Families, Systems, & Health

Effectively addressing burnout, well-being, and resilience: Individual, team, and system approaches.
This is an introduction to the special section “Effectively Addressing Burnout, Well-being and Resilience.” In this special section, we aimed to present work that is uniquely pertinent to the mission of Families, Systems and Health. While the authors welcomed work that focused on the study of burnout, well-being, and/or resilience among individual clinicians, they were especially interested in more “upstream” study of these topics among health care teams and systems-level interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Piloting the role of the chief well-being officer in Veterans Health Administration: The auspicious start.
Introduction: Emerging evidence from private sector hospitals indicates that a chief well-being officer (CWO) can be an impactful role to lead organizational burnout mitigation efforts in health care systems. A descriptive process evaluation was conducted to learn about facilitators and barriers of integrating this role within the Veterans Health Administration (VA). A pilot intervention inclusive of three domains—culture of well-being, efficiency of practice, and personal resilience—was implemented. Method: Eight VA medical centers and two regional network offices received 18 months of implementation support from October 2021 to March 2023. Appointed CWOs were tasked with implementing key interventions in at least two work units at each location. Administrative records were used to track implementation progress. Surveys were administered to participating work units pre- and postintervention to assess changes in key measures. Qualitative interviews elicited information about intervention implementation including barriers and facilitators. Results: Not formally hiring CWOs in the role resulted in limited time to work on intervention implementation. This was insufficient and it impacted their ability to truly function in the role. Several work units experienced multiple challenges and were unable to implement the full intervention. Despite these challenges, when examining work unit changes, improvements in culture of health and well-being and change readiness were observed. Conclusion: The results support the importance of a formalized CWO role; however, findings highlight important factors that must be addressed for successful integration of role to drive intervention effectiveness. Comprehensive interventions addressing both system- and individual-level drivers of burnout show promise for improving VA workforce well-being but warrant further study. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Lessons learned from the Health Resources and Services Administration health workforce well-being grantees.
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)
The great reconnection: Restorative justice as remedy for fragmented healthcare communities.
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)
How can a growth mindset-supportive learning environment in medical school promote student well-being?
Introduction: There is a growing concern for physician and medical student well-being and burnout. Growth mindset, or the belief that ability can be developed, as well as students’ perception of their instructors’ growth mindset, have been associated with better academic outcomes for a wide range of students. The primary purpose of the present study was to investigate the effects of growth mindset on medical student well-being. Method: We recruited all graduating osteopathic medical students in the class of 2023. This survey included items about student demographics (including identifiable items), experiences in medical school, practice plans, along with financial and other information. The survey of 667 items required a median time of 33 min to complete. Our sample consisted of 4,180 students. Students self-reported growth mindset, perception of instructor growth mindset, and four measures of well-being: flourishing, resilience, burnout, and maladaptive psychological symptoms. Results: Growth mindset and perception of instructor growth mindset were significant predictors of medical student well-being. Further, significant interactions showed that these effects were strongest for students from historically marginalized backgrounds. Discussion: Our work provides a first step toward addressing physician burnout by targeting medical students, which could prevent them from beginning their careers already in a state of burnout. We argue that systemic change is needed to improve student well-being, such as emphasizing growth mindset-supportive pedagogy, which places the emphasis on changing systems instead of individuals. Future research should include causal analyses to better understand the effect and persistence of growth mindset-supportive environments on student well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Rural healthcare workers’ well-being: A systematic review of support interventions.
Introduction: Although there is increased awareness about healthcare workers’ (HCWs’) stress and burnout after the COVID-19 pandemic, support interventions should be tailored according to the needs of HCWs. Given the unique challenges rural HCWs face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of HCWs practicing in rural settings. Method: We conducted a comprehensive search of the existing literature through electronic databases to identify quantitative, qualitative, and mixed-methods studies describing supportive interventions for rural HCWs with well-being-related outcomes between January 1, 2023 and March 31, 2023. We used the Effective Public Health Practice Project, Mixed Methods Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist to evaluate the study quality. Findings: Out of 1,583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized and only six included controls. Included interventions were generally well- accepted. Quantitative and qualitative themes identified shared decision making, effective supervision, and proactive cultural change as promising interventions that warrant further exploration. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. Conclusions: There is limited research in support interventions for rural HCWs. Larger, well-designed studies are needed to explore promising interventions to promote well-being of rural healthcare workforce. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Degree of primary care integration predicts job satisfaction and emotional exhaustion among rural medical and behavioral healthcare providers.
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)
Building a culture of workforce wellness using implementation science-informed strategies: A qualitative content analysis.
