Families Systems & Health最新文献

Introduction: Little is known about the care provided following positive depression screens in obstetrics and gynecology (Ob/Gyn) patients.

Method: This study evaluated documented care plans and outcomes for 445 Ob/Gyn patients with positive depression screens between January 2018 and December 2020. Logistic regression models were estimated to identify predictors of changes in documented care plans and to test if a documented plan was associated with a reduction in depression severity in 6 months.

Results: The sample consisted of 445 patients who were on average 35.5 (SD = 12.8) years; 206 (46.3%) were White and 178 (40.0%) were Black. A total of 64 (14.4%) had a depression care plan documenting antidepressant initiation or change and/or psychotherapy referral. Relative to those aged 18-29, patients 40 or older had approximately 60% lower odds of a documented care plan change (OR = 0.394; p < .05). Relative to those seen by nurses, patients seen by physicians had approximately 70% lower odds of having treatment change (OR = 0.282; p < .05). Patients with a depression care plan documented had approximately 2.7 times higher odds of achieving 50% or more reduction in their Patient Health Questionnaire-9 depression severity score than those without a documented plan (OR = 2.685; p = .009).

Discussion: While most patients did not experience an initiation or change in their depression care plan on the same day as their positive screen, those patients with a plan documented showed significantly more improvement than those who did not. Standardized recommendations may improve depression outcomes among patients with positive depression screens. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Urban, low-income, and Black and Latino children with asthma experience higher morbidity and poorer outcomes compared to their suburban, higher-income, and non-Latino White counterparts. This risk is further compounded by higher rates of co-occurring overweight or obesity. Physical activity contributes to both asthma and overweight/obesity status, however, little is known about factors that may promote/limit physical activity among youth from low-income, urban, and racial/ethnic backgrounds. This study evaluates associations between asthma management behaviors and physical activity among a sample of racially/ethnically diverse youth with asthma of both healthy weight and overweight/obesity status.

Method: 147 children with asthma (M_age = 8.3; 50% overweight/obese status, 58% Hispanic/Latino, and 26% Black) and their families completed the Family Asthma Management System Scale (FAMSS; McQuaid et al., 2005) between 2013 and 2015. Physical activity was measured with waist-worn accelerometers. Differences in FAMSS scores by physical activity levels and associations between FAMSS scores and physical activity for the total sample and by race/ethnicity and weight status were evaluated.

Results: Children who met recommended physical activity guidelines had higher FAMSS "medication adherence", t(89) = -2.04, p < .05, and "collaboration with health care provider", t(89) = -2.09, p < .05. More optimal "environmental control" related to lower levels of physical activity (β = -.21, p < .05) while more optimal "medication adherence" was associated with higher levels of physical activity (β = .21, p < .05). Differences in these associations were identified by race/ethnicity, though not weight status.

Conclusions: Asthma management behaviors were associated with physical activity, with notable differences by race/ethnicity. Tailored interventions simultaneously addressing multiple health behaviors may be warranted. (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: Discussions comparing the components and virtues of models of integrated behavioral health (IBH), that is, collaborative care management and primary care behavioral health, have been ongoing. In this conceptual article, we recommend shifting the focus to a broader set of components we have found essential to serve the needs of our patients, and hopefully the broader aims of dissemination and implementation of IBH.

Method: We detail our 20-year experience including the personnel, program components, challenges, successes, and plans for the future that will meet our patients' behavioral health needs and serve primary care.

Results: We compare our "IBH Plus" approach using the central tenets of primary care known as the "six Cs" (6Cs) to two dominant models, illustrating differences and similarities among them. The "6Cs" are first contact/accessibility, continuity, comprehensiveness, coordination, context-based, and accountability. We detail how each of these "6Cs" guides the structure and functioning of IBH Plus in the team-based patient-centered medical home setting.

Discussion: We believe IBH Plus more clearly relates to and supports the rest of the primary care transformation movement while integrating components of the most popular models of IBH and may support greater implementation of IBH. (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: Studies in the United States have shown associations between family/shared meal frequency and child health and well-being. Less is known about family/shared meal characteristics (e.g., frequency, meal type, meal activities) in adults and international samples and whether there are protective associations between family/shared meal frequency and emotional well-being. Also unknown, is whether family meals provide protective associations for other family members in the household.

