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Families, Systems, & Health - Vol 35, Iss 1

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Families, Systems, & Health Acting as a vehicle to express the voices of change in the healthcare system with a focus on family, the biopsychosocial model, and collaboration; and to participate in making those changes more humane for patients, families, and healthcare professionals. Families, Systems, & Health is a peer-reviewed, multidisciplinary journal that publishes clinical research, training, and theoretical contributions in the areas of families and health, with particular focus on collaborative family healthcare.
Copyright 2017 American Psychological Association
  • Collaborative family health care, civil rights, and social determinants of health.
    Social and economic disadvantage and civil rights infringement, worsens overall health (Adler, Glymour, & Fielding, 2016; McGowan, Lee, Meneses, Perkins, & Youdelman, 2016; Teitelbaum, 2005). While addressing these challenges is not new, there is reason to believe that the administration of Donald Trump and a republican majority in congress will exacerbate these challenges and their effects. How can collaborative family health care (CFHC) practitioners and our field help? The editors pondered this question and also asked a selection of leaders in the field. The editors will first share their ideas about the potential of CFHC to make a difference in daily interactions with patients. Next, they will identify key areas of risk and vulnerability. Finally, using the contributions of respected colleagues, they will propose a partial agenda for CFHC clinicians and the field. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Applying a family systems lens to proxy decision making in clinical practice and research.
    When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science’s evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland’s Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • A philosophy for behavioral health integration in primary care.
    In response to a call for a philosophy that transcends the professional boundaries that threaten behavioral health integration in primary care, this essay explores the thesis that such a philosophy exists in medicine’s core purpose. Drawing on the work of Eric Cassell, a philosophy may be determined that melds the values, themes, and constructs of individual models for behavioral health integration in primary care toward a single, overriding purpose. Effecting such integration challenges current trends in medicine by refocusing medicine on its ethical core. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • How to write a health policy brief.
    Although many health care professionals are interested in health policy, relatively few have training in how to utilize their clinical experience and scientific knowledge to impact policy. Developing a policy brief is one approach that health professionals may use to draw attention to important evidence that relates to policy. This article offers guidance on how to write a policy brief by outlining 4 steps: (a) define the problem, (b) state the policy, (c) make your case, and (d) discuss the impact. The steps and tips offer a starting point for health care professionals interested in health policy and translating research or clinical experience to impact policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Research or intervention or both? Women’s changes after participation in a longitudinal study about intimate partner violence.
    Introduction: The tensions between risk and benefit in research are particularly evident in studies about intimate partner violence. Recalling and relating traumatic experiences may deepen posttraumatic stress or relieve the burden of terrible events long borne in secret. In this article, we examine the effects of study participation in a longitudinal investigation of intimate partner violence using both qualitative and quantitative data. Method: Researchers enrolled 200 women in moderately violent intimate relationships and asked them to report about their relationships every day for 12 weeks. Daily, participants telephoned an automated survey and responded to 34 survey questions. They also completed baseline and end-of-study surveys and maintained telephone contact with 1 researcher weekly. Forty-2 participants completed qualitative end-of-study interviews to describe their relationships and their experiences in the study. Results: Over 12 weeks, participants showed improvements in coping strategies, hope, and mental health, and increased readiness to leave their partners. In qualitative interviews, women reported gaining insight, feeling better emotionally, making behavioral changes, finding comfort in daily surveys, learning resources for help, and taking action to improve their lives. Fourteen percent left their partners by end-of-study; 35% sought counseling. Discussion: The study’s daily survey invited the participant to become more reflective about her relationship, which changed how she saw herself and her situation. The study methods also included weekly conversations with a compassionate researcher, allowing women to tell their stories. These 2 strategies may be incorporated into brief interventions for intimate partner violence in primary care settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Implementation of behavioral health interventions in real world scenarios: Managing complex change.
    Introduction: A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Method: Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. Results: The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. Discussion: This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Collaborative mental health care for pediatric behavior disorders in primary care: Does it reduce mental health care costs?
    Overview: One recently completed randomized controlled trial (RCT) demonstrated the effectiveness of a doctor–office collaborative care (DOCC), relative to enhanced usual care (EUC), for pediatric behavior problems and attention-deficit/hyperactivity disorder. In this study, we sought to extend the literature by incorporating a cost-analysis component at the conclusion of the aforementioned trial. To our knowledge, it was the first study to examine whether the DOCC model leads to lower costs of mental health services for children. Method: Financial records from the RCT provided cost information about all the 321 child study participants in the 6-month intervention period, and claims data from insurance plans provided cost information about community mental health services for 57 children, whose parents consented to release their claims data, in both pre- and postintervention periods. Both descriptive and multivariate analyses were performed. Results: The DOCC group had higher intervention costs, but the cost per patient treated in the DOCC group was lower than the EUC group during the 6-month intervention period. In terms of costs of community mental health services, although the 2 groups had similar costs in the 6 months before the RCT intervention, the DOCC group had significantly lower costs during the 6-month intervention period and 6 or 12 months after the intervention, but not in the 18 or 24 months after the intervention. Discussion: The DOCC model has the potential for cost savings during the intervention period and the follow-up periods immediately after the intervention while improving clinical effectiveness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Couples coping with cardiovascular disease: A systematic review.
