Integrated Care (IC) models have increased, but the current mechanisms to analyze the efficacy and fidelity of behavioral interventions within IC models are limited. A mixed methods concurrent process evaluation was used within the context of a randomized clinical trial to assess intervention fidelity for a Solution-focused brief therapy (SFBT) intervention implemented within an IC model. A qualitative content analysis was conducted to develop a participant survey and charting template for the SFBT intervention. Quantitative data were collected through (1) participant surveys, (2) interventionist self-report surveys, and (3) data from participant charts. Descriptive statistics and repeated measures ANOVA were used to analyze quantitative data. Data triangulation was used to present findings. The average SFBT intervention was 24.6 min and 33/34 (97%) of participants in the intervention group completed all 3 SFBT sessions. Most visits were weekly follow-ups (53.9%), followed by biweekly (28.2%) and then 3-week follow-ups (5.1%). The interventionist used session templates and a self-report checklist to monitor intervention integrity. Those in the intervention group had increased growth regarding Solution-focused core constructs (a scale created by the authors) when compared to the treatment-as-usual group (F [1, 64] = 22.7, p < 0.001): mean difference, 15.1 [95% CI 11.2 to 18.9]. Our study examined fidelity comprehensively and provides a foundation for studies interested in fidelity monitoring of SFBT interventions as well as behavioral interventions within IC models. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 01/05/2023.

Chronic orofacial pain (COFP; i.e., musculoskeletal, neurovascular, or neuropathic pain in the face, mouth, or jaw that lasts for at least 3 months) is prevalent and debilitating. Chronic pain and substance use frequently co-occur, and individuals with COFP face unique challenges (e.g., uncertainty about future pain episodes, difficulty eating, drinking and talking) that may influence substance use. Nevertheless, no work to date has comprehensively assessed substance use among individuals with COFP. Here, we examine the prevalence of substance use among adults with COFP. Participants included 246 adults with COFP who were recruited from the Facial Pain Association. Participants completed an online survey that included a comprehensive assessment of substance use (i.e., Alcohol, Smoking, and Substance Involvement Screening Test) between December 2023 and January 2024. Most participants (82.9%) have used ≥ 1 substance in their lifetime, over two-thirds (68.3%) currently use ≥ 1 substance, and nearly half (43.5%) engage in risky substance use. The most commonly used substances were alcohol, tobacco, cannabis, opioids, and sedatives. This study presents a comprehensive assessment of substance use among adults with COFP. Findings extend prior work documenting high rates of substance use among individuals with chronic pain to a sample of adults with COFP. Given that substance use can exacerbate chronic pain and interfere with pain management, findings underscore the importance of assessing and addressing substance use among individuals with COFP.

As academic medical centers have moved away from using learner ratings of instruction as a demonstration of quality teaching in the promotion process, Indiana University School of Medicine sought to create a peer review of teaching system. We created our system in 2010 and have engaged in continuous quality improvement since. In these efforts, we sought to answer the question, "How can we create a system of peer review of teaching that provides high-quality feedback to faculty and encourages autonomy and growth?" Our peer review of teaching system includes a website, with a brief introduction to the concept of peer review, as well as a series of customizable forms that allows faculty and peer reviewers to choose items for observation and feedback based on teaching setting. This system, called the Peer Review Form Builder (PRFB), combines interactive technology with evidence-based faculty development and is innovative in structure and scope. On the macro level, departments and programs have seen success with the tool by engendering conversations on the values and effectiveness of teaching and education efforts. This systematic, tailored system of peer review of teaching has advanced the stature, quality, and innovation within all aspects of teaching throughout the institution. Further, we have incorporated these values into promotion and tenure documents, by encouraging consistent, systematic peer review as a primary source of evidence to demonstrate teaching effectiveness.

New faculty orientation (NFO) programs are shown to increase faculty satisfaction, enhance collaboration, and support promotion, retention, and academic success. In an effort led by a clinical psychologist, the Children's National Hospital (CNH) NFO was developed, piloted, and is in its 3rd year. Data are shared regarding program development process, feasibility, and acceptability. In 2020, CNH faculty were surveyed about their new faculty member experience. CNH leaders were interviewed about important topics to include in an NFO. In FY22, the NFO was piloted across 15 Divisions. Year 2 (FY23) invited all new early career faculty. Year 3 (FY24) invited all new faculty. Feedback was obtained via REDCap after meetings and before/after the 10-month program. In 2020, 62% of recently hired faculty surveyed indicated not having any institutional level orientation. Leadership interviews supported the need for an NFO; suggested topics included promotion and provider wellness. In FY22, 27/38 invited faculty chose to participate. For FY23, 36/48 chose to participate. In FY24, 69/95 invited are participating. A needs assessment showed CNH faculty and leaders supported an NFO Program. Participants report finding the program helpful; they learned about institutional resources, benefits, and operations and appreciated the networking opportunities. Longer-term metrics include faculty satisfaction, promotion, and retention.

