Showing papers in "Families, Systems, & Health in 2023"

COVID-19 pandemic experiences.

Abstract: Article presents a poem which relates a COVID-19 pandemic experience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Five visits with Diane.

Abstract: This brief article is based on a patient's experience the author witnessed as a medical oncology scribe. The article describes five visits with a cancer patient named Diane as she started chemotherapy. Mere months since Diane's first visit, she died. The doctor read a slip of paper on her desk and told the author with tears in her eyes. The author turned over the visits she had with Diane, trying to find solace in the comfort she had in the end. It had all gone so fast, though. Four visits and she was gone. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Brief conjoint visits between an embedded behavioral health provider and primary care team member: When are they used and what are the barriers and facilitators?

Abstract: INTRODUCTION Conjoint visits utilize the expertise of primary care providers (PCPs) and behavioral health providers (BHPs) to address complex comorbidities in patients. The objectives were to describe the use and features of conjoint visits and identify barriers and facilitators as described by BHPs in integrated settings. METHOD Three hundred and forty-five BHPs who worked in integrated primary care, a majority identifying as female and white, completed an online survey between October 2018 and July 2019. RESULTS Results indicated common reasons for conjoint visits were for mental or behavioral health concerns. Though they reported high comfort using conjoint visits (M = 4.3/5), 56.5% of BHPs participated in them less than monthly or never. Using a constant comparison approach, qualitative data were coded to reveal six categories of barriers and five categories of facilitators to conjoint visits. The most common barriers were a result of a lack of systemic support, such as 73.5% reporting lack of time, while the most common facilitators were coordination (60.7%) and interprofessional communication (39.3%). DISCUSSION Although conjoint visits are used infrequently, findings suggest it is not because they are unhelpful as providers generally found this type of appointment favorable. Rather, they and their teams lack time, training, and support needed for implementation. This research provides an introduction for researchers or clinicians to better understand the use of conjoint visits for patients with high needs and complexities. Future work focused on addressing barriers cited by providers regarding conjoint visits would increase providers' ability to use this form of care when it is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Policies during COVID-19 and their impact on immigrant families' psychological well-being: A critically engaged practice.

Abstract: INTRODUCTION The COVID-19 pandemic has exacerbated, and complicated stressors related to immigrant families' experience with U.S. immigration policies. METHOD This article uses a critically engaged practice (CEP) framework to examine three policies and their implications for the health and well-being of immigrant families during the COVID-19 pandemic (a) Detention and Removal of Alien Parents or Legal Guardians policy, (b) Order Suspending the Right to Introduce Certain Persons from Countries where a Quarantinable Communicable Disease Exists, and (c) Field Guidance on Deportability and Inadmissibility on Public Charge Grounds. RESULTS Our article presents a CEP framework to empower clinicians in integrated healthcare settings to better understand and communicate policies with their patients. DISCUSSION Policy-informed CEP asks clinicians to (a) remain current with policy change; (b) have the ability to interpret policy and or policy change to clients; and (c) be aware of not only the primary effects of policy on the family but also the secondary impacts to their system. Clinical implications are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family strain, but not family support, is linked to worse pain interference among midlife adults reporting new chronic pain.

Abstract: INTRODUCTION Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife. METHOD We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain. RESULTS The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later. DISCUSSION Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Whole person care: Outcomes from a 5-year care model integrating primary care into a behavioral health clinic.

Abstract: Integrated mental and physical health care has the potential to improve health outcomes. A behavioral health organization established a reverse integration program site using a co-located model to provide primary care services to patients receiving behavioral health services. We ask whether this model of co-located care was effective in improving a range of physical health outcomes for clients. This program was funded with a grant from the Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration.Patients received services in a community mental health setting that embedded primary care services. The population included adult patients with mental illness, substance use disorder (SUD), or co-occurring medical diagnoses in an urban setting. Just under half of the patients identified as non-White, and over one quarter identified as Hispanic. These characteristics demonstrate a medically complex and underserved population. This description and exploratory analysis utilized National Outcome Measures data and clinical health measures from electronic health records. We stratified data by SUD and mental illness diagnoses. We measured changes in health outcomes for this complex population of 532 patients from 2015 to 2019.From enrollment to last visit, patient outcomes improved for blood pressure and cholesterol. Conversely, waist circumference and breath carbon monoxide levels significantly worsened.This reverse integration co-location program demonstrates that positive health outcomes can be achieved through evidence-based care, adaptable clinic arrangements, and robust community connections and support. More work is needed to generate positive health outcomes in medically complex patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinician's commentary to accompany "Unmet need for mental health services utilization among under-resourced Black and Latinx adults".

