A new public health psychology to mend the chasm between public health and clinical care.

Emerging global health challenges and ever-growing health disparities indicate a need to improve the manner by which we deliver health prevention and health care services to people and the populations in which they are nested. One means of addressing the physical, psychological, and social health of people is to more fully and intelligently integrate the social and structural deterministic perspectives of health inherent in public health efforts with the individualistic and behavioral focus of medicine. This integration of public health with clinical care is predicated on the notion that people are burdened by socially produced psychological states that undermine their health. To date, neither public health nor clinical care has effectively attended to psychosocial conditions such as fear, loneliness, medical mistrust, powerlessness, and stigma, all of which fuel disease. Psychological principles provide the means of coalescing the efforts of public health with clinical care by addressing these very psychosocial stressors that undermine health and perpetuate disease. In this regard, there is a need to reorient the discipline of public health psychology. Such a conceptualization of health and well-being provides a framework to both identify and intervene on these conditions. Public health psychologists should collaborate directly with both public health experts and clinical providers to develop tools which effectively ameliorate the psychosocial drivers of disease. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A systematic review of stigma in sexual and gender minority health interventions.

Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.

The behavioral neuroendocrinology of maternal behavior: Past accomplishments and future directions.

Research on the neuroendocrine-endocrine-neural regulation of maternal behavior has made significant progress the past 50 years. In this mini-review progress during this period has been divided into five stages. These stages consist of advances in the identification of endocrine factors that mediate maternal care, the characterization of the neural basis of maternal behavior with reference to endocrine actions, the impact of developmental and experiential states on maternal care, the dynamic neuroplastic maternal brain, and genes and motherhood. A final section concludes with a discussion of future directions in the field of the neurobiology/neuroendocrinology of motherhood.

Accelerating Our Science: Finding Innovative Solutions to Tomorrow's Health Challenges.

This introduction to the special issue outlines key ways that behavioral medicine researchers can accelerate their science. The authors highlight the 2020 Society of Behavioral Medicine's annual meeting plenary sessions, that fit this theme.

Direct primary care-Where does integrated behavioral health fit?

Primary care is increasingly viewed as key to growing health system market share in value-based purchasing strategies for both public- and private-sector programs. Yet not all primary care physicians are interested in becoming part of large multispecialty practices or working in employed arrangements. Instead, a growing number of physicians are launching independent direct primary care (DPC) practices in order to maintain professional autonomy, mitigate burnout, and ensure long-term meaningful engagement with patients and families. Given that the typical size of a DPC care team is small, what does this mean for integrating behavioral health? As primary care evolves under various payment and delivery models, the integration of behavioral health services will require adaptability based on practice size, scope of practice, patient acuity, and payment model. Indeed, advocates of integrated behavioral health can "skate to where the puck is going to be"1 by familiarizing themselves with innovations in primary care, such as the DPC model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' interest in resources to address their child's behavioral health through primary care.

INTRODUCTION: The purpose of this study was to investigate parents' interest in additional primary care-based resources for their children's behavioral health, including parenting support. METHOD: We surveyed 264 English- or Spanish-speaking parents (80% mothers) of children between the ages of 3 and 11 years as they arrived for an appointment at an urban, pediatric primary care clinic. Measures included demographics, the Pediatric Symptom Checklist (PSC-17) as a parent report of the child's behavioral health, and interest in behavioral resources (e.g., a parenting class, online videos). We used multiple regression to evaluate the predictors of resource interest. RESULTS: Most parents reported interest in behavioral health resources, including many parents not reporting behavioral symptoms high enough to meet criteria for a positive PSC-17. Overall, 82% of parents reported interest in at least 1 resource item; 28% reported interest in all 7 resource items. The resource item with the most interest was online videos and resources (64%). More behavioral health issues (indicated by higher PSC-17 total scores) were positively related to interest in resources; 20% screened positive for behavioral health concerns. DISCUSSION: Parental report of child behavioral health issues was related to greater interest in resources for children's behavioral health; of note, much of the interest came from parents reporting levels of behavioral health concerns that would be scored as negative on the screening tool in practice. These results provide support for efforts to increase parenting and behavioral health resources through primary care, and raise questions about how to best direct resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ke Ku'una Na'au: A Native Hawaiian Behavioral Health Initiative at The Queen's Medical Center.

Although acute care facilities have not typically focused on resolving the psychosocial determinants of health, new models are emerging. This article provides details of the Ke Ku'una Na'au (KKN) Native Hawaiian Behavioral Health Initiative implemented in 2016 at The Queen's Medical Center in Honolulu, Hawai'i. The program is focused on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults and improving their health care outcomes after hospitalization. The program was piloted on 2 medical units to assist patients who identified as Native Hawaiian, were ages 18 and older, and living with chronic diseases, psychosocial needs, and/or behavioral health problems. The program model was developed using a team of Native Hawaiian community health workers referred to as navigators, who were supported by an advanced practice nurse and a project coordinator/social worker. Navigators met patients during their inpatient stay and then followed patients post discharge to support them across any array of interpersonal needs for at least 30 days post-discharge. Goals were to assist patients with attending a post-hospital follow-up appointment, facilitate implementation of the discharge plan, and address social determinants of health that were impacting access to care. In 2017, 338 patients received care from the KKN program, a number that has grown since that time. In 2015, the baseline readmission rate for Native Hawaiians on the 2 medical units was 16.6% (for 440 Native Hawaiian patients in total). In 2017, the readmission rate for Native Hawaiians patients on the two medical units was 12.6% (for 445 Native Hawaiian patients, inclusive of KKN patients) (P=.092). This decrease suggests that the KKN program has been successful at reducing readmissions for vulnerable patients and, thus, improving care for Native Hawaiians in the health system generally. The KKN program has offered relevant, culturally sensitive care meeting a complex, personalized array of needs for over 338 patients and has shown demonstrated success in its outcomes. This information will be useful to other acute care organizations considering similar programs.

