Showing papers in "Families, Systems, & Health in 2020"

Mapping colocation: Using national provider identified data to assess primary care and behavioral health colocation.

Abstract: Introduction Evidence supports that integrated behavioral health care improves patient outcomes. Colocation, where health and behavioral health providers work in the same physical space, is a key element of integration, but national rates of colocation are unknown. We established national colocation rates and analyzed variation by primary care provider (PCP) type, practice size, rural/urban setting, Health and Human Services region, and state. Method Data were from the Centers for Medicare & Medicaid Services' 2018 National Plan and Provider Enumeration System data set. Practice addresses of PCPs (family medicine, general practitioners, internal medicine, pediatrics, and obstetrician/gynecologists), social workers, and psychologists were geocoded to latitude and longitude coordinates. Distances were calculated; those Results Of the 380,690 PCPs, > 44% were colocated with a behavioral health provider. PCPs in urban settings were significantly more likely to be colocated than rural providers (46% vs. 26%). Family medicine and general practitioners were least likely to be colocated. Only 12% of PCPs who were the sole PCP at an address were colocated compared with 48% at medium-size practices (11-25 PCPs). Discussion Although colocation is modestly expanding in the United States, it is most often occurring in large urban health centers. Efforts to expand integrated behavioral health care should focus on rural and smaller practices, which may require greater assistance achieving integration. Increased colocation can improve access to behavioral health care for rural, underserved populations. This work provides a baseline to assist policymakers and practices reach behavioral health integration. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

COVID-19 and mental health in America: Crisis and opportunity?

Abstract: There is opportunity in every crisis. COVID-19 has presented an unprecedented crisis. What opportunity can be gleaned from it? Unlike crises in the more recent past, such as the bombing of the Twin Towers and Pentagon on 9/11, COVID-19 is an ongoing global pandemic, affecting nearly every person on the planet in some shape or form. It is not only the physical effects of the SARS-CoV-2 virus that are lethal; the mental health effects are also taking their toll. The impact of physical distancing, stay-at-home orders, job loss, isolation, and fear have resulted in a considerably greater number of people's experiencing symptoms of anxiety disorder and depressive disorder in the United States. Accessing health care services has been a particular challenge given concerns about exposure to the virus and an overwhelmed health care delivery system. In response, policymakers at the federal and state levels implemented changes aimed at addressing access to essential care to include telehealth services. As the public experiences firsthand the struggles of coping with mental health issues in a fragmented dysfunctional health system, there is an opportunity is to use this crisis as a springboard to advocate for permanent changes to promote telehealth, to elevate the importance of integrated behavioral health, and to support the destigmatization of mental illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of a family diabetes self-management education intervention on the patients' supporters.

Abstract: Introduction Diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients. The health effects of these "family models" of DSME on participating family members are rarely studied. Opportunity exists for the participating family members to benefit from the healthy lifestyle recommendations offered through such programs. Method Using data from a randomized controlled trial to assess the effect of family DSME compared to standard DSME among Marshallese adults with Type 2 diabetes, this study examined baseline to 12-month changes in A1c, body mass index (BMI), food consumption, and physical activity among participating family members, comparing outcomes of family members based on attended at least 1 (n = 98) versus attended no (n = 44) DSME sessions. Results Overall, family member attendance was low. There were no differences in the level of change from baseline to 12 months for A1c, BMI, food consumption, and physical activity between groups. After controlling for attendance and sociodemographic measures, lowering of BMI was the only significant predictor of not having an A1c level indicative of diabetes at 12 months. Discussion Future research on family DSME should consider ways to improve family member attendance; have them set their own health improvement goals; and integrate healthy lifestyle education, such as healthy eating and being physically active, along with the DSME core content to create an added benefit of diabetes prevention for participating family members. The limitations of this study and recommendations for future research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A physician communication coaching program: Developing a supportive culture of feedback to sustain and reinvigorate faculty physicians.