Abstract: Comments on the article by T. B. Loeb et al. (see record 2023-28006-001), which highlights a need to understand mental health service (MHS) utilization among Black and Latinx individuals given disparate and detrimental outcomes associated with underdiagnosis and untreated mental health disorders. The present author addresses four questions related to the article: (1) How does this article, written by researchers, resonate with your experience as a clinician? (2) What is one thing you might do differently in your practice after reading this article? (3) What factors might facilitate or hinder the uptake/implementation of ideas in this piece? and (4) What is one unanswered question that you would like to see pursued as a follow-up to this article? (PsycInfo Database Record (c) 2023 APA, all rights reserved).

When one is the other.

Abstract: This poem is inspired by Brian Sinclair, an Indigenous Canadian man who passed away in 2008 after waiting 34 hours to be seen in an emergency department in Winnipeg, Manitoba. His death was entirely preventable. He died due in part to groupthink, ignorance, and systemic racism. This poem explores the "othering" that many Indigenous individuals, such as Brian, experience in healthcare settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

My first day in the ER: Should I be worried about.

Abstract: In this poem, a medical resident describes his first day in the emergency room. He describes the patient bleeding and his plummeting pulse. The resident wonders if he worries too much or whether, when it truly matters, he will be enough. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Community-recruited parent perspectives of concern dismissal by pediatric providers.

Abstract: Effective communication is a central tenet of family centered care, yet parent concerns are sometimes un- or underattended to by pediatric providers. This study aimed to explore the prevalence of, and factors related to, parental perceptions of concern dismissal by pediatric providers.In Spring 2020, 270 community-recruited parents of children ages 6-12 years (74% White, 74% female, 69% married) responded to an online survey about perceived concern dismissal experiences with their children. Characteristics of concern dismissal, differences in concern dismissal occurrence by parent factors, and emotional and practical impacts were assessed and explored.Thirty-three percent reported having experienced concern dismissal, most often in pediatric primary care settings. Concern dismissal was reported more frequently among parents employed in health care settings than those without health care employment histories. Most dismissed concerns related to the child's physical health and many incidents were characterized by provider impoliteness or provision of less testing or treatment than expected or desired. Many parents expressed disappointment in the health care system after experiences of concern dismissal.Concern dismissal was found to be common and upsetting for community-recruited parents. Future research should incorporate child and provider perspectives with demographically diverse samples. Pediatric providers should continue to work toward implementation of family centered care to decrease the likelihood of perceived dismissal by thoroughly recognizing and responding to concerns presented by parents and caregivers of pediatric patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinician commentary to accompany "Adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice".

Abstract: Comments on the original article by Bignall et al (see record 2023-07853-001) regarding adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice. The commentator states their belief that the article is genuinely applied research and reading the article reiterates the importance of adapting some of their practices to engage in more culturally sensitive strategies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived family functioning within Chinese pregnant women and husband dyads: Levels, consistency, and correlates.

Abstract: INTRODUCTION Understanding differences in perceived family functioning between pregnant women and their partners can protect and promote women's health. The purpose of this study was to examine consistency and differences in perceived family functioning within pregnant woman-partner dyads in China and explore correlates of effective family functioning. METHOD From 2020 to 2021, 175 pregnant women and husband dyads (100% Han nationality, Mage = 30.3 [4.5] years) were recruited from the women's psychological clinic of Changsha Hospital for Maternal & Child Health Care using convenience sampling. We assessed family functioning and depression and anxiety symptoms. We examined consistency and differences in perceived family functioning between pregnant women and their husbands. RESULTS Most pregnant women (76.6%) and husbands (71.4%) perceived their family functioning as effective. Pregnant women and their husbands shared poor consistency in family functioning, with an intraclass correlation of 0.25 and most weighted kappa coefficients of individual items < 0.2. Participants reporting effective family functioning had higher education levels and lower depression and anxiety scores. DISCUSSION Most pregnant women and their partners perceived effective family functioning, but showed poor consistency. Higher education and milder symptoms of depression and anxiety were associated with effective family functioning both in pregnant women and their partners. For primary healthcare system workers, differences in perceptions of family functioning should be fully taken into account when conducting family based integrated care for pregnant women. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reflections on the signs and science of belonging in integrated care.

