Families, Systems, & Health

The shortcomings of science at the point of care delivery: An editors’ retrospective.
The editors feel so much gratitude for the opportunity that they had to witness, create, and develop published science. They absolutely loved working with hundreds of authors and seeing the fruition of their work, which they hope will be applied at the Point of Care delivery in practice settings for real-world impact. The editors feel indebted to so many partners in this work (see the Acknowledgments section). They welcome the new editors, CR Macchi and Rodger Kessler, whom we know we will strive to continue to increase the impact of work published in Families, Systems, & Health on the field of integrated care. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Parenting dimensions and views on adolescent decision making in health care: A cross-national study of Belgian and Dutch parents.
Background: The aim of this study was to investigate the link between parenting and parents’ perspectives on health-related decision making for adolescents. During adolescence, there is a gradual increase in responsibility and autonomy, which influences parenting behavior and child development. Understanding how parenting is associated with parents’ views on medical decision making is crucial in the context of the parent–child–physician triad. This study was the first to explore parenting and parents’ views on adolescent health care decision making. We compare Belgian and Dutch parents—two countries selected for their different legal frameworks on medical adolescent decision making. Method: An online questionnaire surveyed 984 Belgian and 992 Dutch parents (ages 35–55) with at least one child. Analytical methods included t tests, structural equation modeling, and latent profile analysis. Results: Parents considered adolescents to be competent decision makers at 16.7 years old. Dutch parents granted autonomy at younger ages than Belgian parents. Parents with high behavioral expectations granted autonomy to adolescents at higher ages, while those high in autonomy support and punishment granted autonomy at lower ages. When classifying parents into profiles, we distinguished four types: highly permissive, moderately permissive, moderately restrictive, and highly restrictive groups. The majority of the sample was classified into moderately and highly restrictive profiles. Conclusion: The study highlighted the importance of providing parents with education and support on adolescent development and autonomy. Parenting practices that encourage autonomy and support open communication between parents and adolescents may contribute to a more trusting and supportive parent–child context for adolescent medical decision making. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A qualitative study of supporters of adults following a suicide-related psychiatric emergency.
Introduction: Family, friends, and romantic partners (i.e., supporters) play a key role in the implementation of safety and support measures for loved ones with elevated risk for suicide; yet despite the link between interpersonal factors and suicide risk, few supporter-focused interventions exist. Method: This qualitative study to inform intervention development was conducted from September 2021 to March 2022 and explored (a) the feasibility and acceptability of a single-session phone call to a support person (n = 30, 67% female, 88% White non-Hispanic, Mage = 40.3 [SD = 17.1]) nominated during an emergency department (ED) visit for suicide risk and (b) the needs of supporters during and after a loved one’s suicide crisis. Results: Of the 30 supporters nominated, 27 were eligible to participate and were contacted. Eighteen completed an interview (66%). Seven core themes with 26 subthemes were identified characterizing the supporter’s experience prior to, during, and following their loved one’s suicide crisis. We found moderate acceptability and feasibility of a single-session supportive phone call to a support person following an ED visit for suicide risk. Discussion: Supporters reported a period of stress prior to and during the ED visit as well as adaptive coping with continued barriers and challenges. Brief interventions aimed at improving communication between the supporter, patient, and their care team; defining roles; and enhancing practical and emotional support are likely to be acceptable and feasible. Further study is needed to determine whether brief interventions to improve supporter self-efficacy can benefit both supporter and patient. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A descriptive examination of international family/shared meals: Prevalence, meal types, media at meals, and emotional well-being.
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)
Longitudinal associations of diabetes-specific family conflict and diabetes management in adolescents with type 1 diabetes.
Introduction: Diabetes-specific family conflict is a risk factor for diabetes indicators (e.g., higher hemoglobin A1c (HbA1c), lower adherence), but little longitudinal data are available to understand associations across time. To better inform targets and timing of interventions, we examined (a) whether fluctuations in conflict covary with diabetes indicators within adolescents across time; (b) whether reciprocal associations exist; and (c) whether aspects of the parent–adolescent relationship (e.g., parental acceptance) buffer associations across time. Method: Adolescents (N = 235, ages 11.5–15.5 at baseline, 53.6% female) completed measures of diabetes-related conflict with mothers and with fathers (separately), parental acceptance, and adherence every 6 months across 1 year (three time points). HbA1c was obtained from medical records. Data were collected in 2009. Results: Bivariate between-person correlations indicated that at each time point, adolescents who reported more conflict with mothers and fathers also had higher HbA1c and lower adherence. Within-person correlations (fluctuations across three time points) indicated that fluctuations in conflict with mothers were associated with fluctuations in HbA1c but not adherence. Actor–partner multilevel models indicated that fluctuations in family conflict at each time point were not associated with future diabetes indicators. Parental acceptance did not moderate associations of family conflict and diabetes indicators. Discussion: While findings corroborate extant literature noting that adolescents with high average diabetes-specific family conflict may benefit from interventions designed to reduce conflict, conflict at one time point may not be predictive of future diabetes indicators. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
The interdisciplinary training academy for integrated substance/opioid use disorder prevention and health care: A qualitative look at a new remote field education model.
