Families Systems & Health最新文献

Introduction: Prolonged activation of the body's stress response from chronic exposure to adverse stressors may have a significant impact on lifelong psychosocial functioning. Screening for the impact of prolonged adversity in childhood has become an integral component of pediatric care. While past research has separately explored the impact of caregiver chronic illness and caregiver toxic stress on children, the relationship between caregiver chronic illness disability burden, caregiver parental toxic stress, and their child's psychosocial functioning is not well understood. This study aimed to investigate how caregiver chronic illness disability burden and caregiver toxic stress impact childhood psychosocial dysfunction (CPD).

Method: This pilot study was conducted at two free family medicine clinics in Inland Southern California between August and December 2022. It surveyed caregivers with chronic illness of any age or functional capacity who are full-time caretakers of children aged 4-17 years old. Validated screening tools assessed caregiver disability burden (World Health Organization Disability Assessment Schedule 2.0-12), parental toxic stress (Functional Impact of Toxic Stress for Parents), and pediatric psychosocial functioning (Pediatric Symptom Checklist-17). Regression analysis tested if caregiver scores on these measures predicted CPD. Twenty-nine participants completed the survey.

Results: High caregiver chronic illness disability burden and toxic stress together significantly predicted CPD. Caregiver toxic stress alone predicted CPD, whereas chronic illness disability burden alone did not.

Discussion: This study highlights the relationship between caregiver chronic illness disability burden, caregiver toxic stress, and childhood psychosocial dysfunction, and may contribute to providing holistic care to children and their caregivers. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: For physicians, the added responsibility of being an informal caregiver (IC, providing regular care for seriously ill loved ones) can create challenges such as increased rates of burnout that have received little attention. In this study, we explored physician mothers' informal caregiving experiences and probed their perspectives on how health systems can better support their needs.

Method: From September 14, 2021, to October 31, 2021, we distributed an online survey to a national sample of physician mothers who self-identified as ICs; survey questions examined their caregiving responsibilities and perspectives on workplace changes needed to support them.

Results: Of 23 respondents, 48% were caregivers for a child, and 74% coresided with their care recipient; 26% spent on average 40 hr per week caregiving and 44% were ICs for 5 years or more. Main caregiving responsibilities included communicating with health care providers (91%) and managing and/or attending medical appointments (70%). Three central themes emerged from open-ended questions: (a) "It's an exhausting and unrecognized burden"; (b) "Our health care system is difficult to navigate, even for physicians"; and (c) "Flexible work schedules, no penalties." Within these themes, respondents described feeling unrecognized and unsupported as ICs in their workplaces.

Conclusion: Physician mothers who are ICs fill critical, demanding roles as health care leaders and caregivers at home. Balancing these dual roles presents significant challenges that can have adverse effects, leaving physician-mother ICs vulnerable to burnout and attrition. Targeted support strategies including flexible staffing models, expanded telehealth, and paid informal caregiving leave may improve experiences for physician ICs more generally. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Most Americans with symptoms of depression and anxiety receive treatment exclusively from their primary care providers (PCPs). Existing primary care interventions typically do not occur within the initial patient interaction, rely on delivery by mental health specialists, and have lengthy training programs. This study evaluated the feasibility and acceptability of the training workshop for an ultra-brief cognitive-behavioral therapy (UB-CBT) single-session intervention for depression and anxiety symptoms that was developed to address these barriers.

Method: The 1-hr UB-CBT training workshop was piloted in 2021 with 38 providers at three adult primary care and five family medicine sites in Vermont. PCPs completed questionnaires after the training workshop. Data were collected in 2021 with a sample of participants who were primarily women (66%) and white (82%). We used a concurrent triangulation design integrating mixed-methods data.

Results: Most providers found the training highly feasible and acceptable. The majority agreed or strongly agreed that the workshop provided sufficient training for using the intervention (91%), they were satisfied with the UB-CBT intervention (92%), and the intervention seemed easy to administer (97%). Qualitative findings highlighted that providers especially liked the user-friendliness and general feasibility of the intervention, but had some concerns about time.

Discussion: We outlined several steps that will address PCPs' concerns to improve the UB-CBT training experience and intervention. Future research should examine the effectiveness of the UB-CBT intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Diabetes-specific family conflict is a risk factor for diabetes indicators (e.g., higher hemoglobin A1c (HbA1c), lower adherence), but little longitudinal data are available to understand associations across time. To better inform targets and timing of interventions, we examined (a) whether fluctuations in conflict covary with diabetes indicators within adolescents across time; (b) whether reciprocal associations exist; and (c) whether aspects of the parent-adolescent relationship (e.g., parental acceptance) buffer associations across time.

Method: Adolescents (N = 235, ages 11.5-15.5 at baseline, 53.6% female) completed measures of diabetes-related conflict with mothers and with fathers (separately), parental acceptance, and adherence every 6 months across 1 year (three time points). HbA1c was obtained from medical records. Data were collected in 2009.

