The Intersect of Pregnancy Loss, Trauma, and Spirituality: A Dyadic Perspective.

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.

Defining Moral Injury Among Military Populations: A Systematic Review.

Military service often requires engaging in activities, witnessing acts, or immediate decision-making that may violate the moral codes and personal values to which most individuals ascribe. If unacknowledged, these factors can lead to injuries that can affect the physical, psychological, social, and spiritual health of military men and women. The term moral injury has been assigned to these soul-ceasing experiences. Although researchers have attempted to define moral injury and what leads to such experiences, inconsistencies across definitions exist. In addition, nearly all existing definitions have lacked empirical support. The purpose of the present systematic review was to explore how moral injury has been defined in research with military populations, using Cooper's approach to research synthesis as well as PRISMA guidelines. An in-depth review of 124 articles yielded 12 key definitions of moral injury across the literature. Two of these 12 definitions were grounded in empirical evidence, suggesting that much more research is needed to strengthen the face validity and reliability of the construct. Quality rankings were developed to categorize each of the included articles. The findings punctuate the need for empirical evidence to further explore moral injury, particularly among samples inclusive of service members and the biopsychosocial-spiritual experiences associated with such injuries.

Medical Residents' Experiences With Medically Unexplained Illness and Medically Unexplained Symptoms.

Patients who present with medically unexplained illnesses or medically unexplained symptoms (MUI/S) tend to be higher utilizers of health care services and have significantly greater health care costs than other patients, which add stress and strain for both the patient and provider. Although MUI/S are commonly seen in primary care, there is not sufficient information available regarding how providers can increase their level of confidence and decrease their level of frustration when working with patients who present with MUI/S. The goal of this article is to present findings from a qualitative phenomenology study, which highlights medical residents' experiences of caring for patients with MUI/S and the personal and professional factors that contributed to their clinical approaches. Results from these studies indicate that residents often experience a lack of confidence in their ability to effectively treat patients with MUI/S, as well as frustration surrounding their encounters with this group of patients.

The clinical, operational, and financial worlds of neonatal palliative care: A focused ethnography.

OBJECTIVE: Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center. METHOD: In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families. RESULTS: Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support. SIGNIFICANCE OF RESULTS: The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

Paediatric palliative care: a review of needs, obstacles and the future.

AIM: This literature review offers a response to the current paediatric palliative care literature that will punctuate the need for a framework (i.e. the three world view) that can serve as an evaluative lens for nurse managers who are in the planning or evaluative stages of paediatric palliative care programmes. BACKGROUND: The complexities in providing paediatric palliative care extend beyond clinical practices to operational policies and financial barriers that exist in the continuum of services for patients. EVALUATION: This article offers a review of the literature and a framework in order to view best clinical practices, operational/policy standards and financial feasibility when considering the development and sustainability of paediatric palliative care programmes. KEY ASPECTS: Fifty-four articles were selected as representative of the current state of the literature as it pertains to the three world view (i.e. clinical, operational and financial factors) involved in providing paediatric palliative care. CONCLUSION: In developing efficient paediatric palliative care services, clinical, operational and financial resources and barriers need to be identified and addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management plays a crucial role in addressing the clinical, operational and financial needs and concerns that are grounded in paediatric palliative care literature.

Quality of life and BMI changes in youth participating in an integrated pediatric obesity treatment program.

BACKGROUND: Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL. METHODS: A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate. RESULTS: Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression. CONCLUSIONS: We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth's BMI changes, but also psychosocial changes including QOL.

Exploring the protective experiences of those who "protect and serve": A psychometric evaluation of Protective and Compensatory Experiences Survey within a military sample.

OBJECTIVE: The current study evaluates the psychometric properties of the Protective and Compensatory Experiences Survey (PACES; Morris et al., 2018) within a military population. The study's aims are to evaluate if the PACES is a reliable measure to use with military samples and to examine the validity of the PACES measure when exploring protective experiences in relation to adverse childhood experiences (ACEs) and adult traumatic stress (ATS) in an active duty military sample. METHOD: Active duty Service members were recruited to complete an online survey that included measures pertaining to ACEs, PACES, and ATS. RESULTS: The reliability and validity of PACES indicate that Service members who are involved in protective and compensatory experiences as youth are less likely to have experiences of stress both as children and as adults. CONCLUSIONS: Given the need for mission readiness of Service members and their higher likelihood to experience ACEs than civilians, the role of protective and compensatory factors is vital to their livelihood and career. PACES psychometrics offer a reliable and valid measure to use when exploring the risk and resilience experiences of Service members across the lifespan. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The importance of assessing for depression with HRQOL in treatment seeking obese youth and their caregivers.