Introduction: The opioid syndemic presents a critical need for effective interprofessional training in health care, especially in behavioral health disciplines. Addressing this need, the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA) was developed to provide adaptable educational experiences for emerging behavioral health professionals. This study, reflecting years 2020–2023, explored the experiences and perspectives of ITA fellows regarding interprofessional collaboration and opioid workforce development, focusing on how these elements are integrated. Method: After conducting focus groups, we employed applied thematic analysis to qualitatively analyze the experiences of ITA fellows (11 women and six men; 41% Hispanic/Latino and 59% White; 14 Master of Social Work students and three psychology postdoctoral fellows). This method allowed for a detailed exploration of their perceptions and the nuances of their learning process within the context of opioid workforce development. Results: The findings indicated that fellows’ learning processes were adaptive, evolving over time to meet their changing needs. Initially, fellows faced challenges related to role clarity and process understanding. However, they reported significant professional growth as the program progressed, highlighting the effectiveness of the ITA’s interprofessional approach in a remote learning setting. Discussion: The study emphasizes the need for ongoing research to identify and overcome barriers to effective interprofessional collaboration. The results contribute insights into the role of remote field education in preparing future health care professionals to address complex health crises effectively. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Ultra-brief cognitive-behavioral therapy (for routine primary care visits: Feasibility and acceptability of a brief provider training workshop.
Introduction: Most Americans with symptoms of depression and anxiety receive treatment exclusively from their primary care providers (PCPs). Existing primary care interventions typically do not occur within the initial patient interaction, rely on delivery by mental health specialists, and have lengthy training programs. This study evaluated the feasibility and acceptability of the training workshop for an ultra-brief cognitive-behavioral therapy (UB-CBT) single-session intervention for depression and anxiety symptoms that was developed to address these barriers. Method: The 1-hr UB-CBT training workshop was piloted in 2021 with 38 providers at three adult primary care and five family medicine sites in Vermont. PCPs completed questionnaires after the training workshop. Data were collected in 2021 with a sample of participants who were primarily women (66%) and white (82%). We used a concurrent triangulation design integrating mixed-methods data. Results: Most providers found the training highly feasible and acceptable. The majority agreed or strongly agreed that the workshop provided sufficient training for using the intervention (91%), they were satisfied with the UB-CBT intervention (92%), and the intervention seemed easy to administer (97%). Qualitative findings highlighted that providers especially liked the user-friendliness and general feasibility of the intervention, but had some concerns about time. Discussion: We outlined several steps that will address PCPs’ concerns to improve the UB-CBT training experience and intervention. Future research should examine the effectiveness of the UB-CBT intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Patient perspectives on primary care behavioral health integration in an urban mental health professional shortage area: Benefits, facilitators, and barriers.
Introduction: While studies have described the benefits of integrating behavioral health (BH) into primary care (PC), few have examined patients’ perspectives, especially in large, urban health systems. In 2015, the University of Chicago Medicine launched the Primary Care Behavioral Health Integration Program, located in a mental health professional shortage area. Method: In 2021, semistructured interviews were conducted with adult patients who had discussed their depression symptoms with their primary care clinician (PCC). Participants were asked about their experiences of being screened for depression, discussing BH, and being referred to behavioral health clinicians (BHCs). Interviews were analyzed using thematic analysis and constant comparison, and they were conducted until theme saturation was achieved. Results: Fifteen participants were interviewed, the majority of whom were women and African American/Black, with an average age of 52. Participants expressed that PC–BH integration helps patients recognize BH problems and navigate the BH care system, emphasizes the connection between physical and mental health, and eases conversations through familiar setting and established trust. Patients enumerated barriers to integration, including barriers to BH care in the PC setting, barriers to BH conversations with PCCs/BHCs, and barriers to referrals to psychiatry/external therapy. Patients highlighted facilitators of integration, including trust with their PCC, collaboration between PCCs and BHCs, and population-level screening. Discussion: These perspectives affirm the core strength of PC–BH integration: making BH more accessible and destigmatizing, especially for underserved communities. They also emphasize the importance of collaboration between PCCs and BHCs, shared identities, and actively involving patients in program design and quality improvement interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Strengthening community capacity to address trauma through a Community Ambassador Network.
