomes, including children's engagement in health-risk behaviors that may negatively influence their mental and physical health. This study compares physical health indicators of youth with currently and formerly incarcerated parents with youth with no history of parental incarceration. Method Using cross-sectional data from the 2016 Minnesota Student Survey (MSS), this secondary data analysis examined behavioral indicators of physical health among 8th, 9th, and 11th grade students (N = 119,029). Self-reported behavioral indicators of physical activity, fruit and vegetable consumption, fast food consumption, sugar-sweetened beverage consumption, and sleep were assessed. We also included a measure of perceived overall health. Logistic regression models controlling for demographic characteristics compared youth with currently and formerly incarcerated parents to youth with no history of parental incarceration. Results As predicted, parental incarceration was significantly associated with lower levels of healthy behaviors and higher levels of unhealthy behaviors. Contrary to expectations, youth with currently incarcerated parents did not differ significantly from youth with formerly incarcerated parents. Discussion Parental incarceration was associated with youth engagement in health risk behaviors, even if the parent was not currently incarcerated. These results suggest parental incarceration is associated with poor health behaviors that have implications for future health, and emphasizes the need for practitioners and policymakers to focus on interventions for this high-risk group of children and their families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceived stress and obesity-promoting eating behaviors in adolescence: The role of parent-adolescent conflict.

Abstract: Introduction Stress has been consistently related to obesity-promoting eating patterns (i.e., emotional, external, and restrained eating) throughout the life span, including during adolescence. One particularly salient source of stress within adolescence is parent-adolescent conflict. The current study sought to examine whether parent-adolescent conflict is a significant predictor of adolescent obesity-promoting eating patterns, beyond general adolescent stress. Methods A sample of adolescents (N = 51; 39.2% overweight or obese) completed a study examining stress and eating behaviors. As part of the larger study, adolescents completed measures related to parent-adolescent conflict, general adolescent stress, and obesity-promoting eating patterns. Adolescent height and weight were measured objectively and used to calculate adolescent body mass index (BMI) percentile for age and gender. Results General adolescent stress predicted all three obesity-promoting eating patterns, emotional, external, and restrained eating, controlling for adolescent BMI percentile. Higher levels of parent-adolescent conflict significantly predicted greater restrained eating, controlling for adolescent BMI percentile and general adolescent stress. Conflict did not predict emotional or external eating patterns. Discussion Adolescents' perceptions of parent-adolescent conflict appear to present a unique source of stress, above and beyond general perceived stress, that is, particularly relevant to the experience of restrained eating patterns. These findings provide support for the potential integration of assessment and intervention for parent-adolescent conflict within previously established behavioral weight control interventions to decrease restrained eating behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Defining the things we can change to improve access to mental health care

Abstract: Access and utilization of mental health care are critical components of ensuring public health. In this conceptual article, we define modifiable factors affecting mental health care utilization with the goal of providing a pragmatic framework for providers and clinics to increase access to mental health care. Five shared constructs emerged from a review of prominent health behavior theories: (a) mental illness beliefs, knowledge, and recognition; (b) mental health treatment beliefs and knowledge; (c) stigma including perceived norms, public stigma, and self-stigma; (d) help-seeking behaviors including knowledge, motivation, self-efficacy, and skills; and (e) external barriers and facilitators such as cues, logistics, and social support. We explore how these constructs influence mental health care utilization including interpretation and perception of mental health symptoms, acceptability and awareness of treatment options, and skills and ability to find, schedule, and attend mental health care. Finally, we make recommendations on how this broader framework can be used by primary care clinician innovators to implement interventions to reduce disparities and improve access to mental health care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.

