Families Systems & Health最新文献

From the perspective of a mother with young children, this free verse poem describes one experience of miscarriage, including physical and psychological trauma as well as confusion and shock. Reflecting upon the mother's need for care in the context of her own caregiving responsibilities, the poem weaves her words with the words of her health care providers. It also engages with the language commonly used to describe or label fetuses, living, or dead, and how that language can shape the psychological experience of pregnancy and pregnancy loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: The current study examines the psychometric characteristics of the Family Climate Questionnaire (FCQ), which was intended to measure the degree of autonomy-support among family members for a respondent with health concerns.

Method: The sample included military veterans (N = 350), a portion of whom had congestive heart failure (N = 86) or diabetes (N = 77), and a portion who were referred from primary care for behavioral health concerns (N = 187). Overall, 92.6% of the participants were male, and 56.7% were Black or African American and 40.6% were Caucasian.

Results: The findings highly supported the factor structure, internal consistency, and construct validity of the Autonomy Support subscale. In addition, there was high support for factorial invariance across subsamples of veterans with chronic medical problems compared to those referred from primary care. The findings for an additional subscale developed for this study, Coercion, were less supportive, with insufficient convergence in factor structure and relatively poorer internal consistency.

Discussion: The FCQ Autonomy Support measure appears to have potential as a useful measure of a family environment that supports autonomy for health among individuals with both medical and mental health conditions, and it is a flexible measure that can be used with a range of family member types. The FCQ Coercion measure received less consistent empirical support and will require additional development and testing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: A growing number of children have developmental delay (DD) or intellectual and developmental disabilities (IDD), and early intervention (EI) can improve their developmental trajectory. However, access to EI is fraught with disparities. This article describes the development of Parent Navigator (PN) program that placed three parents with lived experience in a pediatric medical home to serve as community health workers to provide support to families with a child with DD or IDD to access EI and other needed resources.

Method: We used a mixed-methods approach to program evaluation that included (a) documenting the number of referrals to the EI programs made by the PNs; (b) documenting referral outcomes; (c) conducting a physician satisfaction survey; and (d) interviewing the PNs to reflect on their experiences assisting families.

Results: From July 2018 to September 2020, our PNs facilitated 623 referrals to EI due to significant developmental concerns found during a pediatric visit. Rates of successful connection to EI were 71%. Survey results indicated that pediatricians felt the PNs were a valuable part of the healthcare team and helped reduce their own job stress. The PNs provided multiple examples of their methods of addressing barriers to EI access by relating to families with their own lived experience and by "meeting families where they are at."

Discussion: The PN program might be a successful approach to addressing disparities in EI access for families in need by using an innovative method of employing individuals with lived experience in the pediatric primary care setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Burnout and moral injury are among the most pressing issues facing healthcare and public safety today. In 2021, Congress provided $120 million through the American Rescue Plan Act for 44 Health Resources and Services Administration grants to implement evidence-informed strategies to address burnout and improve mental health among the health workforce. This article examines facilitators and barriers to implementation and reported impact of grantees' interventions.

Method: Key informant interviews (n = 39) and surveys (n = 36) with grantees were conducted between May and August 2023 and qualitatively analyzed using inductive and deductive approaches.

Results: This study found grantees were adapting their program modality, timing, and content to meet the needs of their workforce. Many grantees were increasingly focused on training/engaging leadership, establishing structures for worker engagement, and allowing worker voice and priorities to guide operational changes. Though many grantees could not yet report program impact, those who could provide early data documented decreases in staff turnover, burnout, and moral distress. A common challenge was ongoing resource constraints, including staff and leadership turnover.

Discussion: Findings suggest health and public safety organizations continued to struggle with staffing post-COVID, increasing the challenges of implementing their programs to improve burnout and well-being. However, just 18 months into their activities, grantees reported their efforts were leading to changes in organizations, culture, and the experiences of individuals. Key lessons include the importance of engaging workers, building trust, and developing intentional communication, evaluation, and feedback strategies to advance organizational-level efforts to improve worker and learner well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: The role of structural inequalities in the long-term benefits of early childhood programs has not been assessed. Previous findings in the Chicago Longitudinal Study, an early childhood cohort investigation with low-income families, indicate that Child-Parent Center (CPC) participation beginning in preschool was associated with a variety of positive health behaviors. In this secondary analysis, we assessed if structural inequalities (neighborhood poverty, history of discrimination) modified the magnitude of associations between CPC and health and education outcomes (cardiovascular health, body mass index, educational attainment) 30 years later.

Method: The Chicago Longitudinal Study cohort of 1,539 children (93% Black, 7% Hispanic) grew up in high-poverty neighborhoods and attended CPCs or the usual district programs. At midlife (ages 32-37, M = 34.9 years, 2012-2017), 1,073 participants completed telephone interviews on structural inequalities, health, and education. Regression analyses were conducted with inverse propensity score weighting.

Results: After accounting for structural inequality, CPC participation was significantly associated with outcomes. Mean differences on Framingham risk scores, for example, were significant for CPC preschool at ages 3 and 4 (coefficient = -2.15, p = .004, standardized difference = -0.20). Neighborhood poverty moderated (reduced) the association between CPC and cardiovascular health. Neighborhood poverty and perceived discrimination had independent contributions with outcomes.