Introduction: Successfully addressing burnout in health and human services settings is a topic of growing interest and impact in the field. Implementation science gives us strategies to build organizational readiness to create a culture of workforce wellness. This study used strategies for identifying and preparing wellness champions and building feedback loops to begin to build a culture of workforce wellness. The primary aim of this study was to assess perspectives on establishing feedback loops across all levels of the organizational hierarchy. Method: This study took place in a community mental health organization that provides services across four different states. Champions in each state were identified and connected with leaders and teams. The champions supported the engagement of leaders and the design of feedback loops. Champions remained engaged throughout the process of assessing needs and sharing workforce wellness data. A qualitative content analysis was conducted on data collected during meetings that were intended to create organizational practice to policy feedback loops. Results: Staff across all levels of the organizational hierarchy shared feedback and participated in facilitated reflective discussion. Participants offered several suggestions for addressing burnout. Across all participants, workplace connections were perceived as a protective factor against burnout. Discussion: This implementation science strategy to help combat burnout is an effective and feasible way to include frontline staff voices and build connection and trust between leaders and staff in health and human services settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Parental incarceration and adolescent food insecurity.
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)
Centering family voice during a public health crisis: Challenge and opportunity for health collaborations and community systems of care.
Introduction: Evidence is lacking about how to integrate family and community voice into systems of care. This is particularly relevant in public health crises when reducing barriers to health care and resources is critical for everyone, but especially community members who typically experience more barriers to care. Addressing this gap, this study investigated the voice strategies used by systems of care to respond to the COVID-19 pandemic. Method: We conducted semi-structured interviews in three U.S. counties with agency leaders representing healthcare, public health, and early childhood partners in local systems of care (n = 15) and resource navigators who worked with families (n = 4). Results: We found that systems of care were better able to identify and respond to family priorities when they used diverse voice strategies, implemented among multiple agencies involved and at multiple time points. Family and community voice helped uncover blind spots in the crisis response, facilitating reaching more individuals in need. Flexibility in safety net service policies and protocols was critical to each organization in the system of care. Discussion: Systems of care that develop a multi-dimensional approach to voice strategies that can be readily mobilized in a public health crisis will be more apt to meet emerging needs. Questions remain about whether power sharing that occurred in the context of crisis translates into reform that builds out from family priorities. Common issues to meeting family needs that could be addressed prior to a crisis included outdated resource lists, confusing application processes, poorly translated materials, and insufficient broadband access. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Enhancing access to early intervention by including parent navigators with lived experience in a pediatric medical home.
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)
Structural inequality modifies midlife outcomes of a multisystemic early childhood program.
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)
The Family Climate Questionnaire: A general measure of autonomy support from family members.
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)
Family-focused practice and policy recommendations to improve the inpatient experience for patients undergoing a stem cell transplant.
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)
“Integrated behavioral health plus”: The best of the worlds of collaborative care management, primary care behavioral health, and primary care.
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)
Promoting successful health care transitions for young people aging out of foster care.
Improving adolescent to adult health care transitions (HCTs) would benefit all young people in the United States but has particular importance for the more than 120,000 adolescents and young adults (AYA) placed in foster care. Leveraging clinical guidelines and evidence-based interventions, HCT efforts inclusive of and specific to AYA placed in foster care can be strengthened through greater collaboration between child welfare, health care, and other AYA-serving systems. This Health Policy Brief advances the importance of structured Health Care Transition services for adolescents and young adults placed in foster care. Additionally, it highlights opportunities for health care providers, youth-serving systems, and health policy stakeholders to collaborate with child-welfare involved young people in order to prioritize evidence-based health care transition interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Knowing.
In this narrative, the author describes how she hears the story of someone who is the victim of abuse, but the author could not have known about the vicitm's abuse and many fears. These fears include fear of others' judgment, fear of screams, fear of abandonment, and fear of being with others. In these stories, the author has heard the unspoken burdens of others around her. This particular victim has taught the author compassion, empathy, and patience when she interacts with her patients, colleagues, and friends. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Naming the stars.
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)
Born in a tube by the Guadalupe River.
In this poem, the author describes how her mother gave birth to her, alone, in the Guadalupe River on her prom night. Her mother let her rest in an inner tube. Decades later, the author remembers what her mother had to do do—how she rationed gas, scissored coupons, sent her to school in stolen shoes. Then came the gutting cancer, and the author was left to carry her mother. She gave the author the grit to wake each day. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Warm night in July.
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)
Integrated care identity: Evolutionary leaps and future directions.
As integrated care becomes mainstream, adaptively framing team members’ identities based on their work context will help align their attitudes and required competencies. This article explores the emergence of integrated care identity, focusing on behavioral health professionals, and offers suggestions for future development. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Families, Systems, & Health - Vol 42, Iss 3