Families Systems & Health最新文献

Introduction: This medical family therapy-informed study explores the experiences of young couples living with sickle cell disease (SCD) as they engage with the health care system. Recognizing the critical role of disease management and health care provider interactions, the research focuses on how these couples access care and manage illness together. Young adults with SCD are particularly vulnerable to poor disease management, reduced health-related quality of life, and frequent episodic pain crises. While prior research has examined individual challenges in disease management, limited attention has been given to the shared experiences of young adults with SCD and their partners in navigating the health care system. This study addresses that gap by capturing couples' experiences through a systemic lens.

Method: Between August 2021 and February 2022, 18 individuals (nine couples) were recruited from SCD support groups and virtual platforms across the United States. Individual interviews were conducted and analyzed using transcendental phenomenology to explore both individual and shared perspectives on health care navigation.

Results: Two overarching themes and five subthemes emerged, reflecting how partners' perspectives influence the couple's shared experience of navigating the health care system.

Discussion: By incorporating both individual and shared perspectives, this study contributes to the development of collaborative health care strategies for young adults with SCD. It highlights the importance of improving disease management and health care interactions to enhance the well-being of couples living with chronic illness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: As demand for integrated behavioral health services grows, understanding specialized training programs' contribution to workforce development becomes crucial. This study examines the career trajectories of graduates from a primary care psychology internship program in Puerto Rico to inform integrated care workforce strategies.

Method: We analyzed data from an annual program survey conducted between March and June 2024 with 62 graduates (71% response rate) from a primary care psychology internship program (2007-2023 cohorts). The survey captured professional credentials, employment characteristics, and service patterns. Hispanic women comprised 85.5% (n = 53) of participants, who represented consecutive cohorts over 15 years. We analyzed descriptive statistics for licensure status, employment settings, leadership roles, and the population served.

Results: Most graduates (72.6%, n = 45) obtained psychology licensure. While 32.3% (n = 20) completed postdoctoral training, most entered practice directly. Currently, 41.9% (n = 26) work in primary care settings, and 51.6% (n = 32) in integrated care environments. Half of the sample (50.0%, n = 31) hold leadership positions. Most (61.3%, n = 38) work with underserved populations, with 46.8% (n = 29) working with people who experience substance use disorders.

Discussion: The findings suggest that program graduates are engaged in roles within integrated care and underserved areas. However, structural barriers, including limited postdoctoral opportunities and regional economic factors, influence career development paths. This study highlights the need to systematically examine the career trajectories of integrated care internship graduates while considering the contextual factors that shape workforce development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Traumatic stress is an experience that contributes to a variety of medical and behavioral health concerns that present in the primary care context. The intersection of traumatic stress and health care is conceptualized as medical trauma (MT), where individuals receiving health care services are exposed to traumatic stress related to their health care experiences. Currently, MT may be an overlooked and underresearched phenomenon in health care, with significant implications for primary care teams. An understanding of ways to conceptualize, recognize, and address MT in the primary care context is an important step in creating trauma-informed primary care spaces.

Method: In this article, we provide a description of MT from the available literature and a method of conceptualizing the experience of traumatic stress related to health care experiences through the enduring somatic threat model.

Results: We identify potential risk factors and health care experiences typically associated with MT. Next, we identify strategies to recognize and address experiences of MT within the context of primary care through an exploration of assessment and intervention strategies. Finally, we provide a brief MT case example to highlight presentation, assessment, and intervention in the primary care context.

Discussion: MT has the potential to significantly affect patients' wellness and quality of life, with the associated biopsychosocial concerns presenting in primary care due to the context and goals of these settings. Future efforts should aim to enhance the integrated primary care team members' ability to conceptualize, assess, and address MT. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Living donor liver transplantation (LDLT) necessitates effective shared decision making (SDM) to ensure optimal outcomes. Traditional models focus on the physician-patient dyad; however, in Taiwan, family involvement is integral to the decision-making process. This study addresses the gap by proposing a tripartite model that incorporates physicians, patients, and family members to capture the cultural nuances influencing LDLT decisions.