Results: Bivariate between-person correlations indicated that at each time point, adolescents who reported more conflict with mothers and fathers also had higher HbA1c and lower adherence. Within-person correlations (fluctuations across three time points) indicated that fluctuations in conflict with mothers were associated with fluctuations in HbA1c but not adherence. Actor-partner multilevel models indicated that fluctuations in family conflict at each time point were not associated with future diabetes indicators. Parental acceptance did not moderate associations of family conflict and diabetes indicators.

Discussion: While findings corroborate extant literature noting that adolescents with high average diabetes-specific family conflict may benefit from interventions designed to reduce conflict, conflict at one time point may not be predictive of future diabetes indicators. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The author presents a poem about how their brother, who was a medical was student was discriminated against. A patient refused to be touched by a Black person and the resident in charge did nothing, but told her brother to, "step back." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Structural social connectedness is the structure and size of a person's social network, including whether persons live with or have regular contact with others. The COVID-19 pandemic disrupted structures that facilitate social connectedness. This study investigated how a person's structural social connectedness influenced diabetes self-management strategies through the COVID-19 pandemic.

Method: The study followed an explanatory sequential mixed methods design. First, quantitative data were collected via surveys of 54 patients living with diabetes (67% female, M_age of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, M_age of 62 [9] years) as a follow-up to the survey to help explain quantitative findings. Longitudinal mixed methods analysis integrated both phases to offer a holistic view of the factors influencing diabetes self-management.

Results: A full-factorial analysis of covariance tested home and workplace social connectedness effects onto glycemic control and four self-management measures. In integrated analysis, researchers categorized patients into four groups by level of home and workplace social connectedness. Individuals with home social connectedness were more likely to overcome pandemic-related self-management challenges than those without home social connectedness. Although the workplace provided social connectedness, it imposed structural barriers to self-management.

Discussion: Structural social connectedness influenced how patients navigated diabetes self-management challenges through the COVID-19 pandemic. Results suggest clinicians should consider how home and workplace connectedness interact to facilitate or impede patient self-management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This poem is a circular narrative about the trauma of loving someone with a substance use disorder, how our past creeps into clinical encounters, and the liminal spaces that only exist late at night. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Despite the well-documented youth mental health crisis, there has been a lag in the development of a specialized workforce to meet needs of young people experiencing these challenges. Little is known about the comfort of primary care pediatricians when faced with children and adolescents with mental health care concerns.

Method: A brief online survey was conducted to assess patterns of behavioral and mental health concerns in pediatric practices affiliated with a pediatric health system in Alabama. The survey asked about frequency of conditions that providers encountered, comfort treating these conditions, and frequency of external referrals.

Results: Pediatric providers reported high volumes of children with mental health concerns and varying levels of comfort treating independently. Providers frequently refer externally.

Conclusions: High rates of referrals could further stress an already overloaded system of specialty care. Interventions must be implemented to ensure a workforce prepared to meet the growing needs of youth requiring support for mental and behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Addressing U.S. health disparities in behavioral health care requires innovative solutions to expand access beyond the traditional specialty behavioral health (BH) service model. One evidence-based strategy to increase access is task shifting, whereby tasks usually reserved for licensed clinicians are delegated to less specialized but uniquely capable health workers. Health care systems in the United States have been slow to adopt this approach, despite the widespread success of task shifting in other countries. However, two large government health care systems have employed unique task-shifting models for decades, integrating nonclinician health workers into BH settings: the Defense Health Agency (behavioral health technicians) and the Veterans Health Administration (peer specialists).

Method: This conceptual article provides overviews of these successful approaches. Challenges and opportunities, and the potential for other U.S. health care systems to adopt task shifting for behavioral health care with paraprofessionals such as community health workers (CHWs), are discussed.

Results: CHWs and other paraprofessionals are ideally situated to increase access to behavioral health care, but barriers must be overcome. Recommendations are provided based on lessons from these federal system approaches to task shifting.

Discussion: Expanding task-shifting paradigms as the Defense Health Agency and Veterans Health Administration have done may be vital to reaching more people who could benefit from BH intervention and prevention strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Community ambassadors (CAs) are advocates that build trust with communities on behalf of service systems and facilitate access to resources. Whether and how CAs can support community engagement within a large initiative to build capacity to address the impact of trauma is unclear. This study explores how a Community Ambassador Network supported community engagement with "Innovations 2 Initiative" (INN 2), a 5-year initiative that addressed trauma across nine communities in Los Angeles County.

Method: CAs were recruited from nine community-based partnerships to participate in a focus group, which explored their roles and experiences with INN 2 and their impact on community engagement. Data were collected in 2022 and were analyzed using a pragmatic two-phase strategy for efficient qualitative data analysis. Twenty-six CAs participated in six focus groups. Participants mostly spoke English (82%), identified as Latinx (50%) or Black (23%) and as cisgender female (48%); average age was 40 years.

Results: CAs implemented workshops and provided health education to the community. They reported being the community's first point of contact with INN 2 and believed they improved credibility of the human service sector. While CAs felt supported by the Department of Mental Health, some wanted more trust from their supervisors.

Discussion: CAs described various ways that they engaged historically excluded communities in INN activities and the organizational supports that facilitated this work. Training in trauma informed principles and support from their supervisors were regarded essential to this work. (PsycInfo Database Record (c) 2024 APA, all rights reserved).