Abstract: INTRODUCTION Physician-patient communication involves complex skills that affect quality, outcome, and satisfaction for patients, families, and health care teams. Yet, institutional, regulatory, and scientific demands compete for physicians' attention. A framework is needed to support physicians continued development of communication skills: Coaching is 1 such evidence-based practice, and we assessed the feasibility of implementing such a program. METHOD Participants were 12 physicians, representing high and low scorers on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. We added items to capture empathy and family experience to the Calgary-Cambridge Observation Guide for the Medical Interview. Coaches observed communication associated with patient satisfaction and quality measures: introductions (I), asking about concerns (C), and check for understanding (U), or ICU. Participants received a report describing their communication behaviors, emphasizing strengths, and identifying areas for improvement. RESULTS Scores on the ICU significantly discriminated between low and high HCAHPS scorers, physicians from surgical and cognitive specialties, men and women. We collected anonymous feedback regarding the value of this training; participants recommended expanding the program. DISCUSSION Based on physician endorsement, experienced coaches are expanding the coaching program to physicians throughout our institution. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Family functioning, coparenting, and parents' ability to manage conflict in adolescent anorexia nervosa subtypes.

Abstract: Introduction Studies about family functioning in adolescent anorexia nervosa (AN) are conflicting and often do not consider the possible differences between the restricting and binge/purging subtypes (AN-R and AN-B/P). Moreover, an underestimated element is the quality of the coparenting relationship, that is, the level of coordination and agreement between parents, as well as the methods of managing parental conflict. Method The study aims to explore family functioning, coparenting and conflict management in a sample of 60 adolescents with AN-R and AN-B/P and their relations with AN severity in terms of body mass index (BMI). Patients and parents completed the following questionnaires: Family Adaptability and Cohesion Evaluation Scales, Coparenting Scale-Revised, and Conflict Management Questionnaire. Results No differences are found in general family functioning between the two groups, but mothers in the AN-R group show a higher coparental conflict and a tendency to use negative-passive ways of conflict management than mothers of the AN-B/P group. Moreover, the presence of a coparental conflict is associated to lower BMI and to more dysfunctional family functioning. Discussion These findings underline the importance of increasing knowledge on specific aspects of general family functioning. In particular, it seems that the way parents manage conflict between themselves as partners can have a role in the maintenance of AN. Clinical implications of these results are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Collaborative patient- and family-centered care for hospitalized individuals: Best practices for hospitalist care teams.

Abstract: Traditionally, hospital medicine services have been dominated by the physician and hospital team, with significant barriers to patient- and family-centered care. This article offers principles and associated strategies to reduce those barriers and guide implementation of systemically informed, collaborative, and culturally responsive patient- and family-centered care provided by hospitalist care teams, especially regarding collaborative decision-making for treatment and discharge planning. Such an approach is associated with reduced lengths of stay and hospital costs and lowered rates of medical errors and mortality. It also is linked to improved patient and family cooperation and adherence; enhanced quality of care and clinical outcomes; and increased levels of satisfaction among health care professionals, patients, and families. Such care uses resources wisely and is effective and ethical. We hope articulating and illustrating these principles and strategies will facilitate efforts to shift the health care culture from being physician-centered to truly team-, patient-, and family-centered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Implementation science on the margins: How do we demonstrate the value of implementation strategies?

Abstract: Implementation science (IS) has developed as a field to assess effective ways to implement and disseminate evidence-based practices. Although the size and rigor of the field has improved, the economic evaluation of implementation strategies has lagged behind other areas of IS (Roberts, Healey, & Sevdalis, 2019). Beyond demonstrating the effectiveness of implementation strategies, there needs to be evidence that investments in these strategies are efficient or financially sustainable. In this editorial, we lay out conceptual challenges in applying economic evaluation to IS and the implications for conducting economic analyses in integrated primary care research. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Four innovations: A robust integrated behavioral health program in pediatric primary care.