PURPOSE: The purpose of this manuscript is to (1) explore the health-related quality of life (HRQOL) of youth attending a tertiary obesity treatment center compared to healthy population reference data; (2) compare the congruence between the HRQOL of youth self-reports and caregiver proxy reports; and (3) examine the associations between youth HRQOL and (a) teen and (b) caregiver depression. METHODS: The sample included 267 youth and caregiver dyads. A cross-sectional descriptive design was used. Analyses included paired t tests, analyses of variance, correlations, and Chi-square cross-tabulations. RESULTS: Overweight youth reported significantly (P < 0.001) lower scores than a previously published healthy sample on all totals and subscales of the PedsQL. For younger overweight children and caregivers, there was closer agreement on social (r = 0.45) and emotional functioning (r = 0.32); whereas teens and caregivers agreed most on school functioning (r = 0.47) and emotional functioning (r = 0.44). Regardless of age, youth and caregivers disagreed most on physical functioning. Caregivers who reported higher depressive symptoms had less agreement with their child on their perceived HRQOL; however, teens with more depressive symptoms had stronger agreement with their caregivers on their previewed HRQOL. CONCLUSIONS: Based on our findings, there is not consistent agreement between youth and caregiver perceptions of youth HRQOL domains (physical, emotional, social, and school) and inconsistency in age groups (children and teens). Depressive symptoms in caregivers and teens can provide mechanistic insights into youth and caregiver HRQOL congruence. These findings underscore the importance of a comprehensive biopsychosocial assessment when providing treatment to overweight youth and their families.

MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population: A Conceptual Model.

Recruitment and retention of a diverse physician population across stages of medical education is essential for the success of the healthcare system. MedFTs have a unique role to play in advocacy and intervention related to the recruitment and retention of these physicians at all stages of their education and career. As MedFTs expand their influence in healthcare systems, they must ground into their fundamental theories, like systems theory and the Four World View, all while advancing in their professional competencies to attune their skills and those whom they are entrusted in training. The conceptual model, MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population, provides a framework for MedFTs to use their influence to enact change related to diversity and equity in the healthcare system. In addition, the model provides avenues for intervention and advocacy on the part of the MedFT related to each of the four worlds and their specific role(s) in the health care.

Medical Family Therapy in Rural Community Health: A Longitudinal "Peek" into Integrated Care Successes.

Integrated behavioral health care (IBHC) continues to grow as an evidence-based service delivery model adopted by healthcare systems all over the world to better care for the holistic needs of patients and their families. Medical family therapy (MedFT), as a field, has offered innovation to IBHC models by delivering biopsychosocial-spiritual (BPS-S), relational, and family-oriented care across a variety of healthcare contexts. This article details a longitudinal review of a program, spanning 16 years, that grew from no behavioral health services to one that is highly integrated, and embeds MedFTs in a number of rural community health centers. This model highlights the importance of interdisciplinary teams, including Peek's clinical, operational, financial, and training worlds, as well as decision-making metrics for systems that predominately care for underserved and minoritized populations. The authors illustrate a framework for how the levels of primary care/behavioral healthcare collaboration relate to the work and practice of MedFTs as conceptualized through the MedFT Health Care Continuum and meet the BPS-S needs of diverse populations seeking pediatric, adult, and dental healthcare services. Also described are shifts made in the model over time based on (a) growth in cultural humility, (b) relationally-oriented practice, operations, finance, and training data, and (c) research informed decisions. Recommendations include ways MedFTs can facilitate provider and administrative buy-in, assess model fidelity, and strive for quality outcomes for patients.

Clinical, operational, and financial evaluation practices in integrated behavioral health care.

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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family-Centered Primary Care for Older Adults with Cognitive Impairment.

Cognitive impairment (e.g. dementia) presents challenges for individuals, their families, and healthcare professionals alike. The primary care setting presents a unique opportunity to care for older adults living with cognitive impairment, who present with complex care needs that may benefit from a family-centered approach. This indepth systematic review was completed to address three aims: (a) identify the ways in which families of older-adult patients with cognitive impairment are engaged in primary care settings, (b) examine the outcomes of family engagement practices, and (c) organize and discuss the findings using CJ Peek's Three World View. Researchers searched PubMed, Embase, and PsycINFO databases through July 2019. The results included 22 articles out of 6743 identified in the initial search. Researchers provided a description of the emerging themes for each of the three aims. It revealed that family-centered care and family engagement yields promising results including improved health outcomes, quality care, patient experience, and caregiver satisfaction. Furthermore, it promotes and advances the core values of medical family therapy: agency and communion. This review also exposed the inconsistent application of family-centered practices and the need for improved interprofessional education of primary care providers to prepare multidisciplinary teams to deliver family-centered care. Utilizing the vision of Patient- and Family-Centered Care and the lens of the Three World View, this systematic review provides Medical Family Therapists, healthcare administrators, policy makers, educators, and clinicians with information related to family engagement and how it can be implemented and enhanced in the care of patients with cognitive impairment.