    Introduction: Cardiovascular disease (CVD) is the leading cause of death for both men and women. Its potential ramifications on all aspects of life, for patients and partners, are just beginning to be understood. Although research has focused on the individual who has received the diagnosis, relatively little is known about how couples manage CVD. This article presents a systematic review of literature that focuses on how couples cope with one partner’s CVD diagnosis. A systematic review is warranted to orient practitioners, policy makers, and researchers to the state of existing knowledge and its gaps and to identify what still needs to be done. Method: Data were extracted from 25 peer-reviewed articles that met our inclusion criteria. Content examined included theory integration, coping constructs and instruments, samples, analyses, and findings. Results: Most articles successfully integrated theory in the studies’ respective conceptualizations and designs. Most used valid and reliable instruments to measure coping. Principal limitations included problematic sampling strategies and analysis techniques, thereby limiting external validity. Discussion: Principal implications of this review’s findings relate to our fields’ need to provide more care focused on dyads (vs. individual patients), adopt an integrated model in health care, and conduct systemic, longitudinal research to gain a better grasp on how coping changes over time. Doing so will serve to better equip providers in the support of patients and partners living with CVD. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • In search of a new identity: An institutional consultation at a sub-acute inpatient unit in a general hospital.
    Introduction: Hospitals are constantly morphing under the pressure of ever-evolving health care technologies, procedures, and reimbursement practices. In turn, healthy institutional identities and personnel allegiance contribute to counterbalance the potentially destabilizing effects of those changes. An institutional consultation was requested at a general hospital recently created sub-acute unit (SAU) due to malaise and dissatisfaction in the nursing staff. Method: The consultation included a total of 3 group meetings with the SAU nursing staff as well as observation of procedures and milieu in this and adjacent units. In the course of this process, a structure of demeaning narratives about the unit and the nursing personnel’s own role in the context of changes within the hospital was detected, destabilized, and transformed, and the kernel of a new identity for the unit was developed, using a shift in a routine evaluation procedure for patient’s progress as a fulcrum for generating change. Results: Follow-up evaluation indicated a qualitative improvement in the unit milieu and nurses’ job satisfaction, resonating with an enhancement in the staff’s identification with the unit’s reformulated mission as part of a constructive continuum of care. This improvement was also acknowledged and rewarded by hospital administration. Discussion: While maintaining a stance of positive connotation, assumptions of good intent, and a systemic view of the organization, demeaning collective narratives can be transformed through timely interventions that restitute pride and meaningfulness to the personnel and improve the unit’s quality of care. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Reducing barriers to mental health care for student-athletes: An integrated care model.
    Research suggests that National Collegiate Athletic Association (NCAA) Division I student-athletes have higher levels of stress and other behavioral health issues, including substance use, than nonathletes. For several reasons, student-athletes may be less likely to admit to behavioral health issues and seek mental health care. Integrated care is a model of care that integrates behavioral health into a medical practice. This article explores the newly released NCAA Best Mental Health Practice guidelines and the application of integrated care to a Division I athletic training room setting using the three-worldview framework for successful integration, incorporating clinical outcomes, operational reliability, and financial stability. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Considering a family systems approach to surrogate decision-making.
    Comments on the original article by Rolland, Emanuel, and Torke (see record 2017-05300-001) regarding a family systems approach to medical decision-making by proxy. The authors expanded the focus of clinicians beyond the patient to a more comprehensive understanding of the patient’s family. They assert that a better understanding of family dynamics may help clinicians to engage with families more effectively when decision-making is needed for seriously ill loved ones, and may lessen the emotional challenges families and clinicians face when decisions are needed. However, the current authors point out surrogate decision-making can be an onerous responsibility. Rolland, Emanuel, and Torke identify the growing body of research on the high prevalence of posttraumatic stress disorder, anxiety, and depression among those who have been in the position of making medical decisions for loved ones. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The relationship between trauma and research: A response to Burge et al. (2017).
    Comments on an article by Burge et al. (see record 2017-00531-001). The authors provide an important contribution to the field of intimate partner violence (IPV) research. In their article, Burge et al. contribute to IPV research by publishing a study that seeks to learn, from the voice of the participant (victim), what their experiences are in a study that required rigorous and frequent research-participant interactions. As a result, we see a new perspective emerge: might participation in research actually help victims? (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • “Doctor, are you listening?” Communication about children’s mental health and psychosocial concerns.
    Effective communication is critical, including in the pediatric primary care setting. Pediatric primary care providers (PPCPs) are in a unique position to address psychosocial and mental health concerns during office visits, and effective communication skills play a crucial role in providing an opportunity for parents and patients to disclose and discuss such concerns. In this article, the authors encourage two relatively simple strategies that have shown potential for enhancing effective communication in pediatric primary care regarding mental health and psychosocial issues: (a) ensure that pediatric residents and practicing providers have access to brief, targeted communications training and (b) strongly promote the use of screening tools both to encourage discussion and to assist in identifying children who may benefit from further assessment and/or treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Plan: Pray.
    Presents a poem the author wrote about patient she encountered who made her feel humbled. The experience she had with this young woman led her to reflect on the similarities and differences in their lives. The author connected with the patient as a woman who dreams of an easier life for her children and in their shared belief in the power of prayer to bring comfort. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Barry Jacobs, 2016 recipient of the CFHA Don Bloch, MD Award.
    The Don Bloch Award is presented annually by the Collaborative Family Healthcare Association (CFHA) to a person who has made singular contributions to forwarding the cause of collaborative family health care. The 2016 Don Bloch Award was presented to Dr. Barry Jacobs, a licensed clinical psychologist and family therapist who exemplifies Don's intellectual, behavioral and relational attributes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Acceptance speech for the 2016 Don Bloch Award from the Collaborative Family Healthcare Association.
    Presents the acceptance speech from Dr. Barry Jacobs for the 2016 Don Bloch Award from the Collaborative Family Healthcare Association (CFHA). (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The future of collaborative care without the Affordable Care Act: We did it before and will do it again.
    This article provides insight into the challenges we face in 2017 following the repeal of the Affordable Care Act by the newly elected Republican Congress and president. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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