Abstract: The increase in behavioral health problems presenting in pediatric primary care (PPC) has led to a greater focus on the prevention and treatment of mental health concerns. As a result, care has shifted from colocation to integrated PPC models. However, the literature provides limited guidance on the development and implementation of integrated PPC models that aim to transform both PPC and the larger health care system. We developed an integrated behavioral health (IBH) approach modeled with fidelity to the Integrated Practice Assessment Tool to fully integrate behavioral health into PPC. Over the 4 years since the application of our model, we have been successful in the development of an integration process and model for practice transformation of an urban PPC center and the spread and scale of IBH services to 2 additional clinics. Four elements combine to make our integrated behavioral health program novel: (a) clear mission and vision, (b) provision of universal prevention services, (c) continuous quality improvement, and (d) emphasis on practice and systems transformation. Trends in practice and scholarly inquiry indicate the need for robust pediatric IBH models, with a clear mission and vision; articulation of how research informs the development and implementation of the model; and infrastructure to meaningfully examine the model's impact. Cognizant of these needs, Cincinnati Children's Hospital Medical Center developed an IBH program. We provide key learnings for IBH program development, PPC transformation, and innovative systems redesign. We describe these elements and make recommendations for future research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Healthcare provider burn-out: A war with uncertainty.

Abstract: Referring to provider burn-out as a foe to be conquered is a palatable representation that fits within a familiar medical narrative-combating disease, fighting illness, curing and vanquishing the cancer. Even the words we use to describe our daily work-"on the front lines" or "in the trenches" or "fighting the good fight"-places us on a metaphorical battlefield. Is provider burn-out inflicted by another entity, and if so by whom or by what? Is it, by contrast, a disease or a condition? Is burn-out something that just happens or is it created? The World Health Organization International Classification of Disease (World Health Organization, 2019) added burn-out in 2019, but also made a clear statement that this is an occupational phenomenon and not a medical condition. It defines burn-out as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life" (WHO, 2019). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Linking family and intimate partner relationships to chronic pain: An application of the biobehavioral family model.

Abstract: INTRODUCTION Research is needed to determine mechanisms of effect linking family relationships and chronic pain for adults. Guided by the Biobehavioral Family Model (BBFM), the present study examined indirect effects between a negative family emotional climate and chronic pain disease activity, as mediated by biobehavioral reactivity. METHOD Data for this study are from the Midlife Development in the United States; specifically, a subsample of participants who reported experiencing chronic pain (n = 1,461, ages 32-84). Participants self-reported family strain, biobehavioral reactivity (i.e., anxiety, depression), and chronic pain disease activity (i.e., pain interference, global health). A subsample of participants (n = 1,070) completed an intimate partner strain measure, indicating they were married/in a committed relationship. Structural equation models were tested with maximum likelihood estimation and bootstrapping. RESULTS Family strain was indirectly associated with chronic pain disease activity via biobehavioral reactivity-Model 1; χ²(10) = 40.75, p < .000, root mean square error of approximation [RMSEA] = .07, comparative fit index [CFI] = .96, standardized root-mean-square residual [SRMR] = .04; partial mediation occurred for partnered participants. This finding was replicated when modeling family strain simultaneously with intimate partner strain, though intimate partner strain was not associated with chronic pain disease activity-Model 2; χ²(5) = 8.29, p = .14, RMSEA = .03, CFI = .99, SRMR = .01. DISCUSSION These findings add to the growing literature that emphasizes the role of family relationships in chronic pain. Future research is needed to replicate our use of the BBFM to specify pathways of effect, incorporating relational and observational data, with diverse samples. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

You, me, and diabetes: Intimacy and technology among adults with T1D and their partners.

