Jennifer Hodgson

Introduction to Medical Family Therapy: Advanced Applications

Medical Family Therapy is a burgeoning field grounded in the biopsychosocial-spiritual framework and systemic perspective. Its contributions extend from the 1980s when it was first recognized in a primary care setting (family medicine) to today where it has extended into secondary, tertiary and other specialized healthcare contexts. Its contributions span clinical, educational, research, and policy arenas. The development of a Medical Family Therapy Health Care Continuum, as depicted in this chapter, allows for members of all healthcare disciplines to determine the scope and depth of skill they want to develop through reading this text, Medical Family Therapy: Advanced Applications, as well as continue to pursue through other methods of professional development.

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 familys 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.

Understanding Social Support and the Couple's Relationship Among Women with Depressive Symptoms in Pregnancy

This qualitative study explored the experiences of seven couples where the female partner experienced depressive symptoms during pregnancy. Female and male partners were interviewed together and data was collected and analyzed according to Colaizzis () phenomenological research design. The interviews yielded the following themes: (a) Challenges and stressors associated with depressive symptoms during pregnancy, (b) Pregnancys effect on mood states, (c) Relationship dynamics that influence moods, (d) Pregnancy and the influence of mood on relationship dynamics, and (e) Reliance on external sources of support. The findings extend current research and provide insight into possibilities of how to enhance assessment and intervention for women who are depressed during pregnancy by including a relational component. Findings, clinical implications, and future research are discussed.

Patient and provider relationships: consent, confidentiality, and managing mistakes in integrated primary care settings.

Health care in the United States is advancing toward increasingly integrated primary care systems. With this evolution comes a responsibility for providers to carefully consider a variety of issues related to ethical conduct. While working within the same teams on behalf of the same patients and families, professionals representing different disciplines are guided by different sets of baseline ethics guidelines and codes-and the overlap and differences between these principles can easily translate into ethical breaches. Using a clinical vignette as the basis for our discussion, we address issues of informed consent, confidentiality, and grievance procedures specifically. We review extant literature and formal ethics codes upheld by nine leading professional organizations across these foci, offer recommendations about how to manage this clinical scenario, and highlight what is needed to advance our understanding of integration ethics.

A Conceptual and Empirical Basis for Including Medical Family Therapy Services in Cancer Care Settings

Psychosocial interventions in oncology settings have largely been individually and group-based despite evidence that a family-based approach fills a treatment gap in the cancer care experience. Medical Family Therapists are trained to address the family as the unit of treatment and provide services that consider family dynamics, reorganization of couple and family roles, and broader systemic issues. This article describes the conceptual bases for Medical Family Therapy services provided in cancer care settings, and reviews research on their implementation and effectiveness. Following a review of the literature, recommendations for studying the effectiveness and efficacy of MedFT in cancer care treatment are detailed.

Implementation of a “Learner-Driven” Curriculum: An Screening, Brief Intervention, and Referral to Treatment (SBIRT) Interdisciplinary Primary Care Model

ABSTRACT Although screening, brief intervention, and referral to treatment (SBIRT) has been a popular model to address potential substance abuse issues in primary care, there is a need for innovative approaches for training providers and staff on SBIRT protocols. An interdisciplinary approach to SBIRT training, named ICARE, was implemented at 3 different medical settings. The ICARE team trained 85 employees at an academic family medicine residency center and 37 employees across 2 rural community health care clinics. Using an innovative “learner-driven” approach, the authors implemented a combination of didactic and interactive training strategies that included on-site coaching, patient simulation exercises, as well as large- and small-group learning.

Keys to Implementing Empirically Supported Therapies

ABSTRACT Adopting a therapeutic model that fits with ones philosophical view of the world is hard enough. Developing one that is empirically validated is a completely different challenge. With some jurisdictions moving toward empirically supported treatments (ESTs) as the standard of care, clinicians need to know how to use ESTs and how to obtain training in them. This article reviews the current state of dissemination of eight ESTs and summarizes how marriage and family therapist might obtain training in the particular models. Descriptions of the data collection procedures and the implications for clinicians who are interested in pursuing EST training are included.

Following Bariatric Surgery: an Exploration of the Couples’ Experience

BackgroundBariatric surgery is the most effective intervention for morbid obesity, resulting in substantial weight loss and the resolution of co-morbid conditions. It is not clear what impact bariatric surgery and the subsequent life-style changes have on patients’ couple relationships. The purpose of this phenomenological study was to examine the lived experience of couples after one member of the couple underwent bariatric surgery.MethodsThis study utilized a phenomenological approach of semi-structured interviews of the couples jointly (n = 10 couples). Colaizzi’s method of analysis for phenomenological studies was utilized to elucidate the central themes and distill the essence of the participants’ experience.ResultsAll of the couples felt their post-operative success was due to a joint effort on both members of the couples’ part. The participant couples described the following five emerging thematic experiences: (a) changes in physical health, (b) changes in emotional health, (c) changes in eating habits, (d) greater intimacy in the relationship, and (e) the joint journey.ConclusionsThis research provides greater insight into the experience of the couple than has been previously reported. The use of qualitative research techniques offer new approaches to examine the biopsychosocial outcomes and needs of bariatric surgery patients. Further research is warranted in order to develop culturally appropriate interventions to improve the patient’s surgical and biopsychosocial outcomes.

A Pilot Study to Reduce Risk for Antepartum Depression Among Women in A Public Health Prenatal Clinic

This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) ≥10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS ≤10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.

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.