Families Systems & Health最新文献

The perceived disconnect between research and clinic contexts may thus result in frontline clinicians and administrators questioning the approachability and applicability of science to their day-to-day work with patients and families in integrated care. Science grinds along so painstakingly slowly that even within the research community, some thought leaders have called for a moratorium on RCTs in favor of approaches that will yield more immediate public health impact (Kessler & Glasgow, 2011). The aim of this editorial is to describe a both/and research approach called "hybrid studies" and to discuss achievable strategies for doing this kind of work on the front lines. Sure, you can get a multimillion-dollar grant and do a formal research study, but real people on the frontlines can do this type of work too! Hybrid studies have the capacity to answer the two essential questions in healthcare science concurrently and advance the progress of science translation (usable science). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The author expresses themselves with a poem about what it was like going to the dentist as a child, when their parent was the dentist. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction: Children from disadvantaged populations receive referrals, diagnoses, and services for autism spectrum disorder (ASD) late or not at all. We describe barriers to referral for and receipt of evaluation for ASD among young children from disadvantaged families and activities by autism family navigators (AFNs) to address these barriers.

Method: Trained AFNs offered navigation to families of children aged 16-30 months with positive ASD screens from community health center clinics in 2015-2018. AFNs interviewed families to identify perceived barriers to care and documented system barriers and navigation activities. We coded, categorized, and described barriers and AFN activities. Case studies illustrate barriers and navigation activities.

Results: Of 22 participating mothers, 82% were Latinx and 64% were native Spanish-speaking; 71% had household incomes <$30,000/year and 57% had no high school diploma. Half of the families experienced five or more barriers to ASD evaluation, most commonly pragmatic barriers. Information barriers/needs were 5 times more common among Spanish-speaking than English-speaking mothers. One-fifth of families identified negative experiences or expectations of care. System barriers included incomplete screening tests, inadequate referrals, and waiting lists. AFNs implemented navigation activities, most frequently categorized as care coordination (95%), education (68%), social/emotional support (36%), family advocacy (27%), and self-advocacy coaching (23%). AFNs also trained providers and staff to improve screening and referral implementation.

Discussion: In this largely Latinx sample, families experienced numerous barriers to obtaining ASD evaluations for their screen-positive children, likely reflecting the complexity of negotiating both healthcare and educational systems. Trained AFNs can assist parents to overcome barriers to timely diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comments on the original article by Hightshoe, et al., (see record 2024-10422-003) regarding barriers to referral and evaluation and corresponding navigation services for toddlers screening positive for autism spectrum disorder. This article described how a largely Latinx sample experienced unique barriers and how the (autism family navigators) AFNs were able to respond directly to the needs of families by remaining flexible. It appears that AFNs were engaging in cultural humility by considering each family's culture and social factors, like when they advocated for adequate interpretation services for collaborative planning meetings. The current author would be interested to know more about the cultural training and skills used to facilitate engagement and build rapport. The case studies illustrate the necessity of having good working relationships in which families can indicate potential barriers, such as not being able to confirm an appointment with a facility or potential bias due to lack of insurance or immigration status, that need to be discussed to create an effective plan of intervention. These disclosures reveal areas of vulnerability that were only able to be discussed through the creation of safe space. Therefore, it would be essential to know how these working relationships were built and the geopolitical protections or risks (e.g., immigration healthcare policies that may impact mixed-status families) that could contribute to AFN and patient engagements. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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).

Introduction: The primary care behavioral health (PCBH) model of integration has been widely implemented across a number of noteworthy health care systems. However, lack of consistent measurement and reporting of the degree to which the PCBH model has been implemented as developers intended has resulted in two disadvantages in the field. First, clinical quality improvement efforts are hampered by lack of clear guidance on what elements are central to PCBH implementation. Second, the dearth of empirical studies reporting model fidelity impedes cross-study comparisons and limits the rigor of PCBH-focused research. Efforts to expand measurement of PCBH model fidelity would benefit from identification of accessible, unbiased metrics that could complement existing self-report measures.

Method: In this article, we describe how we partnered with our clinical informatics team to incorporate PCBH fidelity metrics into the electronic medical record (EMR), allowing for monthly extraction and review of these data.

Results: Next, we describe how we have used monthly fidelity monitoring to inform clinical quality improvement efforts in the context of a developing integrated care program and provide an example of how PCBH fidelity data might be reported in a research article.

Discussion: Leveraging EMR data to support PCBH fidelity measurement has the potential to strengthen clinical quality improvement efforts and enable more consistent measurement and reporting of PCBH fidelity data in research. Future efforts should aim to parse out the relative contribution of different variables to the success of PCBH integration and evaluate the effectiveness of implementation strategies at supporting high fidelity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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 author expresses themselves with poetry about their medical education, experiences, and rotations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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).

Comments on the original article by French, et al. (see record 2023-74550-001) regarding adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care. This article provided a potential treatment pathway for certain patients. However, it has left the question: What options are available for patients who decline to participate in this collaborative care approach? It is important to emphasize that we do not want to deny them access to treatment for their (opioid use disorder) OUD. Are there alternative interventions with a lower intensity that may still hold value for patients who opt out of this particular approach? In future research, the current authors would like to see expanded treatment pathways that match patients at all levels of engagement. By offering a more diverse range of options, we can better meet the needs of a broader spectrum of patients, ultimately improving treatment outcomes for individuals with OUD and psychiatric symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).