Abstract: OBJECTIVE Limited research has examined the impact of technology on intimacy and relationships among individuals with type 1 diabetes (T1D). The current study examined the experiences of individuals with T1D and their partners and evaluated the expectations for how advances in technology such as automated insulin delivery systems may impact physical intimacy. METHOD The Insulin Delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) study is a multisite study examining expectations for automated insulin delivery systems among adults and youth with T1D as well as partners and caregivers. For the current analysis, data regarding the impact of diabetes on relationship intimacy were extracted from focus groups or individual semistructured interviews with adults with T1D (n = 113) and partners of individuals with T1D (n = 55). RESULTS Three independent coders conducted thematic analysis utilizing NVivo software. Two primary themes were identified: vulnerability in romantic relationships because of managing diabetes and the unique challenges of physical intimacy because of the use of diabetes technology. CONCLUSIONS Participants expressed the hope that diabetes technology, and automated insulin delivery systems in particular, will offer opportunities for flexibility in their diabetes management. These options may decrease their sense of vulnerability through provision of greater control over diabetes management and when/whether to disclose diabetes, minimizing discomforts in the context of sexual intimacy, and reduction of fear about diabetes complications. Patient-reported outcomes and expectations for diabetes technology should be incorporated into patient-provider conversations about sensitive issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"Now I have hope": Rebuilding relationships affected by chronic pain.

Abstract: Introduction A novel couple-based intervention was created to address the individual and interpersonal needs of people with chronic pain and their romantic partners, as research has shown that pain negatively impacts both partners. A pilot study revealed positive outcomes in both partners, though the extent to which improved relationship functioning contributed to these outcomes is unknown. The purpose of this study was to examine couples' experience of the treatment to determine whether addressing relational flexibility was appraised by couples as playing an important role in this novel intervention. Method Fourteen couples who completed the treatment participated in interviews and gave feedback about the intervention. Interviews were analyzed using a multiphase thematic analysis to provide information about the treatment effects and mechanisms of change from the couples' perspectives. Results Couples described the intervention as essential in rebuilding their relationships, which had been negatively impacted by the effects of chronic pain. Discussion The presence of chronic pain had contributed to feelings of isolation, helplessness, and resentment within relationships. Participants valued this dyadic treatment because it enhanced their communication, connection, and intimacy. Their reports reinforce the importance of targeting both partners in pain treatment when relationship distress is present, as the improvements made in individual treatment are unlikely to be maintained if patients return to environments that are unsupportive and distressed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Rural clinics implementing collaborative care for low-income patients can achieve comparable or better depression outcomes.

Abstract: Introduction The gap between depression treatment needs and the available mental health workforce is particularly large in rural areas. Collaborative care (CoCM) is an evidence-based approach that leverages limited mental health specialists for maximum population effect. This study evaluates depression treatment outcomes, clinical processes of care, and primary care provider experiences for CoCM implementation in 8 rural clinics treating low-income patients. Method We used CoCM registry data to analyze depression response and remission then used logistic regression to model variance in depression outcomes. Primary care providers reported their experiences with this practice change 18 months following program launch. Results Participating clinics enrolled 5,187 adult patients, approximately 15% of the adult patient population. Mean PHQ-9 depression score was 16.1 at baseline and 10.9 at last individual measurement, a statistically and clinically significant improvement (SD6.7; 95% CI [4.9, 5.3]). Suicidal ideation also reduced significantly. Multivariate logistic regression predicted the probability of depression response and remission after controlling for several demographic attributes and processes of care, showing a significant amount of variance in outcomes could be explained by clinic, length of time in treatment, and age. Primary care providers reported positive experiences overall. Discussion Three quarters of participating primary care clinics, adapting CoCM for limited resource settings, exceeded depression response outcomes reported in a controlled research trial and mirrored results of large-scale quality improvement implementations. Future research should examine quality improvement strategies to address clinic-level variation and sustain improvements in clinical outcomes achieved. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

COVID-19: Complexity and the Black Swan.