Method: A retrospective chart review was conducted on 105 LDLT cases from the Transplant Surgery Department at National Cheng Kung University Hospital (2015-2022). The study employed thematic analysis to examine qualitative data extracted from medical records, including medical, psychiatric, and social evaluations, thereby identifying key themes in the decision-making process.

Results: Analysis revealed that LDLT decision making in Taiwan is predominantly family-centered. Three main themes emerged: the initiation of SDM by physicians and primary caregivers, a comprehensive risk assessment process integrating both clinical and psychosocial perspectives, and a final decision-making stage driven by collective family consensus. These findings highlight the complex interplay between medical factors and familial dynamics in donor selection and transplant outcomes.

Discussion: The study extends traditional binary decision-making models by highlighting the critical role of family involvement in LDLT. The tripartite framework not only reflects Taiwan's cultural context but also offers valuable insights for improving clinical practices and health care policies. Integrating family-centered approaches into SDM processes may enhance patient safety, promote ethical practices, and ultimately lead to better transplant outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Caregivers play an important role in their child's asthma management. This study examines the association of caregiver empowerment with family asthma management, and the patient-provider relationship for urban children and their caregivers.

Method: Data were collected between 2011 and 2014. Participants were racially diverse dyads of caregivers and children (N = 141) between 7 and 9 years old diagnosed with asthma, living in urban school districts.

Results: Results showed that caregiver empowerment was not associated with family asthma management; however, better family asthma management ratings were related to having a caregiver born in the United States who spoke English, and an annual family income above the poverty threshold. Caregiver empowerment was inversely associated with the patient-provider relationship, suggesting that caregiver increased comfort in navigating one's community and health services was associated with lower ratings of the patient-provider relationship.

Discussion: The findings highlight the importance of considering caregiver empowerment when understanding the patient-provider relationship for children diagnosed with asthma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Parents of adolescents with Type 1 diabetes typically experience distress and changes in their parent-child relationships, which can influence overall diabetes management. This study assesses the acceptability and preliminary outcomes of a four-session acceptance and commitment therapy (ACT) group intervention for parents of adolescents with Type 1 diabetes.

Method: In total, 10 parents of adolescents (aged 13-18 years old) completed a four-session ACT group intervention, with seven mothers and one father completing written feedback and quantitative measures. Written feedback from parents and facilitators was collected to assess the acceptability of the group and its strengths and shortcomings. Participants completed the following quantitative measures: the Parent Diabetes Distress Scale to assess diabetes-related distress including parent-child relationship distress and the Valued Living Questionnaire to assess adherence to personal values.

Results: Overall, written feedback indicated high acceptability of the group to both parents and facilitators, with most parents recommending it to peers. Postintervention, there were trends toward distress reduction in each domain of the Parent Diabetes Distress Scale, except personal distress. Higher scores in valued-based living were also indicated postintervention for most parents, suggesting parents were living more in line with their values.

Conclusions: This study demonstrated the acceptability of an ACT group as an intervention for parents of adolescents with Type 1 diabetes. The quantitative findings, supplemented by written feedback, indicated that ACT principles may help parents shift focus onto their values around parenting and caregiving and support the parent-child relationship. Potential adaptations are discussed to further develop the intervention and reduce participant dropout. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Integrating behavioral health into primary care through the Primary Care Behavioral Health model is crucial for addressing physical and mental health needs. Despite its importance, undergraduate medical education often lacks education and exposure to integrated behavioral health (IBH).

Method: This study aimed to address this gap by implementing an IBH curricular experience within a third-year family medicine clerkship and evaluating its impact on the students' knowledge and confidence in understanding IBH and managing mental health in primary care. The curriculum included a didactic lecture on IBH, a shadowing session with a behavioral health consultant and pre- and postsurveys to evaluate change in knowledge and attitudes. Data were collected from January 2023 through April 2024.

Results: Quantitative data were analyzed using the Wilcoxon signed-rank test, and qualitative responses were examined through thematic analysis. In total, 65 matched pre- and postsurveys revealed significant improvements in understanding the Primary Care Behavioral Health model (median increase from 3 to 4, p < .001) and in awareness of management strategies for conditions commonly seen within primary care, including anxiety and depression. Qualitative themes identified enhanced understanding of IBH, contributions to professional development, and constructive curricular feedback.

