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Introduction: Integrated behavioral health care is an important pathway to providing whole person care. It is delivered through a transdisciplinary lens and team and funded through complex policies, billing codes, and systems. While the clinical practice of integrated behavioral health care has received attention in the research, less is known about how health care systems demonstrate and evaluate the utility, effectiveness, impact, and longevity of integrating behavioral health into primary care. Method: Health care professionals (N = 145) working in integrated settings were recruited to participate in a metaevaluation about their evaluation practices. Descriptive and regression analyses were used to summarize and evaluate findings on clinical, operational, and financial evaluation practices. Results: There were a variety of types of evaluation practices across the national sample, as well as understanding across professional roles. Findings from the survey, which included primary care providers, behavioral health clinicians, and administrators working in integrated care settings confirmed that there was a lack of knowledge about evaluation and resources necessary to engage in the evaluation of clinical, operational, and financial outcomes. Furthermore, administrators were more likely to know about evaluation practices compared to medical providers and behavioral health providers. The survey also highlighted that organizational barriers to implementing integrated care were an issue across programs. Discussion: Utilizing clinical, operational, and financial evaluation together provide a more comprehensive review of the implementation integrated behavioral health. Real-world implementers and evaluators should consider forming integrated and inclusive evaluation teams, including administrators, medical providers, behavioral health clinicians, patients, and families. Public Significance Statement Providing behavioral health services in primary care is a critical step in improving access to behavioral health care, including mental health and substance use treatment. This paper presents the result of a survey of professionals working in primary care with integrated behavioral health services. These healthcare professionals reported on how they determine success with providing integrated behavioral services, and offers recommendations for measuring outcomes to continue to build access to care. Keywords: program evaluation, integrated care, primary care behavioral health, implementation, measurement Supplemental materials: https://doi.org/10.1037/fsh0000683.supp This article was published Online First May 12, 2022., Primary care is the first and most frequent point of entry for people receiving health care services in the United States (Miller & Patel, 2011). As a system, primary health [...]

Objectives Pregnancy loss and trauma are unexpected yet frequent occurrences for females in the United States, however little research exists on the role of pregnancy loss and trauma with both partners in couple relationships. The purpose of this study was to use dyadic analyses to better understand the role of trauma, spirituality, and pregnancy loss in the context of the couple relationship. Method Drawn from a secondary data set, the dyadic sample included survey responses from (n = 97) matched, pregnant heterosexual couples. Couples responded to questions related to traumatic experiences, previous pregnancy history, relationship satisfaction, and spirituality. Actor-partner independence models were conducted to explore pregnancy loss, trauma, and spirituality on relationship satisfaction. Results Female partner's experience of trauma and loss predicted relationship satisfaction, but the male partner's experience did not. In addition, spirituality moderated the effects of loss and trauma for female partners but not for male partners. Conclusion The outcomes from this study punctuated the importance of learning about relational dynamics (e.g., pregnancy and interpersonal traumas) through dyadic samples and analyses. Implications include research and clinical recommendations to incorporate biopsychosocial-spiritual metrics into research designs with diverse samples and dyads., Author(s): Corin E. Davis [sup.1] , Angela L. Lamson [sup.1] , Emily M. Meier [sup.1] , Grace A. Pratt [sup.2] Author Affiliations: (1) grid.255364.3, 0000 0001 2191 0423, Department of [...]

Frequent emergency department (ED) use has been operationalized in research, clinical practice, and policy as number of visits to the ED, despite the fact that this definition lacks empirical evidence and theoretical foundation. To date, there are no studies that have attempted to understand ED use empirically, without arbitrary use of 'cut-points.' This study was conducted to identify the best-performing, empirically grounded definition of frequent ED use. The performance of machine learning supervised clustering algorithms based on the most common definitions of frequent ED use in peer-reviewed literature (i.e., 3+, 4+, 5+ visits per year) were compared to unsupervised clustering algorithms that take into account numerous systemic factors associated with patients' ED use. All ED visits for the State of Florida, 2011-2015. including more than 100 clinical and payment-related variables per visit were employed in the model. Supervised algorithms using number of visits to the ED, alone, were unable to differentiate patients into clusters, while unsupervised models using all patient data formed clusters in which patients within a given cluster were alike, and patients between clusters were different. Cluster size and characteristics were stable across years. The results of this study indicate that mean number of ED visits by patients differ between patient clusters, but this does not allow for accurate identification of ED patients. Machine learning algorithms using all systemic and biopsychosocial patient data can be used to identify and group patients for the purpose of developing and testing integrated, whole health interventions. Public Significance Statement This study's findings through machine learning analyses reinforce the importance of relying on research and science to determine the factor's that influence high utilization of emergency departments over anecdotal or media based definitions and descriptions of frequent utilizers based solely on number of ED visits. Keywords: informatics, systems, biopsychosocial, emergency department, machine learning, In 2015, there were 136.9 million visits to the emergency department (ED) in the United States, equaling 43.3 visits to the ED per 100 persons for that year (Centers for [...]

