Tai J. Mendenhall

Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination.

Integrating behavioral health services within the primary care setting drives higher levels of collaborative care, and is proving to be an essential part of the solution for our struggling American healthcare system. However, justification for implementing and sustaining integrated and collaborative care has shown to be a formidable task. In an attempt to move beyond conflicting terminology found in the literature, we delineate terms and suggest a standardized nomenclature. Further, we maintain that addressing the three principal worlds of healthcare (clinical, operational, financial) is requisite in making sense of the spectrum of available implementations and ultimately transitioning collaborative care into the mainstream. Using a model that deconstructs process metrics into factors/barriers and generalizes behavioral health provider roles into major categories provides a framework to empirically discriminate between implementations across specific settings. This approach offers practical guidelines for care sites implementing integrated and collaborative care and defines a research framework to produce the evidence required for the aforementioned clinical, operational and financial worlds of this important movement.

Citizen Health Care: A Model for Engaging Patients, Families, and Communities as Coproducers of Health

Citizen health care is a way to engage patients, families, and communities as coproducers of health and health care. It goes beyond the activated patient to the activated community, with professionals acquiring community organizing skills for working with individuals and families who see themselves as citizens of health care— builders of health in the clinic and community—rather than merely as consumers of medical services. Over the past 7 years, the authors and their colleagues have developed and field-tested a structured process for implementing this model into everyday practice settings. In this article, we describe the origins of the model, its core tenets and practices, and examples of its implementation in community settings. We discuss how citizen health care differs from other models of collaborative and community-based work, and we outline research and training directions.

The Family Education Diabetes Series (FEDS): community-based participatory research with a midwestern American Indian community

Indigenous people around the globe tend to struggle with poorer health and well-being than their non-indigenous counterparts. One area that this is especially evident is in the epidemic of diabetes in North Americas American Indians (AIs) - who evidence higher prevalence rates and concomitant disease-related complications than any other racial/ethnic group. As researchers and AI communities work together to transcend conventional top-down, service-delivery approaches to care, community-based participatory research is beginning to show promise as a way to partner contemporary biomedical knowledge with the lived-experience, wisdom, and customs of Indigenous people. This study describes the Family Education Diabetes Series (FEDS) as an example of such effort, and highlights pilot findings assessing its value and impact across key diabetes-relevant variables. Following 36 intervention participants across baseline, 3-month, and 6-month time periods, data show significant improvements in weight, blood pressure, and metabolic control (A1c). Strengths and limitations of this investigation are presented, along with suggestions about how to further advance and empirically test the work across other Indigenous communities.

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.

The Families and Democracy and Citizen Health Care Project

This article describes and updates the work of the Families and Democracy and Citizen Health Care Project, which engages with community concerns in order to effect change on many system levels. The project draws on family therapys tradition of interest in larger social issues and adds democratic public theory and community organizing strategies. Since 1999 we have developed 14 citizen initiatives with a wide range of groups on a diverse set of problem areas. We describe the overall project and several of its initiatives, we address research and evaluation issues, and we outline opportunities for marriage and family therapists to learn how to do this work in their own communities.

Contact in Adoption: The Experience of Adoptive Families in the USA

Contact in adoption is a complex issue that adoption professionals frequently negotiate. Today most adoption placements include an initial plan for contact that in many instances changes over time. By understanding contact as an issue that presents itself over the course of an adopted persons lifetime, the complexities it brings to the adoption experience can be seen. Gretchen Miller Wrobel, Harold D Grotevant, Jerica Berge, Tai Mendenhall and Ruth McRoy discuss contact from a US perspective using findings from the Minnesota/Texas Adoption Project, a longitudinal study of openness in adoption. They examine how curiosity, satisfaction with adoptive contact, family communication and searching influence decision-making about the extent of contact. Implications for adoption professionals in the USA and the UK are also presented.

Partners in diabetes: A collaborative, democratic initiative in primary care.

Contemporary healthcare is in a state of rapid and constant change. With these developments has come an increased appreciation for the complex landscape of competing constituencies and multifaceted elements that define it. As efforts in medicine extend beyond visit-based services into the comparatively less familiar territory of preventive and patient-oriented care, a call has emerged for increased partnerships between providers and patients (Hayes, 1996; Standridge, 2000). These partnerships are in contrast to traditional hierarchal modes of care that position providers as experts who deliver services to passive patients, and can overcome commonplace barriers of limited resources and time constraints that frequently impede new initiatives. Active patient involvement can thereby tap important and already existing resources that have not been tapped previously for the of individuals and communities.

Students Against Nicotine and Tobacco Addiction (S.A.N.T.A.): Community-Based Participatory Research in a High-Risk Young Adult Population

Students Against Nicotine and Tobacco Addiction (S.A.N.T.A.) is a community-based participatory research project involving an active collaboration between University health providers and Job Corps students, administrators, teachers, counselors, and staff. In this article, we describe the project, its evolution, and key strategies that have employed over the course of the initiative and its ongoing efforts.

The Family Education Diabetes Series Improving Health in an Urban-Dwelling American Indian Community

Community-based participatory research has shown great promise as a mutually engaging and respectful way to partner contemporary biomedical knowledge with the lived experience, wisdom, and customs of American Indian people. Designed and implemented through this approach, our Family Education Diabetes Series (FEDS) has evidenced pilot and longitudinal physiological data supporting its effectiveness. However, the multifaceted nature of the program makes it difficult to know which factors are responsible for its success. This difficulty hinders efforts to improve the FEDS and/or inform others’ work to advance similar projects. In this study, we conducted a qualitative investigation using talking circles to explore participants’ views about what elements of the FEDS are most salient. Our findings suggest that social support and group-oriented sequences hold the most value. We conclude that an emphasis on these processes (instead of program content per se) is most indicated in effecting behavior change and facilitating ongoing disease management.

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.