Abstract: For this inaugural reflection, the author began by thinking about what the Collaborative Family Healthcare Association (CFHA) has been for them, and they suspect for many others. As a naïve early career professional, the author joined CFHA with wide-eyed optimism about the future of the integrated care movement and the giddy excitement only a true nerd can appreciate when you get to befriend the individuals who have made one's career possible. This community is the space where peers and leaders sharpened the author's knowledge and where they became a passionate advocate for integrated care. Activities within CFHA have inspired several initiatives in their institution and community. Yet, when they think of CFHA, it is not the technical access or the ocean of knowledge that comes to mind. Instead, what lights up for them is the feeling that this is a community to which they belong. This is illuminated by the warmth of handshakes and hugs, contagious laughter, shared meals, and moments of joys and sorrows. This sense of belonging they received from CFHA has instilled confidence and agency in other areas of their professional development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Community-recruited parent perspectives of concern dismissal by pediatric providers.

Abstract: INTRODUCTION Effective communication is a central tenet of family centered care, yet parent concerns are sometimes un- or underattended to by pediatric providers. This study aimed to explore the prevalence of, and factors related to, parental perceptions of concern dismissal by pediatric providers. METHOD In Spring 2020, 270 community-recruited parents of children ages 6-12 years (74% White, 74% female, 69% married) responded to an online survey about perceived concern dismissal experiences with their children. Characteristics of concern dismissal, differences in concern dismissal occurrence by parent factors, and emotional and practical impacts were assessed and explored. RESULTS Thirty-three percent reported having experienced concern dismissal, most often in pediatric primary care settings. Concern dismissal was reported more frequently among parents employed in health care settings than those without health care employment histories. Most dismissed concerns related to the child's physical health and many incidents were characterized by provider impoliteness or provision of less testing or treatment than expected or desired. Many parents expressed disappointment in the health care system after experiences of concern dismissal. DISCUSSION Concern dismissal was found to be common and upsetting for community-recruited parents. Future research should incorporate child and provider perspectives with demographically diverse samples. Pediatric providers should continue to work toward implementation of family centered care to decrease the likelihood of perceived dismissal by thoroughly recognizing and responding to concerns presented by parents and caregivers of pediatric patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A biopsychosocial-spiritual wellness check program for internal medicine residents: A brief report.

Abstract: INTRODUCTION The pandemic has significantly impacted medical residents. We created and implemented a biannual biopsychosocial-spiritual Wellness Check Program (WCP) to help internal medicine residents self-assess for burnout, enhance resilience, and to promote early identification and referral to mental health services. We report the preliminary findings from our quality improvement pilot effort at Loma Linda University Health (LLUH). METHOD Residents participated in biannual sessions with licensed therapists employed by Loma Linda University, Office of Physician Vitality (OPV). Visits consisted of an evidence-guided discussion about general wellbeing, relationships, family life, coping strategies, and referrals. Archived, confidential WCP session notes between July 1, 2019 and December 31, 2019 were reviewed and a simple tally system was used to record coping strategies, concerns, and referrals made. RESULTS Partner and family issues were the most prevalent concern, followed by mental health issues, and relationships with colleagues, faculty, or staff. Most residents described several coping strategies: 66.36% listed two to three, and 26.36% listed four or more. Referrals were offered to community or employee assistance program therapists, follow-up with the OPV, psychiatry, couple counseling, given Web based psychoeducational links, or referred to their program director. Nine other residencies requested the WCP providing anecdotal evidence of its feasibility and usefulness. DISCUSSION As the pandemic surged, these visits normalized reflections about wellbeing, intentional coping strategies, and resilience practices. We continue to gather data to refine and further structure this program and help residents monitor and address their resilience needs and wellness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

C-WHO 2022 Don Bloch award.

Abstract: On October 15th, 2022, Cornerstone Whole Healthcare Organization became the first organization to receive the Don Bloch Award, CFHA's primary organizational award of significance. Named after Don Bloch, MD, a seminal founder of CFHA and the award's very first recipient, the Don Bloch award recognizes an individual, and now an organization, whose work and character exemplify Don Bloch and thus advances the field of integrated care, regardless of career stage. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Catatonia.

Abstract: In this poem, the author/doctor describes a female teenage patient with catatonia. The author asks her what she is thinking of. Her mother delays among the sleepers in the waiting room, touches the author's sleeve, blessing the faint music, fleet as hope. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A health care experience from an immigrant educator.