Abstract: In previous President's Columns (Valeras, 2019a, 2019b), the properties of complexity and complex adaptive systems have been discussed, in terms of the value of continual and iterative change, in order to nudge a system to emerge differently, rather than maintain the status quo. COVID-19 is not a nudge; it is a tidal wave. Engaging with and understanding complexity science allows us to examine the internal rules of our health care system and recognize our own role as agents that can systematically and deliberately disrupt the status quo. The intertwined and interdependent complex relationships that exist in health care between persons, business, academia, and government buffer the system from rapid and drastic change. COVID-19, however, swiftly disrupted many of the rules keeping the system in its previous state. Some would describe this sudden and dramatic systems change as a Black Swan. This column will examine the role of the Black Swan, as it relates to this pandemic. The Black Swan is a term coined in the 2nd century by Roman poet Juvenal's description of something being rara avis in terries nigroque simillima cygno, Latin for "a bird as rare as the black swan" (Taleb, 2007, p. xxxi). At this time, reference to a black swan was meant as a statement of impossibility, because all historical records of swans had been white. In 1697, Dutch explorers discovered black swans living in the wild in Western Australia (Taleb, 2007, p. xxi), and the black swan became a metaphor for events that come as a surprise, have major implications, and can often be understood only with the benefit of hindsight. This theory of the black swan was further articulated by Nassim Nicholas Taleb in his books Fooled by Randomness (Taleb, 2001) and The Black Swan (Taleb, 2007). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

PurifyR: an R Package for highly automated reproducible variable extraction and standardization

Abstract: Life science experiments that employ automated technologies, such as high-content screens, frequently produce large datasets that require substantial amounts of preprocessing before analysis can be...

Patient experience with a large-scale integrated behavioral health and primary care initiative: A qualitative study.

Abstract: Introduction: Patient engagement in research can improve a health system's responsiveness to patient need, but patient experience with integrated care is not well understood. This qualitative study explores patient experience and provider perceptions of patient experience with the Behavioral Health Integration and Complex Care Initiative (BHICCI), which is a large-scale system redesign that delivers integrated care to persons with complex needs. Methods: We conducted 8 patient focus groups (n = 54 patients) and n = 32 interviews with BHICCI providers at five community health settings participating in the BHICCI during which patients and providers described how patient experience with care had changed under the initiative. Results: Patient experience and provider perception of patient experience aligned under 2 themes: (a) care coordination is essential for positive patient experience; and (b) the BHICCI strengthened patient provider relationships. Perspectives diverged under theme (c) patient experience with programmatic "growing pains." Discussion: This study highlights the importance of seeking outpatient feedback and incorporating these experiences into the redesign of integrated care systems. Formal mechanisms, such as patient advisory boards, are needed to ensure that health care quality improvement initiatives are patient centered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Burnout among behavioral health providers in integrated care settings

Abstract: Introduction Burnout in health care, especially among physicians, is a growing concern. It is now well accepted that physician burnout leads to increased depersonalization of patients, lower personal accomplishment, employee turnover, and worse patient outcomes. What is not known, however, is to what extent behavioral health providers (BHPs) in medical settings experience burnout and its associated sequela. Method Participants (n = 230) from a variety of practice settings and levels of integrated care completed practice and burnout questions via an online survey. Practice-related questions and a modified version of the Maslach Burnout Inventory was administered to BHPs who work in different levels of collaboration with other medical providers. Results Overall, BHPs who work primarily in fully integrated care settings reported higher rates of personal accomplishment in their everyday job (B = 1.49; 95% confidence interval [CI] = 0.40, 2.58). Additionally, those who have worked more than 10 years in these types of settings reported both higher personal accomplishment (B = 1.58; 95% CI = 0.68, 2.49) and lower rates of depersonalization (B = -1.32; 95% CI = -2.28, -0.36). Discussion In contrast to high rates of burnout among many clinicians in the United States, this is the first study to document relatively low rates of reported burnout among integrated care BHPs. The relationships between lower burnout, working in a fully integrated care practice, and experience as a BHP is important to understand when creating and sustaining team-based primary care jobs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Anxiety interventions delivered in primary care behavioral health routine clinical practice.