Abstract: INTRODUCTION The use of mobile delivery to deliver parent training can address barriers to access and improve the translation of interventions in existing settings like pediatric primary care. Studying implementation provides critical information to identify and address barriers and facilitators and inform sustainability efforts. METHOD This study was a descriptive evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework as part of a Hybrid Type I Effectiveness-Implementation trial of the ezParent Program within 4 pediatric primary care clinics. We collected data before, during, and after implementation to evaluate provider implementation and their perspectives on program benefits and barriers to implementation. RESULTS On average, 14% of eligible parents were introduced to the study. Of these parents, 78% expressed interest in participating and 37% enrolled in the study. Seventy-eight percent of staff providers (n = 36) implemented the procedures at least once, and among those who implemented 3 or more times (n = 24), 79% maintained implementation for 6 months. Barriers to implementation include limited time, lack of information, and full practice buy-in and engagement. DISCUSSION Implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the ezParent program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services.

Abstract: INTRODUCTION The Primary Care-Mental Health Integration program is a component of the Veterans Health Administration's patient-centered medical home, which emphasizes comprehensive, patient-centered care. One model of primary care-mental health integration, known as Primary Care Behavioral Health (PCBH), positions trained behavioral health providers as members of the primary care team. Whereas patient perspectives are essential to effective patient-centered care, little empirical information exists regarding patients' goals and priorities for addressing their biopsychosocial concerns in PCBH. METHOD A regional mail survey of Veterans Health Administration patients was used. We collected data from 281 veterans (27% response rate) who received PCBH services in a northeastern region. RESULTS Respondents identified difficulty with sleep (80%), low energy/amotivation (78%), and managing stress (72%) as the most prevalent individual concerns, although the majority endorsed concerns in multiple domains of functioning. Overwhelmingly, patients who endorsed any biopsychosocial problem area reported that they did (53-93%) or would like to (56-81%) address that concern with a behavioral health provider. Respondents most frequently identified anger as a top priority for future care, followed by stress management, energy/motivation, and sleep disturbance. Whereas sample means signaled neutral or better quality of life in most individual domains, total Quality of Life Inventory scores suggested very low (32%) to average (30%) overall quality-of -life ratings for most participants. DISCUSSION In addition to symptom-focused PCBH assessments, providers should gather biopsychosocial data to identify and monitor functional and quality-of -life concerns and evaluate patient preferences in addressing these concerns over the course of clinical care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Patterns of coping among caregivers of children with spinal cord injury: Associations with parent and child well-being.

Abstract: INTRODUCTION Few studies have investigated how caregivers manage stressors associated with their child's spinal cord injury (SCI) and how these patterns relate to their child's coping and adjustment. The current study explored empirically derived coping profiles among caregivers of youth with SCI and the relation of these patterns to parent and youth psychosocial outcomes. METHOD This was a cross-sectional survey of 318 children (ages 1 to 18) and a primary caregiver. Participants completed measures assessing demographics, coping, quality of life (QOL), anxiety, and depression. We utilized hierarchical and nonhierarchical cluster analyses to identify unique coping patterns and one-way analysis of variance with control variables to assess relations between parental coping and psychosocial well-being. RESULTS The analyses produced 3 parent coping clusters, which included avoidant (n = 47), constructive (n = 119), and adjusted/low (n = 152). ANCOVAs revealed that parents in the avoidant cluster, who utilized disengagement and blaming strategies, had significantly worse mental health symptoms compared to the constructive and adjusted low coping clusters. Specifically, avoidant coping was significantly related to increased symptoms of caregiver depression (p < .001) and anxiety (p < .001) as well as children's self-report of anxiety (p = .002), depression (p < .005) and emotional QOL (p < .001). DISCUSSION These findings highlight the importance of fostering constructive and positive coping for both the children who face chronic illness and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

All systems go: An ecological perspective of behavioral health for youth with type 1 diabetes.

Abstract: Introduction Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions. Method This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention. Results This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control. Discussion Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Prevalence and characteristics of universal depression screening in U.S. college health centers.