Abstract: Over the last 2 years in their role as a director of diversity, the author had a sense of fulfillment from hosting small group discussions with medical students on implicit bias. Many of these discussions are centered around cases they developed to mirror their own experiences. As an educator having small group discussions was important for the author. Their goal was to train well-rounded health care professionals with diverse thoughts and skills to serve everyone regardless of how they speak or where they are from. The author wanted to engage in conversations with their students and have a chance to truly observe if they understood the issue of microaggressions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.

Abstract: BACKGROUND Despite guidelines from the American Academy of Pediatrics (AAP), many pediatric practices still do not have standardized screening processes in place to identify children with developmental delays. From April 2014 to April 2017, six federally qualified health center (FQHC) sites in Northern California implemented an intervention to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. METHOD The intervention aimed to optimize each site's screening processes, supported by an automated electronic tablet-based system. To improve follow-up support, social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals and case management support, and collaborate with service partners. We analyze operational and implementation data to characterize site adoption, patient reach, implementation processes, and intervention effectiveness. RESULTS During the intervention's final year, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site, then to 91.8% after automation was expanded to the remaining sites. Follow-up visit rates ranged between 74% and 88%. CONCLUSIONS Implementation of a multicomponent developmental and behavioral health screening and follow-up care intervention enabled FQHC sites to meet AAP recommendations and provide follow-up support. Disseminating the intervention may support population-level improvement in early detection and intervention for developmental delays and behavioral health concerns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

ACEs screening in adolescent primary care: Psychological flexibility as a moderator.

Abstract: Screening for adverse childhood experiences (ACEs) is increasingly recommended in medical settings; however, there is more to learn about which patients experience negative outcomes following ACEs and how to intervene. This study sought to determine whether psychological flexibility moderated the relationship between ACEs and 2 important health outcomes: depression and elevated body mass index (BMI). Specifically, we hypothesized that as psychological flexibility increased, the relationship between ACEs and these mental and physical health outcomes would weaken.Exposure to ACEs, psychological flexibility (AFQ-Y8), depressive symptoms (PHQ9a), and BMI percentiles were assessed using validated, self-report rating scales during adolescent well-child checks in urban primary care practices. A total sample of 402 predominately Black (72.6%), publicly insured (81.8%), and female (63.4%) adolescents with complete data were included in analysis.Psychological flexibility moderated the relationship between self-reported ACEs and depressive symptoms. Patients with high psychological flexibility reported fewer depressive symptoms when they experienced more ACEs, those with average psychological flexibility demonstrated no relationship between ACEs and depressive symptoms, and those with low psychological flexibility reported more depressive symptoms when experiencing higher numbers of ACEs. ACEs were only related to BMIs greater than 99th percentile in this study and moderation was not supported.Psychological flexibility was helpful in differentiating those who experience increased depressive symptoms following ACE exposure in a primary care setting. Psychological flexibility is a modifiable process and may represent an important population health variable to develop prior to exposure or reduce negative outcomes following ACEs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Information sharing in differences of sex development: The creation of a caregiver-support tool.

Abstract: Social support can be a protective factor against the negative mental health outcomes experienced by some parents and caregivers of children with differences of sex development (DSD). However, established social support networks can be difficult to access due to caregiver hesitancy to share information with others about their child's diagnosis. Health care providers in the field of DSD, and particularly behavioral health providers, are well positioned to help caregivers share information with the important people in their lives in order to access needed social support. This article summarizes the development of a clinical tool to help clinicians facilitate discussions regarding information sharing with caregivers of children with DSD.Members of the psychosocial workgroup for the DSD -Translational Research Network completed a survey about their experiences facilitating information sharing discussions with caregivers of children with DSD and other health populations. The results of this survey were used to develop a clinical tool using ongoing iterative feedback from workgroup members, based on principles of user-centered design and quality improvement.Workgroup members consider information sharing an important aspect of working with caregivers of children with DSD. Additional resources and tools were identified as potentially helpful to these discussions.The DSD Sharing Health Information Powerfully-Team Version (SHIP-T) is a resource tool for DSD health care team members to utilize in hospital and ambulatory settings to help caregivers of children with DSD share information with their social support networks. The final SHIP-T is included in this article. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Miraculous existence.

Abstract: In this poem, the author, who is an MD, relates that she is a woman with caramel skin who is trying to learning a healing art. At times she finds herself wanting to give up the pursuit, questioning whether her sacrifice was worth it, whether she belongs in this hallowed profession. She allows herself to consider that the simple fact of her improbable existence is a miracle. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Open to interpretation: An integrated primary care behavioral health training approach for treating linguistically diverse patients.