Abstract: Introduction Although anxiety is highly prevalent in primary care and a top reason for referral to primary care behavioral health (PCBH) services, there are limited data on which anxiety interventions are used in routine PCBH practice. The objective of this study was to identify interventions delivered when treating anxiety in PCBH practice. Method We conducted an online survey of PCBH providers regarding their clinical practice with patients who present for treatment of anxiety symptoms. The final sample comprised 209 PCBH providers recruited from e-mail listservs of national professional organizations (59.3% psychologists, 23.4% social workers, 12.4% counselors, 4.8% other). Providers reported on use (yes/no) of 17 interventions in their most recent session with their most recent adult patient presenting with a primary concern of non-trauma-related anxiety. Results On average, patients were reported to be 42.2 (14.73) years old, White (73.7%), and male (56.5%) with anxiety symptoms of moderate severity (65.6%). Most reportedly had comorbid sleep difficulties (63.6%), depressive symptoms (58.4%), and/or stress/adjustment (56.0%). Providers reported delivering an average of 5.77 (2.05, range: 1-15) interventions, with psychoeducation (94.7%), relaxation training (64.1%), and supportive therapy (60.8%) being most common. Several highly efficacious evidence-based interventions for anxiety, including cognitive therapy (45.0%) and exposure (21.1%), were less common. Discussion While PCBH providers delivered numerous brief interventions for anxiety, cognitive therapy and exposure were underutilized. Furthermore, PCBH patients with anxiety symptoms were complex, with significant severity and comorbidity. These results suggest implications for research, clinical training, intervention design, and future implementation efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care.

Abstract: Introduction There is a significant need to understand the factors that contribute to parents' consumer preferences for behavioral health services in pediatric primary care; however, no validated measure of such preferences exists. We developed the BIPS (Behavioral Information Preferences Scale), a measure of parents' preferences for delivery of behavioral guidance in pediatric primary care and assessed its psychometric properties. Method An initial item pool consisted of 3 sections: Behavior topics, intervention approach, and delivery methods. In addition to the BIPS, parents of young children (N = 396) completed measures of child behavior problems and parenting self-efficacy. We conducted principle component analyses and examined correlations of the resulting factors. Results The behavior topics section resulted in a two-factor solution (conduct/emotions and healthy habits), as did the intervention approach section (behavior change and psychoeducation), whereas the delivery methods yielded three factors (usual care, auxiliary care, and media resources). Patterns of association with parent reported child behavior problems and parenting self-efficacy were indicative of construct validity for the behavior topics and media resources sections. Discussion The BIPS holds potential for informing the design and dissemination of primary care parenting interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The impact of primary care behavioral health services on patient behaviors: A randomized controlled trial.

Abstract: INTRODUCTION Greater understanding of the impact of low intensity psychosocial interventions delivered by behavioral health clinicians (BHCs) working in an integrated care program (ICP) may promote better depression care. METHOD In a randomized controlled trial, 153 participants identified as depressed by their primary care provider (PCP) were assigned to ICP or usual care (UC, management by PCP, including specialty referral). In the ICP condition, BHCs worked collaboratively with PCPs and liaison psychiatrists. RESULTS ICP participants with lower and higher severity symptoms reported significantly greater use of coping strategies than UC participants at the 1-month follow up (lower: p = .002; higher: p = .016). ICP participants with lower severity continued to report significantly greater use of coping strategies than UC participants at the 4-month (p = .024), and 7-month (p = .012) follow ups. ICP participants were more likely to be following relapse preventions plans at the 4-month follow up (lower: 89.5% vs. 50%, p = .0.000; higher 74.1% vs. 33%, p = .0001). ICP participants also reported use of antidepressant medications on more days than UC participants at the 4-month follow up (lower: 21.27 vs. 14.49 days, p = .049; higher: 24.61 vs. 17.08 days, p = .035). Patient retention in the ICP was high, and ICP participants were significantly more satisfied with depression care than UC participants at follow-up assessments. DISCUSSION Delivery of low intensity psychosocial interventions by BHCs was associated with improvements to behavior charge targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

"No one could calm him down": Mothers' experience of autism diagnosis and obtainment of resources in an urban public school district.