Abstract: Introduction Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. Method Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. Results There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. Discussion Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Why and How to Use Patient-Oriented Research to Promote Translational Research

Abstract: As we discussed in our first editorial in the December 2018 issue (Polaha & Sunderji, 2018), an emerging science of knowledge translation (also known as implementation and dissemination science) aims to bridge the disconnect between evidence and practice. Researchers are increasingly engaging with knowledge users and other stakeholders as a key strategy to promote uptake. This may include policymakers, payers, and-the focus of this editorial-patients. Patient-oriented research is featured in national research agendas around the world including in Canada (Canadian Institutes of Health Research, 2018) and the United States (Patient-Centered Outcomes Research Institute, see https://www.pcori.org/), in part as it may contribute one solution to the "bench to bedside" gap (Greenhalgh, Jackson, Shaw, & Janamian, 2016; Jull, Giles, & Graham, 2017; McGavin, 2017). In this editorial, we provide a general introduction to research, its potential, and its realized value. We also suggest strategies for conducting patient-oriented research effectively, including a description of common barriers and how they can be dealt with. We hope this background will inspire you to get started with patient-oriented research and to learn more, as well as to share your patient-oriented research through Families, Systems, & Health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Promoting health payment reform literacy: Does integrated care save money?

Abstract: INTRODUCTION Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care. METHOD This paper offers a primer on the current state of health care spending in the United States, an overview of public and private payers, and the challenges each faces in paying for integrated care. DISCUSSION Future journal articles in the FSH Policy and Management Department will describe key payment policy and management opportunities for integrated care payment reform. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationship between parent mood and resilience and child health outcomes in pediatric asthma.

Abstract: Introduction Asthma is the most common pediatric chronic disease and disproportionately affects urban, minority, and disadvantaged youth. This study explored the relationship between parent and child psychosocial functioning and asthma-related health outcomes in a sample of at-risk children with asthma. We hypothesized that greater parent resilience would be associated with better parent mood, more symptom-free days (SFDs), better child mood, and less child anxiety. Further, we hypothesized that parent resilience would moderate the relationship between parent mood and SFDs. Method We performed a secondary analysis of baseline cross-sectional enrollment data. Parents of African American children on Medicaid with persistent asthma reported their children's asthma SFDs and their own measures of parent quality of life, mood, and resilience, and child mood and anxiety. Results Baseline data from 217 parents (92.2% female, Mage = 33.8 years ± 9.5) of children (Mage = 6.6 years ± 2.3) were available. Parent resilience was significantly associated with parent mood. Better parent-reported quality of life (QOL) and mood were significantly associated with more child asthma SFDs. In contrast to our hypothesis, parent resilience did not moderate the relationship between parent mood and SFDs. Discussion Higher parent-reported QOL and mood were significantly associated with better parent report of child asthma SFDs. Although parent resilience was associated with parent mood, it did not moderate the relationship to child SFDs. Future research is warranted to better understand the unique contribution of resilience in families with children with asthma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Looking beyond the individual: How family demands and capabilities affect family adjustment following pediatric solid organ transplant.

Abstract: Introduction Better family adjustment following pediatric solid organ transplantation has been associated with a number of beneficial medical and psychosocial outcomes. Yet few studies have examined which pretransplant variables are associated with posttransplant family adjustment. This information can aid in identifying families that may need support going into the transplantation process and those who are at lower risk of worse posttransplant adjustment. Method The sample included 66 parents of children with solid organ transplants and 22 children with solid organ transplants. Information regarding demographic factors, parent and child emotional functioning, and child social support was collected during the child's pretransplant evaluation and information on family adjustment was collected 6 months after transplantation. Results Results indicated that pretransplant demands such as worse parent and child emotional functioning were related to worse family adjustment 6 months after transplantation. Pretransplant capabilities (i.e., higher family income, parent education level, parent marital status, child social support) were not associated with posttransplant family adjustment. Discussion Pretransplant family demands such as parent and child emotional functioning, as opposed to family capabilities, should be assessed by family health care team members prior to transplantation because they may be related to worse family adjustment after the transplant. We offer recommendations for ways to assess and, if indicated, intervene upon pretransplant family demands in an effort to decrease the risk of worse posttransplant family adjustment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Healthcare's wicked questions: A complexity approach.