Introduction: The purpose of this article is to introduce how social networks can be utilized as an effective approach to health informatics and to provide evidence from a quantitative research study regarding the effects of interpersonal interactions at work on healthcare employees' burnout and health. Methods: Tests of moderation were calculated to explore whether interpersonal interactions at work changed the associations between job stress and burnout and health. The study used cross sectional data from a North Carolina convenience sample. Participants were 237 multidisciplinary employees from healthcare organizations who were at least 18 years of age. Results: The results from this study provided evidence that more frequent friendly work-related communication benefitted employees' health, while more frequent hostile or difficult communication was detrimental to employees' burnout and health. Discussion: In this article, an explanation for using social networks to collect quantitative, relational data to determine when interpersonal interactions at work are beneficial or detrimental to employees' health and burnout is provided. The article concludes with a discussion regarding how these results and methods can be used to advance the national movements aimed at addressing healthcare employees' health and burnout. Public Significance Statement This quantitative study highlights the need for collecting data about interpersonal interactions at work when developing and implementing an integrated care protocol. It suggests that policies and programs should be informed by relational data because social structures in the workplace can be beneficial or detrimental to employees' well-being based on the interpersonal interactions. Keywords: social networks, burnout, employees, organizational health, informatics, Health informatics, or the collection and analysis of data to improve the design of health care systems and decisions, can be utilized to examine how to reduce health care employees' [...]

A 20 year retrospective qualitative case study was conducted to investigate the relational impact of choriocarcinoma (a type of gestational cancer) on a couple of child-bearing age. A unique feature to the study was that the primary investigator was the couple's biological son, initiating the first known auto-case study design. Using holistic content analysis, investigators learned that anticipatory grief played a central part in the couple's ultimate detachment and divorce. While the wife began to refocus her emotional energies on her children, in psychological preparation for her possible death, the husband focused on ways to keep the family finances together in preparation for life after cancer. He perceived her emotional detachment from him as abandonment. In spite of taking separate paths, the two perceived one another as heroes. The conceptual and clinical implications for a young couple battling gestational cancer are discussed.

Analysis of student journals examined the effect intergenerational service-learning had upon undergraduate students' attitudes and perceptions of older adults. Students (N = 102) engaged in 12 hours of service-learning with older adults that included writing structured reflection journals. Coding involved open, axial, and selective coding with common themes identified from the journals. Results revealed a positive attitude shift toward older adults over the course of the semester, greater comfort with the idea of aging, and a propensity to describe the experience as being personally and professionally influential in their own lives. Students also reported increased course understanding and a desire to continue volunteering. Implications for intergenerational service-learning are discussed.

The objective of this study was to examine the association between biomedical markers of disease management and psychosocial constructs, while also assessing the correlates and predictors of variability for satisfaction with life (SWL) among African American and Hispanic participants with type 2 diabetes. Data were collected from 142 participants during their first visit within a collaborative care program. Pearson product moment correlations, a multiple linear regression, and a one-way analysis of variance were used to examine the research questions. Researchers found psychological distress, social support, and spirituality accounted for twice the amount of variance in SWL for African American participants compared to Hispanic participants. Social support was the strongest predictor of SWL for African American participants, while psychological distress was the strongest predictor of SWL for Hispanic participants. Social support moderated the relationship between psychological distress and SWL for Hispanic participants, but not African American participants. Spirituality did not moderate the relationship for either ethnic group. One significant relationship was noted for BMI and somatization; otherwise, no significant relationships were documented between psychosocial-spiritual and biomedical constructs, which may relate to limited variability in HbA1c. Clinicians and researchers who work with underserved minority patients with uncontrolled diabetes may see improvement in patients' SWL when screening, treating, and/or studying psychological distress, interpersonal strain, and existential struggles. It is important for practitioners and researchers to consider ethnic group differences in their work since some dissimilarity existed.

Little is known about the experience among adult children who have a parent with Parkinson's Disease (PD). The purpose of this study was to explore, appreciate, and describe their experiences using a phenomenological methodology. Narratives were collected from seven participants who have a parent diagnosed with PD and analyzed according to Colaizzi's (1978) phenomenological data analysis method. Seven thematic clusters were identified and an exhaustive description is presented to summarize the essence of their lived experience. The study indicates a strong sense of essential positivism from the participants' stories, and overall, it seems PD has brought some degree of biological, psychological, socially, and/or spiritual meaning to their lives that they may not have otherwise noticed or experienced.

Background: Caregivers in this qualitative study reported the multidimensional implications of having a child with autism on their family's lives and overall functioning. Method: The Effects of the Situation Questionnaire (Yatchmenoff, Koren, Friesen, Gordon, & Kinney, 1998) was used to gather qualitative data from 80 caregivers. Colaizzi's (1978) phenomenological data analysis method was used to analyse the caregivers' written narratives. Biopsychosocial-spiritual, systemic, and ecological theoretical lenses were used to conceptualise the recorded experiences. Results: Seven thematic content areas emerged from the caregivers' data. They include: psychological implications, familial implications, social implications, services, spiritual benefits, economic challenges, and focus on the future of having a child diagnosed with autism. Conclusions: The results of this study offer valuable insight into how helping professionals may attend to the biological, psychological, social, and spiritual dimensions of those caring for an individual with autism. (Contains 1 table.)

Objective: The newest guidelines for the treatment of ADHD call for the formation of an individualized treatment plan based on collaboration. Because the process of collaboration requires the communication of desired outcomes, the authors' goal is to examine the preferred outcomes of treatment for ADHD for children and parents. Method: A preferred outcomes questionnaire is used to gather data. A listing of the outcomes in ranked order is generated for each group. Spearman's rho is used to generate comparative data. Results: Our results indicate a significant correlation between the preferred outcomes of the children and the parents. There is one outlier regarding the use of medication. Conclusion: The existence of the single outlier concerning the use of medication may infer that an assessment of the child's feelings regarding a medication regimen is therapeutically indicated. (Contains 3 tables and 1 figure.)

Attrition is a significant problem for health care providers working with youth and parents involved in childhood obesity treatment. Barriers for families in childhood obesity treatment have been explored, but [...]