Showing papers in "Families, Systems, & Health in 2021"

Child and adolescent asynchronous technology competencies for clinical care and training: Scoping review.

Abstract: Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, "What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?" The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions' position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Hispanic English language learner families and food insecurity during COVID-19: Risk factors and systems of food support.

Abstract: INTRODUCTION: Although many low-income families have experienced food insecurity during the COVID-19 pandemic, rates have been particularly high among low-income Hispanic and immigrant households. METHODS: The present study draws on data from an ongoing longitudinal study of low-income families and children in Tulsa, Oklahoma to examine food insecurity among English Language Learners (ELLs), all of whom were Hispanic and most of whom came from immigrant families. RESULTS: Findings indicate that, although low-income ELL families were somewhat more likely to experience food insecurity than other low-income families before the pandemic, once COVID-19 erupted, they had 3 times the odds of experiencing food insecurity, even after controlling for prior risk factors and COVID-related income loss. Further, food-insecure ELLs were less likely to receive SNAP benefits than other food-insecure families. DISCUSSION: Taken with other research, results suggest that because of concerns around immigration status, ELL families may have less access to critical benefits that have supported other families throughout the pandemic, such as SNAP and CARES Act stimulus checks. Thus, to meet the urgent needs of persistent food insecurity, aid should refocus on using rapid response systems with community ties, such as mutual aid organizations and school systems, to provide financial and monetary support to low-income ELL families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The association of transmission concerns and social distance from loved ones with distress in medical professionals providing care during the COVID-19 pandemic in New York City.

Abstract: BACKGROUND: Health care workers (HCWs) during the COVID-19 pandemic report high levels of psychological distress. We examined whether concerns regarding transmission of COVID-19 to loved ones and social distancing from loved ones were associated with HCWs' distress. We tested whether living with others modified these associations. METHOD: HCWs at a New York City academic medical center (N = 767; 80.7% female, 58.5% White) enrolled in the COVID-19 Health Care Provider Study and completed a web-based survey between April 9, 2020 and May 11, 2020. RESULTS: Controlling for demographics, distress regarding potential transmission to loved ones and social distancing from loved ones were each significantly associated with higher odds of a positive screen for acute stress, depression, and anxiety (ORs = 1.29-1.59, all ps < .01). Living with others was associated with lower odds of a positive screen for depression and anxiety, though the protective effect for anxiety was evident only for HCWs with no distress regarding transmission concerns. CONCLUSIONS: Transmission concerns and social distancing from loved ones were associated with greater odds of psychological distress, whereas living with others was associated with lower odds of distress. Interventions should consider ways to facilitate the ability of HCWs to receive social support from loved ones, while simultaneously protecting their family's health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Matched emotional supports in health care (MESH) framework: A stepped care model for health care workers.

Abstract: Frontline health care workers (HCWs) are experiencing a range of emotional responses to the COVID-19 pandemic, including anxiety, traumatic stress, and burnout. As many as half of all HCWs will exhibit clinically significant distress. This distress may endure for years, and health care institutions must respond to these emotional needs. We propose the Matched Emotional Supports in Health Care (MESH) Framework to guide institutions in implementing a tiered, or "stepped care" model for deploying sustainable emotional support programs for HCWs for COVID-19 and beyond. Recognizing the variability in HCWs' response to stress, MESH outlines a continuum of services, including universal (e.g., self-help), selected (e.g., support from trained volunteers), and indicated (e.g., professional therapy, psychotropic medication management) interventions matched to individual need. We provide a targeted review of evidence-based resources available at each level of care and potential processes for determining when higher levels of care are needed. Finally, we delineate key implementation factors for institutions to consider in developing, implementing, and sustaining services for HCWs. Employing the MESH Framework may also facilitate health care institutions' ability to meet the fourth aim of the Quadruple Aims of Health Care to ensure a healthy workforce for this and future crises. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health-related quality of life in parents and partners of people with type 1 diabetes: Development and validation of type 1 diabetes and life (T1DAL) measures.

Abstract: INTRODUCTION Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people with T1D. We report on the multistep development and validation process for the self-report Type 1 Diabetes and Life (T1DAL) measures, with versions for parents of youth age <8, 8-11, 12-17, and 18-25 years, and for partners of people age ≥18 years with T1D. METHOD First, we conducted qualitative interviews (total parents/partners n = 38) to develop draft measures and piloted them (total n = 20). Next, we tested the measures' psychometric properties. Participants (total across versions n = 813) at six T1D Exchange Clinic Network sites completed the appropriate T1DAL measure and validated measures of related constructs. We then reduced each T1DAL measure to 20-30 items in length based on psychometric data and participant feedback. Eleven participants reviewed the final measures via cognitive debriefing. RESULTS The T1DAL measures for parents and partners demonstrated good internal consistency (α = .80-.88) and test-retest reliability (r = .73-.86). Correlations with measures of general quality of life, generic and diabetes-specific HRQOL, and diabetes burden demonstrated construct validity. Factor analyses identified 3-4 subscales/measure. Participants reported being satisfied with the shortened measures, which took 5-10 minutes to complete. DISCUSSION The new T1DAL measures for parents and partners of people with T1D are reliable, valid, and ready for use in research and clinical settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Harnessing the electronic health record to advance integrated care.