Abstract: The previous President's Column explored Glouberman and Zimmerman's (2002) differentiation of complex problems versus those that fall under the domains of simple or complicated, concluding with an invitation to enter the fray for health care's future state (Valeras, 2019). In this second column on the subject of complexity, the author invites us to continue to explore the topic of complexity and embrace it within health care, rather than shy away from it, in order influence the future state. One tactic, when engaging with a complex adaptive system, is to ask Wicked Questions. Williamson (2015) defines Wicked Questions as what is used to to expose the assumptions which shape our actions and choices. Some of the Wicked Questions that can be asked regarding the U.S. health care system are discussed. Exploring complexity and complex adaptive systems may provide the way forward for the challenges we face in health care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The impact of behavioral health consultations on medical encounter duration in pediatric primary care: A retrospective match-controlled study.

Abstract: INTRODUCTION The disproportionate time required to effectively manage psychosocial concerns is a key barrier to advancing delivery of behavioral care by primary care providers. Improved time efficiency is one potential benefit of the integration of behavioral health consultants (BHCs) into pediatric care, but few studies have systematically studied this outcome. We examined the impact of embedded BHCs on duration of medical encounters in a pediatric primary care clinic. METHOD We conducted a retrospective matched-pairs analysis of encounters involving behavioral consultations versus encounters for similar patients that did not include a consultation (N = 114) using electronic health record timestamp data. We examined both medical duration (i.e., medical provider services) and total duration (i.e., medical services + behavioral consultation). RESULTS Patient encounters involving behavioral consultation had a significantly longer (+11.23 min) total duration than matched controls, but significantly shorter (-11.67 min) medical duration. DISCUSSION The results indicate BHCs may improve primary care provider efficiency for patients with behavioral concerns, a notable finding given the impact of clinical time-constraints on important health care outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Critical comments mediate the association between carer distress and psychological symptoms in persons recently diagnosed with dementia.

Abstract: INTRODUCTION Carers of persons with dementia (PWD) experience high levels of burden and distress and may use criticism in an attempt to change the behavior of PWD and thereby reduce their distress. We hypothesized that carer distress and criticism would each have an impact on the psychological well-being of the PWD and examined whether criticism mediates the association between carer distress and PWD psychological well-being. METHODS We recruited 61 persons with a recent diagnosis of dementia and their carer via U.K. dementia services and assessed at 2 time points 6 months apart. Carers completed questionnaire measures of burden and distress. We coded critical comments from a Camberwell Family Interview. PWD completed questionnaire measures of quality of life, depression, and anxiety. We conducted correlation, regression, and mediation analyses to explore the relationship between carer variables and PWD psychological outcomes and whether criticism mediated any relationship found. RESULTS Carer distress, carer critical comments, and PWD anxiety and depression at 6-month follow-up were all significantly correlated. Baseline carer distress predicted poorer quality of life in PWD at 6-month follow-up. The number of carer critical comments significantly (p < .01) mediated the effect of carer distress on PWD quality of life. DISCUSSION Interventions addressing carer burden and distress and offering coping strategies to help them to reduce criticism of the PWD would improve the quality of life of those affected by dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A recipe for assessing fidelity in family and health systems.

Abstract: Following recipes is an analogy for maintaining intervention integrity, or, fidelity. Fidelity is the extent to which an intervention is implemented as intended. This editorial presents a recipe for assessing fidelity in family and health systems. The author discusses the challenges posed by the complex recipes of families and health systems interventions, in both research and clinical practice. The author concludes that increasing the measurement and reporting of fidelity is paramount in the exploding literature around family and health systems research. Researchers and practice improvement champions must find ways to assess fidelity or its proximal indicators and work to innovate new, more efficient methods that allow for ubiquitous fidelity assessment and monitoring systems, ensuring the best care for the families and system stakeholders they serve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Framing the future: Family preparedness for care transitions of critically ill children.