Introduction: Community ambassadors (CAs) are advocates that build trust with communities on behalf of service systems and facilitate access to resources. Whether and how CAs can support community engagement within a large initiative to build capacity to address the impact of trauma is unclear. This study explores how a Community Ambassador Network supported community engagement with “Innovations 2 Initiative” (INN 2), a 5-year initiative that addressed trauma across nine communities in Los Angeles County. Method: CAs were recruited from nine community-based partnerships to participate in a focus group, which explored their roles and experiences with INN 2 and their impact on community engagement. Data were collected in 2022 and were analyzed using a pragmatic two-phase strategy for efficient qualitative data analysis. Twenty-six CAs participated in six focus groups. Participants mostly spoke English (82%), identified as Latinx (50%) or Black (23%) and as cisgender female (48%); average age was 40 years. Results: CAs implemented workshops and provided health education to the community. They reported being the community’s first point of contact with INN 2 and believed they improved credibility of the human service sector. While CAs felt supported by the Department of Mental Health, some wanted more trust from their supervisors. Discussion: CAs described various ways that they engaged historically excluded communities in INN activities and the organizational supports that facilitated this work. Training in trauma informed principles and support from their supervisors were regarded essential to this work. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Social connectedness and diabetes self-management across the COVID-19 pandemic: A mixed methods study.
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, Mage of 60 [12] years) in 2021. Then in 2022, we interviewed 25 patients (64% female, Mage 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)
Children’s behavioral and mental health in primary care settings: A survey of self-reported comfort levels and practice patterns among pediatricians.
Introduction: Despite the well-documented youth mental health crisis, there has been a lag in the development of a specialized workforce to meet needs of young people experiencing these challenges. Little is known about the comfort of primary care pediatricians when faced with children and adolescents with mental health care concerns. Method: A brief online survey was conducted to assess patterns of behavioral and mental health concerns in pediatric practices affiliated with a pediatric health system in Alabama. The survey asked about frequency of conditions that providers encountered, comfort treating these conditions, and frequency of external referrals. Results: Pediatric providers reported high volumes of children with mental health concerns and varying levels of comfort treating independently. Providers frequently refer externally. Conclusions: High rates of referrals could further stress an already overloaded system of specialty care. Interventions must be implemented to ensure a workforce prepared to meet the growing needs of youth requiring support for mental and behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Understanding rural social networks addressing adverse childhood experiences: A case study of the San Luis Valley.
Introduction: The purpose of this study is to assess a cross-sector, interorganizational network addressing adverse childhood experiences (ACEs) in a rural Colorado community. We characterize the organizations in the network, assess their awareness of ACEs, and evaluate how they participate in the network. We also assess the network health. Method: Employing a social network analysis approach, we collected survey data from 45 organizations that support young children and their families, including nonprofits, health care clinics, and early childhood education centers, among others. Results: On average, nonprofit organizations had relationships with a greater percentage of network members than other types of organizations. Network members engaged in relationships focused on a wide range of activities (e.g., client assessments, sharing information, providing services), with some organizational types leading the network in certain activities. Scores across all dimensions of trust and value were above 3 (range: 2.1–3.8), which is advantageous for a network and network relationships existed across a range of relational intensities (from awareness to organizational integration). Discussion: Nonprofit organizations that reported high levels of connectedness in the network were able to effectively mobilize the ACEs network. Health clinics participated in a greater share of relationships involving assessment, service provision, and tool sharing than other types of organizations. As such, health care clinics may serve as leaders in directly serving children and families experiencing ACEs in rural communities. The rural context may also explain high levels of trust and value, which can serve as assets for future network development and mobilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Facilitating coordination between medical and educational systems to improve access to pediatric therapies for preschool children with developmental delays and disabilities.
Introduction: A large portion of preschool-age children with developmental delays and disabilities (PCw/DD) do not receive recommended therapeutic services, including legally mandated school-based therapies. This study examines the feasibility of a community-clinical linkage using virtual patient navigation and a medical–educational care plan called Preschool and Me (PreM) to connect clinical settings serving historically marginalized communities with early childhood special education (ECSE) services. Method: Parents of PCw/DD attending an urban pediatric clinic from January to March 2022 were enrolled to receive PreM which included navigation support for ECSE, overcoming barriers accessing ECSE, and health care provider communication. Families completed measures of demographics and indicators of feasibility at baseline and 4-month follow-up. Results: Of the 34 families referred, 30 were eligible and enrolled. Most parents identified as mothers (97%). Most participant children (70% male, 60% Black, 30% Hispanic) were enrolled in public health insurance (93%) and were not receiving any clinic-based therapies (93%). Parents overwhelmingly found PreM acceptable with the majority stating it would be a strong reason to continue care at the clinic. Among families who received PreM, 26 (96%) completed an individualized education plan (IEP) evaluation (96%). Of these, 24 (92%) children were eligible for an IEP. Nineteen children enrolled in an ECSE program; two families awaited school assignments and three families did not consent to the assigned school placement due to neighborhood safety concerns. Discussion: Our findings suggest PreM was feasible, acceptable, and demonstrated promise in supporting families to navigate the ECSE process. Future studies examining effectiveness are warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Increasing access to behavioral health care: Examples of task shifting in two U.S. government health care systems.
