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Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. 'Harmonized' means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a 'good enough' vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being. https://doi.org/10.1370/afm.3108, INTRODUCTION Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in l practice, carrying out this tripartite mission [...]

BackgroundParents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input.MethodA previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested.ResultsThe experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions.ConclusionThe comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

BackgroundParents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input.MethodA previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested.ResultsThe experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions.ConclusionThe comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

Family functioning, family resilience, family health, and family flourishing are concepts used in research across multiple fields. One challenge of their interdisciplinary use is that there are a variety of definitions of each, with researchers sometimes creating their own definitions rather than using well‐established definitions. This can lead to different conceptualization of the same concept across studies. It is, therefore, necessary to develop a conceptual framework to understand the interplay between each of these family concepts, including their differences and overlap, to inform research, practice, and policy. In this article, we present the definitions, concepts, and common measurements of each concept. Based on the examination of the literature, we propose a conceptual framework of family well‐being that demonstrates the interplay of these concepts. We present empirical findings to understand how well some common measures differentiate between each other. Finally, we discuss the implications for research and practice. [ABSTRACT FROM AUTHOR]

Objective: Although stressful life events (SLEs) have been suggested to be associated with child well-being, few studies have examined SLEs with child and family behavioral and emotional well-being, especially within diverse populations. The current study examined the associations between SLEs and child behavioral and emotional outcomes, in addition to family-level measures of well-being. Method: Children 5-7 years old and their families (n = 150) from 6 racial and ethnic groups (n = 25 each for African American, Hispanic, Hmong, Native American, Somali, White families) participated in this mixed-methods study. Participants were recruited through primary care clinics. Results: Results showed that all racially and ethnically diverse immigrant and refugee families were experiencing SLEs. The majority of diverse children were experiencing emotional and behavioral problems (i.e., hyperactivity, emotional) in the face of SLEs (i.e., combined SLE score, health-related events), with Somali children being at highest risk. Additionally, the majority of diverse families did not experience lower family functioning in response the SLEs, except regarding certain SLEs (i.e., health-related, legal). However, specific families (i.e., Somali) experienced lower family functioning in the face of multiple SLEs. Discussion: Health care practitioners should consider screening and providing extra resources for reducing stress in children, given all children in the study had some emotional and behavioral problems in the face of SLEs. Additionally, it would be important for practitioners to know which families are at greatest risk for experiencing SLEs (i.e., African American, Native American, Somali families) to ensure they are provided with the resources necessary to mitigate the impact of SLEs. Public Significance Statement This study investigated Stressful Life Events (SLEs) in racially/ethnically diverse populations. SLEs were prevalent and were associated with lower levels of emotional and behavioral well-being in some children. Many families experienced high levels of family functioning, despite having SLEs, which may provide potential intervention targets. Keywords: stressful life events, emotional well-being, behavioral problems, diverse families, immigrants/refugees, Stressful life events (SLEs) are discrete, acute stressors that disrupt an individual's usual activities and typically result in substantial change and readjustment (Cronholm et al., 2015; Manyema, Norris, & Richter, [...]