Implementing integrated behavioral health: Testing associations between shared clinical time and space and provider referrals.

INTRODUCTION: Behavioral health provider (BHP) availability is widely acknowledged as an important factor in the effectiveness of an integrated care approach within primary care. However, there is little research providing evidence of the impact of BHP availability on physician uptake of integrated behavioral health (IBH) services. METHOD: This quasi-experimental study examines whether shared clinical time and space with a BHP is associated with providers' number of standard IBH referrals and proportion of warm handoffs within total behavioral health (BH) referrals. Data are from 2 family medicine outpatient clinics with 1 shared, part-time BHP and were gathered across 4 months (2,847 unique patients served) using electronic health record chart review of patients referred for BH services. RESULTS: Results of a Poisson regression indicated greater shared time and space between BHP and providers is significantly associated with a greater number of providers' standard IBH referrals, χ²(df = 1, N = 15) = 13.67, p = .000. Results of general linear modeling indicate greater shared time and space is also associated with a greater proportion of warm handoffs (percentage of total referrals). A 1-unit increase in percentage of schedule overlap was associated with a 110% increase in likelihood of a family medicine provider making a warm handoff, Exp(ß) = 2.10, p = .007. DISCUSSION: This exploratory study provides initial evidence to support the notion that shared time and space between BHPs and physicians is an essential component of effective integrated care. Future research is needed to evaluate how shared time and space impact the accessibility, adoption, and effectiveness of the BHP. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

All systems go: An ecological perspective of behavioral health for youth with type 1 diabetes.

INTRODUCTION: Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions. METHOD: This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention. RESULTS: This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control. DISCUSSION: Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Behavioral Medicine: a retro/prospective view of the field.

The year 2017 was the 40th anniversary of the convening of the Yale Conference on Behavioral Medicine (Schwartz and Weiss, 1977). In honor of this defining moment in the history of the birthing of behavioral medicine as a formal integrative field of biobehavioral theories, research and applications, we were invited by the editors to take a retrospective and prospective look at the field. Recognizing that much has been written about this history over the years, we decided to write about the "back-channel," presenting never-before shared events associated with the birthing and evolution of the field in a way that would be fun to write and read. In the process we look back at the evolving definitions of behavioral medicine in light of contemporary advances and controversies in science. Our review includes a discussion of some of the present challenges/opportunities, and then considers the future with some "outside the box" possibilities. We outline some of the enormous advances which have taken place in technology since the 1970s and consider how such technologies can be transformative in redefining our field.

A look at the increasing demographic representation within behavioral medicine.

Meeting the behavioral medicine research and clinical needs of an increasingly diverse United States population is an issue of national concern. We examine the trends in the demographic representation of the behavioral medicine scientific workforce through an analysis of the training grants funded by National Institutes of Health for the field of behavioral medicine from 1980 to 2018. We report the topics of these training grants, and we depict the demographic representation of the training leaders. We provide the demographic representation of the trainees, and of the first authors of publications reported within those training grants. Finally, we report the topics addressed in these behavioral medicine publications, to determine if topic diversity increased as the behavioral medicine scientific workforce diversified. Visualizations are presented that tell a story of how we have, and have not, advanced representation within the field of behavioral medicine. Best practices for launching future successful behavioral medicine scientists are then presented, to ensure optimal representation and diversification occurs in our workforce, our science, and our delivery of our clinical care.

The history and future of digital health in the field of behavioral medicine.

Since its earliest days, the field of behavioral medicine has leveraged technology to increase the reach and effectiveness of its interventions. Here, we highlight key areas of opportunity and recommend next steps to further advance intervention development, evaluation, and commercialization with a focus on three technologies: mobile applications (apps), social media, and wearable devices. Ultimately, we argue that future of digital health behavioral science research lies in finding ways to advance more robust academic-industry partnerships. These include academics consciously working towards preparing and training the work force of the twenty first century for digital health, actively working towards advancing methods that can balance the needs for efficiency in industry with the desire for rigor and reproducibility in academia, and the need to advance common practices and procedures that support more ethical practices for promoting healthy behavior.

Update and future perspective of behavioral medicine in the treatment for chronic pain.

Chronic pain is a biopsychosocial condition, and behavioral medicine has made significant contributions to the understanding of the phenomenon and optimization of therapeutic outcomes. The objective of this article is to provide future perspectives of behavioral medicine in pain management based upon recent development in the field. We will briefly review the mainstream approach of cognitive-behavioral therapy, its variations and new and innovative approaches that are on the horizon. We also review strategies that address potential barriers to pain management. Behavioral medicine is a promising field in pain medicine. The future growth is likely to come from addressing how we incorporate the patient heterogeneity into our treatment approaches and a better understanding of its role in a multimodal treatment.

Introduction to the special series-behavioral medicine at 40: origins, achievements, and future directions.

The Journal of Behavioral Medicine emerged 40 years ago as a part of a concerted effort to promote a greater understanding of health and illness through the integrated lenses of behavioral and biomedical sciences. The aim of this special series is to commemorate the 40th anniversary of the Journal of Behavioral Medicine through state-of-the-science reviews synthesizing the origins, evolution, current status, and future directions of key aspects of the field. In this introduction, we outline the impetus for this special series and highlight the key themes across the included papers.