Abstract: INTRODUCTION Integrated health care is utilized in primary care clinics to meet patients' physical, behavioral, and social needs. Current methods to collect and evaluate the effectiveness of integrated care require refinement. Using informatics and electronic health records (EHR) to distill large amounts of clinical data may help researchers measure the impact of integrated care more efficiently. This exploratory pilot study aimed to (a) determine the feasibility of using EHR documentation to identify behavioral health and social care components of integrated care, using social work as a use case, and (b) develop a lexicon to inform future research using natural language processing. METHOD Study steps included development of a preliminary lexicon of behavioral health and social care interventions to address basic needs, creation of an abstraction guide, identification of appropriate EHR notes, manual chart abstraction, revision of the lexicon, and synthesis of findings. RESULTS Notes (N = 647) were analyzed from a random sample of 60 patients. Notes documented behavioral health and social care components of care but were difficult to identify due to inconsistencies in note location and titling. Although the interventions were not described in detail, the outcomes of screening, referral, and brief treatment were included. The integrated care team frequently used EHR to share information and communicate. DISCUSSION Opportunities and challenges to using EHR data were identified and need to be addressed to better understand the behavioral health and social care interventions in integrated care. To best leverage EHR data, future research must determine how to document and extract pertinent information about integrated team-based interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Caregiver perceptions of importance of COVID-19 preventative health guidelines and difficulty following guidelines are associated with child adherence rates.

Abstract: OBJECTIVE: To describe child adherence to four preventative-health guidelines during the COVID-19 pandemic and investigate caregiver-level correlates of adherence. METHOD: Two hundred thirty-six caregivers (75% female) of children ages 6-12 years (Mage = 8 years; 53% male) living in the United States rated child adherence to four preventative-health guidelines between 10/16/2020 and 11/14/2020. Caregivers also rated perceived importance of each guideline in limiting virus spread and perceived difficulty in obtaining child compliance. RESULTS: Child adherence was highest for mask-wearing (median [Mdn] = 96%) and hand hygiene (Mdn = 95%). Adherence to social distancing guidelines was lower. Mdn adherence for social distancing with family outside the household was 80%, and Mdn adherence for social distancing with friends was 72%. Furthermore, for each of the four guidelines, fewer than half the sample reported 100% adherence (range = 20%-43%). Adherence was positively associated with caregiver perceptions of importance of a given behavior in limiting virus spread (rs = .38-.62) and negatively associated with perceived difficulty in gaining child compliance (rs = -.37-.25). DISCUSSION: Current results indicated parents perceive child adherence to social distancing more challenging than child adherence to mask wearing or hand hygiene. Lower caregiver perceptions of importance of the behavior and greater perceived difficulty in gaining child compliance were associated with lower adherence to all tasks. Brief targeted interventions (e.g., motivational interviewing, parent behavior management training) may be well suited to enhance caregivers' perceptions of value of the behavior, while also addressing behavioral challenges that interfere with child adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emergency department frequent user subgroups: Development of an empirical, theory-grounded definition using population health data and machine learning.

Abstract: Frequent emergency department (ED) use has been operationalized in research, clinical practice, and policy as number of visits to the ED, despite the fact that this definition lacks empirical evidence and theoretical foundation. To date, there are no studies that have attempted to understand ED use empirically, without arbitrary use of "cut-points." This study was conducted to identify the best-performing, empirically grounded definition of frequent ED use. The performance of machine learning supervised clustering algorithms based on the most common definitions of frequent ED use in peer-reviewed literature (i.e., 3+, 4+, 5+ visits per year) were compared to unsupervised clustering algorithms that take into account numerous systemic factors associated with patients' ED use. All ED visits for the State of Florida, 2011-2015, including more than 100 clinical and payment-related variables per visit were employed in the model. Supervised algorithms using number of visits to the ED, alone, were unable to differentiate patients into clusters, while unsupervised models using all patient data formed clusters in which patients within a given cluster were alike, and patients between clusters were different. Cluster size and characteristics were stable across years. The results of this study indicate that mean number of ED visits by patients differ between patient clusters, but this does not allow for accurate identification of ED patients. Machine learning algorithms using all systemic and biopsychosocial patient data can be used to identify and group patients for the purpose of developing and testing integrated, whole health interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care.