Abstract: Introduction: The purpose of this study was to explore the experience of accessing autism diagnosis and resources in a Midwest urban public school district for diverse mothers of children with autism spectrum disorder. Method: We employed thematic analysis using narrative inquiry methodology to analyze the data from 9 mothers (n = 5 African American, n = 2 Hispanic, and n = 2 White) who participated in a focus group. Results: Three themes were identified by the researchers: (a) late medical diagnosis (subthemes: problems that parents didn't perceive as signs of autism spectrum disorder, making comparisons to other siblings or children), (b) negative communication experiences (subthemes: husband and wife, parent and educational professionals), and (c) coping strategies (subthemes: resources, prayer). Discussion: The mothers' narratives indicated a strong need for advocacy and parent-school partnership. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychometric properties of the Portuguese adaptation of General Functioning of Family Assessment Device: A comparative study

Abstract: Introduction The General Family Functioning is a subscale of the Family Assessment Device (FAD) that assess overall family functioning. This study analyzed the psychometric properties of the General Family Functioning subscale in Portuguese families with adolescents diagnosed with Type I Diabetes and healthy adolescents comparing also family functioning in both samples. Method A total of 100 parents of adolescents with Type I Diabetes and 106 parents of healthy adolescents participated in this study. A confirmatory factor analysis was performed for both samples to analyze the adequacy of each model. Results Both confirmatory factor analyses maintained the design in one-factor models with good fit indexes. The internal consistency in both samples was good, but slightly higher in parents of healthy adolescents. The instrument also presented good convergent and divergent validity. Discussion The Portuguese version of the General Family Functioning subscale showed good psychometric properties and reliability in healthy adolescents and in adolescent with Type I Diabetes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Lessons from the team care playbook: Recommendations for COVID-19 vaccination dissemination and uptake.

Abstract: For too many of us, the implications of a worldwide pandemic unfolded in graduated stages of understanding that seemed too sluggish for the opponent we faced. For too many of us, even those of us in health care, the unfolding was terrifying; we felt blindsided and unprepared. If coronavirus disease 2019 (COVID-19) were a bully picking a fight, they got the first punch in before we even raised a fist. Now, many rounds in, health care teams will have an opportunity to deploy a new weapon against COVID-19. Vaccines are coming. We do not know when, who will pay for them, or the logistical aspects (e.g., storage and administration). We do not even know how effective they will be. Moreover, we must plan for mass vaccination in a chaotic and politically charged context that bears little resemblance to the ones with which we have experience. Nevertheless, in this fight, vaccines could be our winning blow. We are getting better at working with unknowns and in disrupted environments during COVID-19. We have some time to prepare, and we have some extant knowledge and experience in vaccine distribution and uptake. Health care teams can use these to best their adversary, and we can and should begin now. The aim of this article is to discuss how to mobilize interprofessional teams within systems of care to engage best practices in vaccine dissemination and uptake in the unique COVID-19 context. We begin by discussing challenges to dissemination and uptake and then provide solutions using our experiences in the primary care system. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Engagement interventions delivered in primary care to improve off-site pediatric mental health service initiation: A systematic review.

Abstract: INTRODUCTION Although primary care clinicians often refer children and families to community-based mental health services, a sizable number of patients do not make it to their 1st appointment. Engagement interventions delivered in primary care that focus on reducing structural and perceptual barriers to accessing care hold promise to improve this referral-to-service gap. To date, no review to characterize and summarize the effectiveness of such engagement interventions has been completed. METHOD We conducted a systematic review of pediatric mental health service engagement interventions delivered in primary care over the past 20 years using MEDLINE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO. We narratively summarized the literature and conducted quality and risk of bias analyses. RESULTS Out of 948 records, 10 studies met inclusion criteria and were reviewed. A variety of engagement interventions were evaluated and demonstrated varying levels of effectiveness in improving service initiation, with the most promising approach being primary care mental health integration. Quality and risk of biases analyses demonstrated several methodological weaknesses of the included studies. DISCUSSION Currently, there is limited evidence for engagement interventions to improve the referral-to-service gap for children and families. More research is needed to develop and evaluate effective mental health engagement interventions, particularly for disadvantaged youth and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Coaching patients to be active, informed partners in their health.