Couple and family interventions for high mortality health conditions: A strategic review (2010-2019).

The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.

A biopsychosocial pilot study of overweight youth and care providers' perceptions of quality of life.

This pilot study examined the relationship between youth and care provider self-reports of depressive symptoms assessed through the Patient Health Questionnaire and reports of youth physical and psychosocial functioning assessed by PedsQL4.0 in a rural outpatient overweight pediatric population (N = 66 child and care provider pairs). The relationship between youth body mass index (BMI), youth and care provider depression, youth quality of life (QOL), care provider perception of youth QOL, and youth and care provider congruence of QOL perceptions was examined. Paired t tests were completed to assess the differences between QOL scores for youth and care providers for subgroups based on age, age and gender, and age and race. The mean age of youth participants was 11.9 years; youth BMI ranged from 26.76 to 54.10 (M = 37.20). Our results showed that there are significant differences in youth and care providers' perceptions of QOL when specific demographic categories are assessed by age, gender, and race.

Emergency department frequent user subgroups: Development of an empirical, theory-grounded definition using population health data and machine learning.

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. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Attachment, Parenting, and Obesogenic Behavior: A Dyadic Perspective.

Pediatric obesity is a growing health concern afflicting the United States. The treatment for pediatric obesity, as a health epidemic, costs billions of dollars to our nation, leaving providers and researchers searching for effective and sustainable ways to better manage the biological, psychological, and social health of individuals and families. While many assessments and interventions continue to emerge, researchers have predominately focused on intra-individual concerns among white non-Hispanic populations. This quantitative study was grounded in a relational theory (attachment theory), with a dyadic and primarily Hispanic sample. Evidence from our study supported that child attachment predicted child obesogenic behavior and that this relationship was mediated by child self-regulation. Children with insecure attachments had more obesogenic behaviors and lower self-regulation of eating than those with secure attachments. Family therapists should be on the frontlines of relational research and clinical interventions that interface with biopsychosocial health across diverse cultures and families.

Caring for an individual with autism disorder: a qualitative analysis.

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.

Camp Golden Treasures: a multidisciplinary weight-loss and a healthy lifestyle camp for adolescent girls.

Camp Golden Treasures, (CGT) the first non-profit weight loss camp for overweight adolescent girls in the nation, was held for six weeks from June 24 to August 3, 2007 at the East Carolina University campus in Greenville, NC. The primary goal was to support campers to lose weight, raise self esteem, and to learn the tools necessary to lead a healthy lifestyle while reducing risks for developing chronic disease or mitigating the effects of existing obesity-related conditions (sleep apnea, insulin resistance, hypertension, lower extremity dysfunction, etc.). While at CGT, campers learned about the importance of physical activity and proper nutrition through workshops, discussion groups and hands-on activities. Additionally campers were taught the necessary tools and strategies needed to make concrete, positive lifestyle changes so they can achieve a healthy weight. Due to the nature of a chronic disease such as obesity, multidisciplinary collaborators including physical therapy, nutrition, health education, management, family therapy, risk management, fundraising, public relations, medical, nursing, and physician coverage were involved in designing, planning, and implementing CGT.

A collaborative care model for patients with Type-2 diabetes.

The research on diabetes has shown the need to move from a traditional medical model to a patient-team orientation. This has led to a number of collaborative programs targeting the patient and family's comprehensive needs. This paper details one collaborative care program for underserved patients with Type-2 diabetes set in rural, eastern North Carolina. Roles of the therapeutic team are incorporated along with a case example highlighting the bio-psychosocial-spiritual model in action. Sustainability, challenges, and strengths are included to facilitate a realistic appraisal of the program.

Use of simulated clients in marriage and family therapy education.

Knowledge of how one should manage suicidal, homicidal, child maltreatment, and domestic violence situations is paramount in the training of marriage and family therapists (MFTs). Simulated patient modules were created to help clinical faculty address these crisis situations in a protected learning environment. The modules were implemented by the MFT faculty in collaboration with the Office of Clinical Skills Assessment and Education at East Carolina University's Brody School of Medicine. Qualitative data over the course of 2 years revealed six thematic domains regarding therapists' performance, therapists' emotions, the simulation experiences, and lessons learned. Educational, clinical, and research recommendations include tools to implement simulation exercises into marriage and family therapy programs as well as suggestions to assess for teaching effectiveness.