Abstract: Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Healthcare employees’ social networks, burnout, and health.

Abstract: INTRODUCTION The purpose of this article is to introduce how social networks can be utilized as an effective approach to health informatics and to provide evidence from a quantitative research study regarding the effects of interpersonal interactions at work on healthcare employees' burnout and health. METHODS Tests of moderation were calculated to explore whether interpersonal interactions at work changed the associations between job stress and burnout and health. The study used cross sectional data from a North Carolina convenience sample. Participants were 237 multidisciplinary employees from healthcare organizations who were at least 18 years of age. RESULTS The results from this study provided evidence that more frequent friendly work-related communication benefitted employees' health, while more frequent hostile or difficult communication was detrimental to employees' burnout and health. DISCUSSION In this article, an explanation for using social networks to collect quantitative, relational data to determine when interpersonal interactions at work are beneficial or detrimental to employees' health and burnout is provided. The article concludes with a discussion regarding how these results and methods can be used to advance the national movements aimed at addressing healthcare employees' health and burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using standard celeration makes COVID-19 data more meaningful.

Abstract: INTRODUCTION: The fourth sudden acute respiratory syndrome (SARS) virus, COVID-19, emerged in late 2019, leading to the most devastating pandemic since the Spanish influenza (H1N1) of 1918, which seized 50 million lives worldwide (https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html). Elected officials must make critical system-level decisions for stymieing the spread of the virus. Businesspersons must make personnel, financial, and operational decisions to minimize transmission while preserving their business's vitality. Members of the public must make personal decisions about personal protective equipment and changing social, recreational, occupational, and spiritual behavior to protect themselves and others. The scientific community can shift how they illustrate the virus's behavior to the public in an appropriate and understandable way so that the public can make informed decisions. This article suggests the use of a single-case design and logarithmic analyses to improve the current methodologies for COVID-19 analysis and illustration. METHOD: The Standard Celeration Chart was used with Theil's incomplete regression and a 7-point change analysis; the authors demonstrate a suitable virus-tracking and mitigation methodology. RESULTS: Analysis and data visualization are standardized, providing an accurate depiction of the virus's growth for public dissemination and decision-making. An analytic strategy is demonstrated for retrospectively detecting meaningful changes in viral growth or prospectively measuring such changes that coincide with known mitigation strategies. DISCUSSION: The authors suggest improvements in bridging science to application by making COVID-19 informatics more meaningful and actionable by lawmakers, businesspersons, and the public. Limitations and future directions for COVID-19 informatics are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevention of psychological trauma among health care providers during the COVID-19 pandemic.

Abstract: The COVID-19 pandemic presented unique biological, psychological, and social threats to health care providers. The failure of local macrosystems placed providers at elevated risk of psychological and physical harm. To reduce the immediate risk of trauma to our local physician workforce, our team initiated a program of proactive psychological first aid in which physicians were regularly contacted by behavioral health colleagues to assess safety conditions and physician's well-being. When threats to the physician's safety were identified, these concerns were escalated to leadership and addressed when possible. When threats to well-being were identified, behavioral health team members provided supportive listening, and, if indicated, provided referral information for appropriate treatment resources. This paper reviews the rationale for this program, addresses ethical concerns, and proposes future directions for responding to threats to safety during events such as the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI).

Abstract: INTRODUCTION Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. OBJECTIVE We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). METHOD CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. CONCLUSION As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Researching warm hand-offs: Should we give a WHOot?

Abstract: This article discusses warm hand-offs (WHOs) in behavioral services and PCBH models. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Burnout trauma both? Identifying and addressing needs during COVID-19 through informatics.

Abstract: In this brief article, the author notes that discussion of work/life integration have become increasingly com mon at her institution, as school-age children regularly make appearances in Zoom meetings, and team mem bers have to shift between dynamic roles in their work and family lives throughout the day. Talk of burnout abounds-and she often find herself wondering if in fact they are only experiencing burnout as an occupational phenomenon, or whether it is a compounded experi ence of burnout and the emotional exhaustion of collective trauma and grief. Even when concerns dissipate about COVID's relentless spread and severe disease, there is no doubt that we will have lingering mental health hangovers from the psychologi cal impacts of the past year; we must be pre pared to leverage informatics and technology to stem the tide. We will navigate through these uncharted waters through thoughtful and effective leadership that culti vates community and a work environment that is with aligned with our organizational and personal values; and as the past year has demonstrated, it is evi dent that technology and informatics will play a piv otal role in the future of work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).