Families Systems & Health最新文献

Background: The primary care behavioral health (PCBH) model of integrated care has been successfully implemented and evaluated in diverse settings. The most common metrics of PCBH service outcomes include provider and patient satisfaction, patient symptom changes, provider productivity, and utilization rates. Missing is the broader perspective of the patient. To address this gap, we solicited qualitative feedback from PCBH patients about the benefits of PCBH services.

Method: Primary care patients (n = 135; M_age = 28.31, 52.6% White, 25.9% Hispanic/Latinx, 72.6% female) seen by six behavioral health interns at two primary care clinics over a 13-month period responded to an open-ended question about what they found most helpful about that day's session.

Results: Roughly half of patient responses about PCBH session benefits encompassed nonspecific aspects of therapy (49.6%), while nearly two-thirds (63.0%) mentioned specific therapeutic techniques delivered by clinicians in session as most helpful. In terms of nonspecific benefits of PCBH, many patients described benefitting from having space to talk, receiving validation, and instillation of hope. Specific aspects of treatment patients reported were helpful included skill building, resource sharing, goal setting/treatment planning, psychoeducation/guidance, and specific cognitive behavioral therapy techniques.

Conclusion: PCBH relies on both nonspecific relational components and special therapy techniques; both are useful to patients, and neither is frequently included in routine evaluations of the effectiveness of PCBH and other models of integrated care. Our findings support the benefits of including patient input when conducting outcome monitoring within the PCBH model. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Integrated primary care (IPC) is a proposed alternative concept to health care aimed at increasing access to care and promoting holistic health by combining treatment for biological, psychological, and social domains. To solidify the importance of IPC compared to traditional methods of health care delivery, outcome measurement is essential to bolster the claim that such a shift in patient care can improve holistic health. This systematic review sought to understand the literature accounting for both physical and mental health outcomes in IPC settings.

Method: Systematic searches within PsycINFO, Embase, and PubMed databases identified 2,729 studies that fit our predetermined criteria. Studies were included if they were within a setting that met our definition of IPC and tracked for both physical and mental health indicators.

Results: In total, 42 screened studies fit our criteria with approximately 28 distinct IPC models represented, each employing different team members to deliver interventions. Fifteen studies found improvements in both physical and mental health outcomes, while others only noted improvement in physical (n = 4) or mental health outcomes (n = 15) alone. Of the 15 studies that found improvement in both outcomes, depression and diabetes were the two that improved together most frequently.

Conclusions: This review found evidence of IPC settings improving both biological and psychological outcomes, with a considerable number demonstrating depressive symptom reduction in comparison to any other physical or mental health condition. Continuing efforts are still needed to measure concurrent physical and mental health conditions to make progress toward improved holistic health care systems. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: The Collaborative Care Model (CoCM) is an evidenced based approach to integrating behavioral health into primary care to improve depression outcomes. This quality improvement study explores the utility of implementing CoCM with fidelity at a federally qualified health center to improve depression remission outcomes based on Uniform Data System metrics. Uniform Data System defines depression remission as Patient Health Questionnaire-9 (PHQ-9) score below 5 at 12 months ± 60 days after initial positive depression screening.

Method: This study used the CoCM registry and medical record data to generate a sample of 251 patients between 2021 and 2022. PHQ-9 was employed to evaluate depression outcomes. Multiple regression and repeated measures t tests were used for hypothesis testing.

Results: The sample consisted of almost three-quarters of women and over half African American with a mean age of 40. CoCM was associated with a 12.60-point reduction in PHQ-9 scores between enrollment and follow-up at 12 months ± 60 days. A 1-point increase in fidelity was associated with a ∼4-point lower PHQ-9 score at posttest, and 1-point increase in treatment adherence was related to a 1-point decrease. Each 25 additional days of enrollment was associated with ∼1/2 point decrease.

Discussion: CoCM delivered with fidelity can support federally qualified health centers in improving depression remission rates at 12 months ± 60 days after initial positive depression screen. Fidelity, treatment adherence, length of enrollment, and time in care can positively impact outcomes. Further research is needed to evaluate additional study variables including psychopharmacology, psychiatric, and medical conditions in depression outcomes. (PsycInfo Database Record (c) 2025 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).

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: 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).

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: 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).

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).