Abstract: Introduction Improving family centered care in the PICU requires understanding the milestones that families need assistance preparing for as well as factors that facilitate or obstruct preparedness. We present a model of family preparedness for transitions in the PICU based on semistructured interviews with clinicians and families that is designed to improve family centered care through the reduction of failed or traumatic transitions. Method We conducted semistructured interviews with 20 clinicians and 25 families in an academic PICU. Transcript analysis focused on identifying factors facilitating or obstructing family preparedness for care transitions. We analyzed interview transcripts for emergent themes and metathemes using grounded theory methodology. Results Family preparedness for care transitions is dependent upon both cognitive and emotional preparedness. Six metathemes form a novel model for understanding the factors influencing both components of preparedness and their interrelationship. Specifically, family preparedness is influenced by (a) individualized backgrounds, coping skills, and support systems as well as the (b) emotional context, (c) care environment, (d) course of care, (e) content of preparatory information, and (f) manner in which care is coordinated to effectively deliver information. We also describe 10 transitional categories that provide context for application of the model. Discussion Cognitive and emotional preparedness for care transitions in the PICU develops through attentiveness to six features. The conceptual model presented here will allow clinicians to support family centered care through interventions to facilitate a shared development of expectations for the future and reduce the risk of failed or traumatic transitions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' interest in resources to address their child's behavioral health through primary care.

Abstract: Introduction The purpose of this study was to investigate parents' interest in additional primary care-based resources for their children's behavioral health, including parenting support. Method We surveyed 264 English- or Spanish-speaking parents (80% mothers) of children between the ages of 3 and 11 years as they arrived for an appointment at an urban, pediatric primary care clinic. Measures included demographics, the Pediatric Symptom Checklist (PSC-17) as a parent report of the child's behavioral health, and interest in behavioral resources (e.g., a parenting class, online videos). We used multiple regression to evaluate the predictors of resource interest. Results Most parents reported interest in behavioral health resources, including many parents not reporting behavioral symptoms high enough to meet criteria for a positive PSC-17. Overall, 82% of parents reported interest in at least 1 resource item; 28% reported interest in all 7 resource items. The resource item with the most interest was online videos and resources (64%). More behavioral health issues (indicated by higher PSC-17 total scores) were positively related to interest in resources; 20% screened positive for behavioral health concerns. Discussion Parental report of child behavioral health issues was related to greater interest in resources for children's behavioral health; of note, much of the interest came from parents reporting levels of behavioral health concerns that would be scored as negative on the screening tool in practice. These results provide support for efforts to increase parenting and behavioral health resources through primary care, and raise questions about how to best direct resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Initial development of a new scale for examining couples' beliefs about their role in their partner's health: The Relationship Health Belief Scale.

Abstract: INTRODUCTION The purpose of this study was to evaluate the psychometric properties of the Relationship and Health Belief Scale (RHBS), a new measure designed to identify how individuals in a relationship see their role and responsibility in their partners' physical health and health management. METHOD Dyadic data from 234 heterosexual couples were used to examine the psychometric properties of the RHBS. Partners were sampled back to back and were asked to complete a battery of measures. RESULTS Results revealed that the RHBS fit a 1-factor solution of 6 items, a summed or mean score can be used, and that it is reliable for both men and women. DISCUSSION The RHBS measure is a brief measure for use in health care settings that physicians and health care providers could administer to identify potential points of intervention for patient's romantic partners to help boost and sustain changes in lifestyle and health management. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Treating pain in primary care: Optimizing an integrated psychological intervention based on perspectives of psychologists, primary care providers, and patients.

Abstract: Introduction Although behavioral health treatment can improve distress and pain functioning for patients with chronic pain, few who are referred by their primary care physician will see a behavioral health specialist. Given the benefits of integrating behavioral health into primary care, this may be an avenue for delivering a psychological intervention for chronic pain. The purpose of this study was to optimize a psychological intervention for patients with chronic pain to be delivered in primary care, utilizing the perspectives of providers and patients. Method Psychologists (n = 9), primary care providers (n = 9), and patients with chronic pain (n = 9) participated in separate focus groups. Participants reviewed the proposed 4-session intervention, provided feedback prompted by a set of open-ended questions, and completed a survey. Results Statements from focus groups were transcribed and coded into 2 thematic categories: (a) content of the intervention and (b) logistics and design. Participants believed that offering a brief, behavioral intervention for chronic pain in a primary care clinic was feasible and useful. All providers (100%) agreed or strongly agreed that they would refer a patient to this intervention, and 100% of patients agreed or strongly agreed that they would participate. Discussion Feedback solicited from the focus groups led to alterations to the treatment manual, such as adding a fifth session, using different psychological strategies, and logistical changes in delivery (i.e., meeting biweekly and intervisit contacts). The modified version of this intervention will be evaluated with a pilot randomized controlled clinical trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Review of Helping couples and families navigate illness and disability: An integrated approach.