Method: In a 2022 cross-sectional study, an online survey was administered in the United States, Italy, and Germany. One adult respondent (49.5% female; Mage = 45.6) from each household (n = 1,983) reported on family/shared meals and well-being. A second family member (e.g., partner, child) responded in a subset of households (n = 1,915). Descriptive statistics by country, Spearman correlations between meal frequency and well-being, and Kruskal-Wallis comparisons of mood indicators across countries were run.

Results: The majority of adults across countries engaged in six or more family/shared meals per week, with more meals on weekends. Breakfast, lunch, and dinner family/shared meals were more common on weekends, and European countries reported engaging in a higher prevalence of all meal types. Higher frequency of family/shared meals was significantly correlated with fewer depressive symptoms, more connectedness, and higher levels of happiness in adults across countries and in a second household member.

Discussion: Family/shared meals were beneficial across an international sample and may provide protective spillover effects for multiple household members. Clinicians and researchers who work with families may want to consider assessing for and intervening on family meal frequency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

It is with a great deal of gratitude that Kirk D. Strosahl and Patricia J. Robinson accept the Don Bloch Award. Thirty-five years ago, when they embarked on their mission to improve healthcare, they never imagined that this recognition would come their way. Now that it has, they want to take about 1,000 words to share their views on health and their understanding of important barriers to improving healthcare services, and offer four practical strategies to consider as we do your part. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Screening to promote social-emotional well-being in toddlers has positive effects on long-term health and functioning. Communication about social-emotional well-being can be challenging for primary care clinicians for various reasons including lack of time, training and expertise, resource constraints, and cognitive burden. Therefore, we explored clinicians' perspectives on identifying and communicating with caregivers about social-emotional risk in toddlers.

Method: In 2021, semistructured interviews were conducted with pediatric clinicians (N = 20) practicing in Federally Qualified Health Centers in a single metropolitan area. Most participants identified as female (n = 15; 75%), white non-Hispanic/Latino (n = 14; 70%), and were Doctors of Medicine or Osteopathic Medicine (n = 14; 70%). Thematic analysis was conducted on audio-recorded interview transcripts.

Results: Clinicians used various approaches to identify social-emotional concerns which were sometimes difficult to distinguish from other developmental concerns. The clinician-caregiver relationship guided identification and communication practices and cut-across themes. Themes include: starting with caregivers' concerns, communicating concerns with data and sensitivity, navigating labels, culture, and stigma, and limiting communication based on family capacity and interest.

Discussion: Prioritizing the clinician-caregiver relationship is consistent with best practice and family-centered care. Yet, the dearth of standardized decision support may undermine clinician confidence and impede timely conversations about social-emotional concerns. An evidence-based approach with developmentally based culturally informed quantitative tools and standardized decision supports could help ensure equitable management and decision making about young children's social and emotional well-being and development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

E Pluribus Unum, out of many, one. This is intended to signify unification and inclusion for the people of the United States. I, a cis-gendered, gay man, have come to appreciate the meaning in a different way. The following poem is a critical reflection of how I came to understand me, as a member of an interconnected society. This piece reflects my lived experiences as an out of the mainstream masculine male, despite my white privilege. In the poem, I include a powerful derogatory word often used by others to destructively affect queer people like me. I have altered the appearance of the word to lessen any additional hurt it might produce. I hope this poem encourages a recognizing, understanding, and respecting of the uniqueness and differences among us. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Despite their ubiquity, stepfamilies generally hold a stigmatized status. The scientific community at large has not been immune to the influence of stepfamily stigmatization. Misusing the term "stepchild" in science is unnecessary on several fronts. "Stepchild" is often intended to denote neglect, oversight, or mistreatment. Scholars should consider using more direct and precise language, especially considering that scientific writing benefits from clarity, parsimony, and precision. In any case, it's time to stop using "stepchild" as a pejorative term. (PsycInfo Database Record (c) 2024 APA, all rights reserved).