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)
A real truth in dementia.
The author describes their experiences with 2 loved ones suffering from dementia and the decline of their cognitive abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Mutual empathy.
The author presents a poem about his experience with cancer and chemo. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Lizardry loves company.
The author discusses their psychiatric rotation experience with a teenage girl who had a history of self-harm and suicide attempts. The author talks about the girl's recovery and how she eventually shared how to she wanted to start an animal therapy business with lizards and other reptiles. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A wait to remember.
The author shares a short story about their experience of the possibility of having a serious eye condition and losing their sight. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Step back.
The author presents a poem about how their brother, who was a medical was student was discriminated against. A patient refused to be touched by a Black person and the resident in charge did nothing, but told her brother to, "step back." (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Traveling by night.
This poem is a circular narrative about the trauma of loving someone with a substance use disorder, how our past creeps into clinical encounters, and the liminal spaces that only exist late at night. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
How to whistle.
The author presents a poem about his father teaching him how to whistle and he had to learn to make his own music after his father died. The poem is about grief, losing a parent, and being resilient. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Life of a Type 1 diabetic.
This article discusses the life of a Type 1 diabetic. Everything is a danger. Stress, flu, infection, or a common cold could all lead to a hospital stay. There are many negative long-term effects: blindness, loss of a limb, heart attacks, etc. Every day is an effort to keep on top of things. The diabetes cannot be forgotten or ignored. The cost of living with diabetes is atrocious, between the devices, insulin, and other needed supplies. It is expensive to be sick. On top of the insulin pump, there are numerous supplies, such as reservoirs to hold the insulin, the infusion sets to put the plastic needle into the body, along with tubing to carry the insulin from the pump to the insertion point on the abdomen. There are also continuous glucose monitors (CGM), which include a transmitter, as well as sensors that have to be changed weekly. These items are much needed for people like the author, who after having diabetes for 24 years, find it difficult to feel low blood sugars. This difficulty feeling low blood sugars is quite dangerous, and may lead to seizures, brain damage, or even death if unnoticed and untreated. With CGM technology, the transmitter and sensors have saved the author on multiple occasions from seizures, or worse. They are a necessity, and the author needs the CGMs to protect her life. The author highlights a promise of hope in the Canadian Government's plan to financially cover "diabetic medications and supplies." And while it would not cover the expensive drugs not currently covered by the author's insurance, it does mean insulin and oral medications for Type 2 diabetes will no longer be paid out of pocket. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Reducing death by suicide by addressing well-being and firearm access: A both/and policy approach.
Objective: Firearm-related suicide is an alarming and growing issue in the United States, accounting for over 25,000 deaths annually. Unfortunately, public perception often underestimates the pervasiveness of this issue, despite widespread support for common sense strategies that could help address it, such as upstream preventative and well-being approaches and reducing access to firearms. Method: Examining recent evidence,this policy brief highlights the critical need for effective policies to prevent and reduce suicide by firearm. Results: Evidence suggests that reducing access to firearms, especially for individuals at heightened risk, is a critical factor in preventing suicide. Additionally, addressing social determinants of health and ensuring equitable access to behavioral health care are holistic, upstream approaches to reduce suicide death by firearm. A both/and policy approach helps to integrate both of these necessary and evidence-based pathways by both investing in upstream approaches to improve mental well-being and increasing firearm safety and restricting access for those most at risk. Discussion: This policy brief serves as a call to action for policymakers, clinicians, mental health advocates, and community members alike to advocate for and implement solutions that save lives. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Directional value statements: Collaborative Family Healthcare Association’s refined values.
In my column in last year’s December issue (George, 2023), I asked you to engage with us to ask bold, uncomfortable questions informed by the ecocycle framework (Liberating Structures: Including and Unleashing Everyone, 1991). At the same time last year, the Collaborative Family Healthcare Association (CFHA) board of directors began our strategic planning. While all parts of the strategic plan are important, this article will present our work to update CFHA’s values. These values represent directional statements and offer a framework to chart our future growth. The term “directional statements” signifies that the values presented here inform us where we need to look or what to look for. They help us locate ourselves and direct us on how to be in a community and in relation to each other and the world. They have already been informative in critical conversations this past year. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Families, Systems, & Health - Vol 42, Iss 4