Discussion: These findings demonstrate that the IBH experience improved students' knowledge and awareness in managing mental health within primary care and emphasize the importance of incorporating IBH into undergraduate medical education curricula to better prepare future physicians for interprofessional, holistic care. Further efforts to standardize the curriculum and expand active learning opportunities may enhance outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Integrated primary care (IPC) can improve access to behavioral health (BH) care, reduce stigma, and facilitate early intervention. However, few studies have examined key informants' perceptions of IPC engagement.

Objective: We qualitatively identified convergent and divergent perspectives of care team members and caregivers on pediatric IPC-related engagement barriers, facilitators, and suggestions for improvements.

Method: Care team members (N = 48, 98.3% female, 72.9% non-Hispanic/Latine White) and caregivers (N = 10, 100% female, 10.0%. Asian, 30.0% Black/African American, 60.0% non-Hispanic/Latine White) completed semistructured interviews on IPC engagement in a large pediatric primary care network. Thematic analysis was used to iteratively identify patterns of meaning, as well as convergent and divergent themes across informant groups.

Results: Convergent barriers included stigma, prolonged wait times, limited BH knowledge, difficulty navigating services, and limited BH provider availability. Whereas care team members identified more family-related barriers (e.g., beliefs, experiences), caregivers identified divergent barriers such as limited childcare. Perceived engagement facilitators converged across groups and mostly pertained to systems-related factors such as the colocation of services. Converging recommendations included additional behavioral clinicians and support staff, provision of psychoeducational resources, and expanding IPC services.

Conclusion: Although key informant groups similarly perceived many IPC benefits, including increased BH access, there are continued patient/family barriers to IPC engagement, with divergence in care team members' versus caregivers' views about the nature of these barriers. Findings suggest a need for systems-level changes to address these barriers and highlight the importance of including the unique perspectives of care team members and caregivers in future research examining IPC effectiveness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Despite strong evidence supporting integrated behavioral health (IBH), implementing the Primary Care Behavioral Health (PCBH) model remains challenging, particularly in safety-net settings like Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs). This study examines facilitators and barriers to PCBH adoption during a New Jersey-based demonstration project funded by The Nicholson Foundation (2013-2019).

Method: We conducted semistructured interviews with 18 behavioral health and primary care staff from 10 FQHCs/CHCs between June and September 2022. A thematic analysis using both inductive and deductive approaches guided our interpretation.

Results: Five key facilitators emerged: (a) external system support, (b) leadership champions driving workflow redesign, (c) positive provider attitudes toward change, (d) comprehensive PCBH training for all staff, and (e) visibility of behavioral health consultants. Major challenges included: (a) lack of resources and standardized training materials, (b) difficulty recruiting and retaining behavioral health professionals, and (c) complex billing processes that delay revenue generation.

Discussion: While PCBH implementation is complex, critical enablers can support success in FQHCs/CHCs. As PCBH gains traction in healthcare systems, insights from this study can inform future efforts, particularly in underserved settings aiming to integrate behavioral health into primary care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this article, the authors provide a brief overview of our collective blind spot as a field and the failure to account for all of women's health across the lifespan. They align their recommendations based on two seminal reports focused on critiquing health care's narrow view on women's health and a call for a broader life course-oriented perspective. The Commonwealth Fund and Manatt's Transforming Primary Health Care for Women, Parts 1 and 2, serve as their guide. Written by Zephyrin et al. (2020a, 2020b), Part 1 is titled A Framework for Addressing Gaps and Barriers and Part 2 is titled The Path Forward. Aligned with the consensus of these two reports and other literature, they provide general guidance to open up their aperture for a broader approach to women's health and mental health issues across the lifespan. More specifically, as advocates for integrated care, they make an argument for sex-specific, sex-aware, and gender-sensitive care with a call to integrate a life course perspective into our educational work, workforce development strategies, and clinical thinking. They also make this call for awareness and action at a time in our national life where matters of equity and issues related to women's health are being challenged, eliminated, or erased. As scientist practitioners, policy influencers, fragmentation fighters, and equity advocates, they are called to remain equity-focused, context-sensitive, and innovate their ways into ensuring whole-person care regardless of social and political climate. (PsycInfo Database Record (c) 2025 APA, all rights reserved).