Abstract: Reviews the book, Helping Couples and Families Navigate Illness and Disability: An Integrated Approach by John S. Rolland (see record 2018-14404-000). Many health care providers have traveled with their patients and families on the journey of disease, disability, and death. This journey is often filled with unanticipated twists and turns: changes in physical functioning, intense emotional experiences, and demands on intimate relationships. In Helping Couples and Families Navigate Illness and Disability: An Integrated Approach, John Rolland has provided clinicians with a map of the territory, guiding them through the challenges of intersecting systems of family relationships, cultural values, and health care practices. This book is a culmination of John Rolland's expertise and writing over his 40-year career. The book expands on his work in theory development while adding an expansive repertoire of practical questions, suggestions, and interventions. His personal experience coping with the illness and death of his young spouse and his parents' health infuses a tender and personal tone to this academic work. In the context of his own journey, he wondered: "What would have been useful information or support for me and my family members at different phases of the illness that could have made a difference in our ability to cope and adapt?" (pp. viii). This question is at the heart of the book. His clinical expertise, theoretical acumen, and personal experiences comprise this comprehensive and readable book. The book is organized into four sections: (a) a conceptual overview of the Family Systems Illness Model (FSI); (b) the application of the model for families, couples and multigenerations, and family/cultural health beliefs; (c) health-related phases and transitions with specific populations (e.g., terminally ill, chronic conditions, aging individuals, and couples); and (d) the clinician's personal-professional dynamic emotional experience. This book will be an important resource for the growing workforce of behavioral health providers. It provides physicians with a family-oriented transition of care model and is applicable for nurses, nurse practitioners, and mental health professionals who coach families through many phases of care-inpatient, rehabilitation, or hospice. It does not include critical analysis of the research on family-oriented care. There are references to studies, but it is not a systematic review or meta-analysis of best practices for family-oriented health care. For family systems novices, this book will be conceptually dense. It is not entry-level reading but will be accessible if incorporated into a seminar by seasoned faculty. Clinicians will find that the FSI model is a necessary GPS for guiding families through their health care and journey of illness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Review of Integrating behavioral health into the medical home: A rapid implementation guide.

Abstract: Reviews the book, Integrating Behavioral Health into the Medical Home: A Rapid Implementation Guide by Kent A. Corso, Christopher L. Hunter, Owen Dahl, Gene A. Kallenberg, and Lesley Manson (see record 2016-51034-000). This practical how-to book is written specifically for an audience working to implement integrated primary care (IPC) from the ground up, moving beyond the clinical competencies required for success in these settings to the business operational requirements to facilitate implementation. The book is divided into three sections, beginning with an introduction to key concepts and tools for successfully IPC practices. Section II is focused on the business practices needed for success, including strategic plan development, return on investment analyses, business cases analyses, hiring, billing, personnel training, and outcome monitoring. The last section is a series of case studies of successful programs from Cherokee Health Systems to Intermountain Health. This is particularly priceless because it provides evidence that IPC can thrive in a multitude of diverse settings, describing practical guidance of what to do and what to avoid. The authors, with more than 84 years of combined IPC experience, offer the reader sage advice, which can be applied readily. Each chapter begins with a Bottom Line, Up Front section, offering bulleted points of specific direction for the lay reader hoping to advance their journey into integration. A nice bonus surprise to the book is the wittiness of this esteemed group, offering refreshing pieces of humor, which is welcomed when thinking through the specific demands of IPC implementation. The book is also an excellent resource manual to delve more deeply into the IPC literature, with each chapter providing a host of references for further study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of a community-based intervention on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's physical activities.