Abstract: In this issue, the article "A Physician Communication Coaching Program," by McDaniel and colleagues (see record 2020-40858-007), addresses this untenable situation through the coaching of physicians as part of continuing medical education. The coaching program hopes to explode the traditional paradigm of physician-patient interaction. An alternative paradigm is the philosophy of health coaching. While McDaniel et al. (2020) describe coaching physicians, the new paradigm involves coaching patients. Health coaching can be summed up in the adage: "Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime." Coaching is teaching "how to fish" by assisting patients to gain the knowledge, skills, and confidence to become informed, active participants in their care (Ghorob & Bodenheimer, 2013). Rather than telling patients what to do, coaching asks patients what they are willing and able to do to improve their health, meeting them where they are. Perhaps a patient with diabetes eats a pint of ice cream every night and cannot give it up. Rather than threatening, scolding, or imploring, physicians and other health personnel engage in a discussion of an action plan that the patient agrees to-perhaps eating only a half-pint of ice cream each night. Success with the realistic action plan breeds more success and eventually the ice cream becomes a rare treat. Randomized controlled trials demonstrate that this approach-compared with traditional care- significantly improves HbA1c levels in patients with diabetes (Thom et al., 2013; Willard-Grace et al., 2015). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population.

Abstract: INTRODUCTION The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Clinical considerations in designing brief exposure interventions for primary care behavioral health settings.

Abstract: Introduction Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. Methods The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. Results Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. Discussion Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parent-perceived barriers to child weight management: Measure validation in a clinical sample.

Abstract: INTRODUCTION Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. METHOD Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. RESULTS Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, χ2(144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06. DISCUSSION The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Coming full circle (to hard questions): Patient- and family-centered care in the hospital context.

Abstract: Roughly 60 years after the first questions were raised about hospitalized patients, Kaslow and colleagues (see record 2020-40858-010) articulate the importance of patient- and family-centered care and outline recommendations for hospitalist care teams. They concisely point out the need for such practices, but more important, they provide many practical examples. Some of the main recommendations include (a) form partnerships, (b) prioritize communication, (c) discuss care goals, (d) share decision-making, (e) collaborate to implement the treatment plan, (f) negotiate differences, and (g) make special accommodations for discharge planning. Within each of these areas, the authors provide specific patient-centered and family-focused practices. At a global level, none of the recommendations provided are unique to hospitalists' practice. Almost all of them are similar to patient- and family-centered care recommendations from other settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Family science and family-based research in integrated and health care contexts: Future considerations for Families, Systems, & Health.

Abstract: The focus on families and application to health sets Families, Systems, & Health apart from other sister journals. Family science is a thriving field of study experiencing rapid advances in the discovery, verification, and application of knowledge about families (Burr, Day, & Bahr, 1993; Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; National Council on Family Relations [NCFR] Task Force on the Development of a Family Discipline, 1988). It is essential that these advances in family science are transferable to research focused on families in integrated health care contexts, and it is our hope that Families, Systems, & Health with be at the forefront in disseminating this work. While there is an abundance of research focused on families and health outcomes, there is much less focused on the dissemination and implementation of family-based interventions in health care and integrated health care contexts. In order to advance our understanding how family members are included in family-based interventions, it is essential to operationalize how family-based interventions involve and assess families. In this editorial, we describe the foundations of family science and health, how these foundations inform family-based research, and the translational bridge of family-based research in health care. We conclude by describing a tiered approach for family involvement and assessment in family-based interventions taking place in health care, with specific attention on dissemination and implementation research in integrated care settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).