Discussion: Findings show that structural inequalities, especially poverty, directly influence and/or moderate long-term effects of CPC participation. Increasing neighborhood resources and socioeconomic status may help comprehensive programs sustain their impacts. Early childhood and sociostructural influences reflect the increasing importance of community contexts to health promotion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Hematopoietic stem cell transplantation (HCT) greatly impacts the social, emotional, and physical well-being of the patient and their family. The transplant process imposes significant lifestyle restrictions that result in patient and family isolation, which has been further amplified during the COVID-19 pandemic era. While hospital systems recognize the importance of family engagement, the pandemic underscored the need to translate this philosophy more fully into practice.

Method: We discuss the importance of engaging the family throughout the transplant experience to improve patient outcomes and overall family health and well-being.

Results: We present the HCT family resilience model, a synthesis of multiple family and nursing theories and HCT concepts to better guide HCT family care. The theories and frameworks that inform our model address family functioning and growth in times of stress, coping strategies that promote positive family outcomes and resilience, and multicultural factors that may affect family experiences. A key contribution of our model is highlighting the role of family engagement in improving HCT family outcomes.

Discussion: Application of a family systems lens highlights the essential role families play in the care of HCT patients and can foster family well-being. We offer the HCT family resilience conceptual model as a guide for practice and policy improvements to optimize care delivery for this patient and family population, as well as direction for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Minimal research on integrated primary care (IPC) or integrated behavioral health (IBH) has examined clinics in rural communities. The relationships between provider burnout, job satisfaction, and IBH/IPC practices remain understudied, particularly in rural settings.

Method: We employed an online survey of 147 medical and behavioral health care providers in primary care settings throughout Montana. Respondents self-identified as predominantly White/European American (89.4%) and female (76.7%). We tested whether degree of adherence to IBH/IPC practices concurrently predicted providers' reports of emotional exhaustion (EE), a dimension of burnout, and job satisfaction. Data were collected during the COVID-19 pandemic, in 2020.

Results: In multiple linear regression analyses, providers' reports of IBH/IPC practices significantly predicted EE (B = -0.036, p < .01) and job satisfaction (B = 0.123, p < .05), suggesting that higher levels of integration were linked to less EE and greater job satisfaction.

Discussion: Our findings contribute to the evidence base regarding the potential usefulness of IBH/IPC models. Specifically, because existing research links provider burnout and low job satisfaction with provider retention difficulties and diminished health, poor patient satisfaction and outcomes, and cost inefficiencies, our findings have potential to inform policy-level discussions regarding the use of IBH/IPC models in rural states like Montana. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Exacerbated by a global pandemic, healthcare organizations have become increasingly isolated spaces and healthcare professionals suffer from threats to psychological safety, occupational burnout, and attrition. Restorative justice (RJ) is a human- and community-centered framework used to foster connections and promote healing among groups and has recently been implemented in healthcare settings. It may serve as a novel approach to promote the well-being of healthcare professionals.

Method: In this article, we describe the conceptual underpinnings of RJ, briefly reviewing the existing literature supporting restorative approaches and exploring its early applications within healthcare. We provide a case example of our own efforts to implement an RJ program to support healthcare professionals.

Results: Using our own program as reference, we describe how we have monitored engagement to guide program improvement and utilized participant feedback to understand impact.

Discussion: RJ offers unique potential for promoting a safe workplace for healthcare professionals and advancing inclusion in medicine. With regularly implemented restorative practices, we hope to effect lasting change within our institution (i.e., improved retention), which should be explored with future studies. In order to improve the health of diverse communities we serve, we must also prioritize the well-being of our own healthcare communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: There is a causal relationship between parental incarceration (PI) and childhood food insecurity (FI). This is a pressing policy issue given that public assistance designed to curb hunger (i.e., Supplemental Nutrition Assistance Program) is often revoked due to incarceration which, on top of the removal of a household income source, can significantly alter children's food access. Yet questions remain regarding the prevalence of FI among youth with incarcerated parents, as well as the interplay of parent-child coresidence, race/ethnicity, and geographic region.

Method: Data come from the 2019 Minnesota Student Survey, a statewide sample of adolescents (N = 112,554). Youth self-reported experiences of PI, parent-child coresidence at the time of incarceration, past-month FI, and race/ethnicity. Based on school districts, regions were classified as city, suburb, town, or rural.

Results: Youth with currently and formerly incarcerated parents reported significantly higher rates of FI (18.11% and 10.41%, respectively) compared to peers who never experienced PI (2.84%; ORs = 7.56 and 3.97, respectively). Among youth with currently incarcerated parents, rates of FI were highest among those who lived with the parent at the time of incarceration (21.79%) compared to those who did not (13.98%). Youth of color and city youth were more likely to experience FI in contexts of PI.

Conclusions: Findings extend the link between PI and child FI. The evidence is concerning given FI's heightened risk for chronic health conditions, which may be compounded by trauma and systemic injustice. This work has implications for policies that expand, rather than reduce, food access and financial assistance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In this poem, the author is a hospitalized patient who had been struck by a car while she was walking on a moonless night. In the emergency room, scalpels, scissors, and stars aligned, assembled by her frightened brain. Name your fears and you banish them. The author never knew the stars had names, nor that sharp edges could soften, could suture as deftly as sever, could stitch a path out of her darkness, and light her from broken to whole. (PsycInfo Database Record (c) 2024 APA, all rights reserved).