Abstract: Introduction Latino grandparents are often involved in rearing grandchildren, but their roles in promoting children's physical activity (PA) have been largely overlooked. This study examined the impact of a community-based intervention called Nietos Activos y Saludables (Active and Healthy Grandchildren) on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's (aged 2-12 years) PA. Method The Spanish language intervention, consisting of 4 weekly sessions, was delivered to 12 Latino grandparents (primarily female, aged > 60 years) in Los Angeles County from October to November 2017. Pre- and posttest surveys and postintervention focus groups assessed the intervention impact. Results Participants indicated that the intervention provided useful information. After intervention sessions, participants achieved a higher score in test on PA requirements for children. They also reported greater knowledge about children's PA, local resources for children's PA, and modifying children's behavior. Additionally, participants reported greater confidence in motivating children in PA and collaborating with parents in promoting children's PA. Results of focus groups generally confirmed the quantitative findings. Discussion Nietos Activos y Saludables intervention has the promise to increase Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's PA. Future studies should test the impact of the intervention on grandparents' behavior and grandchildren's health outcomes using a randomized controlled trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mental illness: Is there an app for that?

Abstract: The aim of this commentary is to consider the advantages and disadvantages of incorporating apps into clinical care and provide a few rules of thumb for clinicians who are helping their patients select the most useful app or apps. We then use this guidance to review three popular health-related apps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Implementing integrated behavioral health: Testing associations between shared clinical time and space and provider referrals.

Abstract: Introduction Behavioral health provider (BHP) availability is widely acknowledged as an important factor in the effectiveness of an integrated care approach within primary care. However, there is little research providing evidence of the impact of BHP availability on physician uptake of integrated behavioral health (IBH) services. Method This quasi-experimental study examines whether shared clinical time and space with a BHP is associated with providers' number of standard IBH referrals and proportion of warm handoffs within total behavioral health (BH) referrals. Data are from 2 family medicine outpatient clinics with 1 shared, part-time BHP and were gathered across 4 months (2,847 unique patients served) using electronic health record chart review of patients referred for BH services. Results Results of a Poisson regression indicated greater shared time and space between BHP and providers is significantly associated with a greater number of providers' standard IBH referrals, χ²(df = 1, N = 15) = 13.67, p = .000. Results of general linear modeling indicate greater shared time and space is also associated with a greater proportion of warm handoffs (percentage of total referrals). A 1-unit increase in percentage of schedule overlap was associated with a 110% increase in likelihood of a family medicine provider making a warm handoff, Exp(β) = 2.10, p = .007. Discussion This exploratory study provides initial evidence to support the notion that shared time and space between BHPs and physicians is an essential component of effective integrated care. Future research is needed to evaluate how shared time and space impact the accessibility, adoption, and effectiveness of the BHP. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Through the woods

Abstract: Many individuals find themselves taking care of a family member or loved one with a terminal illness. This narrative illustrates how my family and I navigated this caretaking process as a system and how this experience shaped my family-centered approach to care in medical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caring is complex: And it always has been.

Abstract: Einstein once said, "Everything must be made as simple as possible, but not one bit simpler." If the health care system continues to value and push oversimplified solutions to complex problems, we sacrifice context. We lose connection to the very system we seek to influence. We put at risk the very value Collaborative Family Healthcare Association (CFHA) was founded on-relationship. As CFHA celebrated its 20th annual conference as a change organization, we came together in Rochester, NY to reflect on two decades of work, innovation, and, above all, relationships-relationships with each other, with the communities we serve, and the health care systems we seek to improve. As Family, Systems, and Health pushes forward the field by taking on translational research, CFHA will as well. It has been CFHA's willingness to acknowledge complexity, through its emphasis on systems, that has distinguished this organization. We strive to improve ourselves, by coming together as a membership, learning from one another, pushing each other to emerge as individuals, to improve the care we provide. I look forward over the next 2 years to delve into the fray with you all. To explore together and discover your approach to the complex problems we face. What we do is not rocket science; it's far more complex! (PsycINFO Database Record (c) 2019 APA, all rights reserved).