Abstract: INTRODUCTION Integrated primary care settings serve an increasingly high volume of linguistically diverse patients. In English language-dominant countries, limited English proficiency (LEP) is associated with disparities in access and quality of behavioral health (BH) care. Interpretive services (IS) aim to address these disparities by assisting in the delivery of clinical care between patients and providers who speak different languages. Yet, there is a need for greater emphasis on the utilization of IS in clinical training for BH professionals (e.g., psychology, social work, counseling, and family therapy). METHOD In this conceptual article, we describe a BH practicum rotation for predoctoral psychology trainees in a free, student-run integrated primary care clinic that largely serves uninsured adults with LEP. First, we discuss our training model which includes a 90-min didactic lecture on IS for BH and supervised applied clinical experiences (e.g., psychotherapy, warm handoffs, and consultation). Then, we present vignettes prepared by trainees about the challenges and benefits associated with delivering BH care with IS at the predoctoral level of training. RESULTS From the practicum experience, clinical psychology trainees reported improved knowledge and competencies in utilizing IS as well as generalizable skills for delivering BH care with a focus on multicultural practice. DISCUSSION We recommend that other integrated primary care BH training sites consider emphasizing training in IS. This article concludes with recommendations for implementation and dissemination of our training model on other sites. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Review of Headspace: Meditation and sleep.

Abstract: Americans today report facing multiple stressors, including the COVID-19 pandemic (American Psychological Association, 2020), anxiety disorders (American Psychiatric Association, n.d.), chronic stress (Bergland, 2017), and more. As smartphones become increasingly ingrained in our society, many adults seek out self-directed stress management techniques facilitated via smartphone. A plethora of options are available, and mobile health applications have become increasingly popular in recent years (Lau et al., 2020). With over 70 million downloads across available platforms and users in over 190 countries (Headspace Inc., 2022), the mobile application Headspace may be one of the most well-known mobile health apps. As of May 2022; Headspace can be accessed via the mobile app or the product website (https://www .headspace.com/). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Primary care provider perspectives on virtual and in-person depression management during the COVID-19 pandemic.

Abstract: INTRODUCTION During the COVID-19 pandemic, primary care providers (PCPs), nurses, and integrated mental health specialists continued to collaboratively manage depression among patients using both in-person and virtual (i.e., hybrid) modalities. Few studies have characterized how hybrid services are currently delivered within interdisciplinary primary care teams. This study aimed to understand frontline PCPs' perspectives on providing hybrid virtual and in-person depression care during the pandemic. METHOD From September to November 2020, 12 semistructured individual interviews focused on depression management were conducted with PCPs in two Veterans Health Administration (VA) clinics in Los Angeles, which resumed in-person services while balancing rising COVID-19 cases. Interviews were audio-recorded, transcribed, and coded for depression management patterns. Themes were derived using a team-based constant comparative analytic approach. RESULTS The pandemic and subsequent expanded use of virtual care necessitated clinic adaptations to depression assessments and procedures. PCPs perceived increased depression and anxiety among patients with existing psychiatric conditions, attributed to social distancing and isolation restrictions. They expressed acceptance of virtual care modalities for patients' depression management. PCPs did not perceive a delay in mental health care delivery in the shift to virtual care but noted the possibility of patients being lost to follow-up. CONCLUSIONS During the pandemic, there has been heightened PCP concern for patients' emotional well-being and adaptations of clinic processes to meet needs for depression care. While PCPs were optimistic about new virtual care options for depression management, virtual care transfers remained poorly defined and the extent to which patient care experiences and health outcomes have been disrupted remains unknown. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Embracing measurement-based care within integrated primary care settings.

Abstract: "Why should I care about doing Measurement-Based Care (MBC)?" This is a phrase that the editor often hears, either explicitly or implied, when working to champion and implement MBC within integrated primary care (IPC) settings. As an implementation and education specialist within the Veterans Health Administration (VHA) healthcare system, the editor has attended many MBC presentations and meetings where this question is uttered by frontline IPC clinicians, often frustrated with the growing demands on their practice. Many of these sentiments are usually framed around the assumption that MBC is not very important or useful, clinically speaking. This sets up a familiar debate of research versus practice: While many clinicians have heard MBC is "good for us," what accounts for the failure to implement MBC clinically? One of the major aims of this guest editorial is to invite the reader to consider the evidence base we have so far, rethink perceived barriers to MBC, and to ultimately decide for oneself that "the juice is worth the squeeze" for routine clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Whole person care: Outcomes from a 5-year care model integrating primary care into a behavioral health clinic.

Abstract: INTRODUCTION Integrated mental and physical health care has the potential to improve health outcomes. A behavioral health organization established a reverse integration program site using a co-located model to provide primary care services to patients receiving behavioral health services. We ask whether this model of co-located care was effective in improving a range of physical health outcomes for clients. This program was funded with a grant from the Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration. METHOD Patients received services in a community mental health setting that embedded primary care services. The population included adult patients with mental illness, substance use disorder (SUD), or co-occurring medical diagnoses in an urban setting. Just under half of the patients identified as non-White, and over one quarter identified as Hispanic. These characteristics demonstrate a medically complex and underserved population. This description and exploratory analysis utilized National Outcome Measures data and clinical health measures from electronic health records. We stratified data by SUD and mental illness diagnoses. We measured changes in health outcomes for this complex population of 532 patients from 2015 to 2019. RESULTS From enrollment to last visit, patient outcomes improved for blood pressure and cholesterol. Conversely, waist circumference and breath carbon monoxide levels significantly worsened. DISCUSSION This reverse integration co-location program demonstrates that positive health outcomes can be achieved through evidence-based care, adaptable clinic arrangements, and robust community connections and support. More work is needed to generate positive health outcomes in medically complex patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Delay and nonreceipt of needed healthcare in U.S. adults with household family members with serious health needs.

Abstract: INTRODUCTION Households may be primary settings for developing noncommunicable and infectious diseases due to shared lifestyle factors and ease of transmission, rendering multiple family members within a household in simultaneous need of health services. Limited resources may force families to prioritize healthcare for individuals with serious health needs over other family members; however, few studies have examined unmet healthcare needs within family contexts. This study examines the odds of U.S. adults' own unmet healthcare needs due to cost when living with a family member who has serious health needs. METHODS In this cross-sectional analysis of 2018 National Health Interview Survey data, we use multivariate logistic regression models to estimate the odds of U.S. adults' own delay and nonreceipt of care when living with a spouse or partner, child under age 18, or parent/parent-in-law with a limiting chronic condition or high volume of past-year healthcare use. RESULTS Of 56,165 adults surveyed, 51.7% were female, and 63.1% were non-Hispanic White. Adults who had a household family member with extensive health needs had 1.5-2.0 times the odds of experiencing delay or nonreceipt of their own needed care. Being female, uninsured, and having a household income ≤ 400% of the Federal Poverty Level was associated with higher risk of having unmet healthcare needs. DISCUSSION Families with limited resources may be forced to prioritize some members' needed healthcare over others'. Policy and programmatic support for individuals with ongoing and acute health needs may help ensure adequate resources for all family members to seek needed care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The physician's fix.

Abstract: I invite readers to ponder the complexities of modern medicine and the impacts of treatments on individuals, their families, and their quality of life. I want readers to challenge themselves- asking difficult questions regarding what really matters during end of life- personhood, dignity, and an acknowledgement that a person is much more than only functioning physiology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care.

Abstract: INTRODUCTION Opioid use disorder (OUD) and psychiatric conditions commonly co-occur yet are infrequently treated with evidence-based therapeutic approaches, resulting in poor outcomes. These conditions, separately, present challenges to treatment initiation, retention, and success. These challenges are compounded when individuals have OUD and psychiatric conditions. METHOD Recognizing the complex needs of these individuals, gaps in care, and the potential for primary care to bridge these gaps, we developed a psychotherapy program that integrates brief, evidence-based psychotherapies for substance use, depression, and anxiety, building on traditional elements of the Collaborative Care Model (CoCM). In this article, we describe this psychotherapy program in a primary care setting as part of a compendium of collaborative services. RESULTS Patients receive up to 12 sessions of evidence-based psychotherapy and case management based on a structured treatment manual that guides treatment via Motivational Enhancement; Cognitive Behavioral Therapies for depression, anxiety, and/or substance use disorder; and/or Behavioral Activation components. DISCUSSION Novel, integrated treatments are needed to advance service delivery for individuals with OUD and psychiatric conditions and these programs must be rigorously evaluated. We describe our team's efforts to test our psychotherapy program in a large primary care network as part of an ongoing three-arm randomized controlled trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).