Career management models are valuable tools for faculty pursuing a career in academic medicine. These models help faculty transition through various stages of their careers, including commonly pursued academic advancements from assistant professor to full professor, as well as less common transitions like moving from full-time to part-time status, taking sabbaticals, going on medical leave, or assuming executive leadership roles. The success of faculty members across these stages is influenced by both environmental factors and individual-level characteristics. Recognizing career stages and transitions, as well as the impact of personal and environmental factors on career growth, is crucial. The proposed Faculty Career Self-Management Model (FCSM) provides a visual and descriptive framework to guide individual faculty and the professionals who support them in understanding, preparing for, and navigating career stages and professional transitions to build and sustain meaningful careers in academic medicine. The FCSM serves as a framework to explore, develop, and share best practices in supporting faculty vitality across the career lifespan.

For pediatric cancer survivors in the post-treatment, school-reintegration period, integrating multi-informant reports and promoting a mutual clinician-family-school understanding of the child's needs are critical for comprehensive care. This study evaluated patterns of agreement between child, parent, and teacher reports of psychosocial functioning in pediatric brain tumor survivors (PBTS) and non-CNS solid tumor survivors (PSTS).

Clinical practice guidelines indicate treatments for specific anxiety diagnoses. Misdiagnosing specific anxiety disorders as unspecified anxiety may prevent patients from receiving appropriate care. Provider knowledge and attitudes may influence diagnostic practices. This study evaluated provider knowledge of diagnostic criteria for anxiety disorders and attitudes toward diagnostic processes and the relevance of diagnosis to patients' treatment. This qualitative analysis of interviews included 32 Veterans Health Administration providers in Primary Care Behavioral Health and Specialty Mental Health. Interview guides were created using a framework that outlines barriers regarding provider knowledge, attitudes, and behaviors as they pertain to following clinical practice guidelines. Most providers described themselves as familiar with diagnostic criteria for anxiety disorders and discussed consulting the Diagnostic and Statistical Manual of Mental Disorders if unsure about criteria. Providers were divided on the relevance of diagnostic specificity to a patient's treatment plan and outcomes. In the Veterans Health Administration, providers across different settings, roles, and tendency toward assigning specific diagnosis disagree on the relevance of diagnostic specificity for a patient's treatment and outcomes. Future research should seek to understand this divide and evaluate methods for optimizing a patient's likelihood of receiving a proper, accurate diagnosis.

Chronic pain acceptance has been identified as a crucial determinant of functioning among individuals living with chronic pain. However, research examining the relationship between chronic pain acceptance and pain-related disability has revealed variability across studies. The aims of this meta-analysis were to synthesize associations between chronic pain acceptance and pain-related disability, and test the moderating influence of pain characteristics, demographic factors, and methodological variables. Searches of PubMed and PsycINFO electronic databases located 24 studies (N = 6072) reporting correlations between chronic pain acceptance and pain-related disability. Meta-analytic calculations were performed using random effects models. Results indicated a negative association between chronic pain acceptance and pain-related disability that can be characterized as moderate in magnitude (r = -.45) and was stable across pain characteristics and demographic factors. Moderator analyses suggested the association between chronic pain acceptance and pain-related disability may be sensitive to the measures used to assess these constructs. These findings underscore the role of chronic pain acceptance in pain-related disability and reinforce the clinical significance of acceptance-based approaches in enhancing functional outcomes among chronic pain patients.

Healthcare leaders must increasingly attend to the monumental challenges facing their organizations (Angood and Falcone, American Association for Physician Leadership, 2023). As such, leadership in healthcare settings demands new skills sets amongst healthcare professionals that transcend the technical skills of any given profession. Academic health center psychologists are well-positioned to contribute to the leadership of academic health centers due to knowledge, skills, and attitudes fostered in doctoral psychology education, practice, and research through the focus on Profession-Wide Competencies. This article calls for psychologists to pursue more leadership opportunities within academic health centers. The article starts by identifying parallels between psychology's Profession-Wide Competencies and needed leadership skills/concepts for healthcare leaders. An example of an academic health center psychologist's leadership in a cohort-based physician leadership program illustrates how Profession-Wide Competencies were used in three structural elements of the leadership program. The article identifies particular leadership opportunities for psychologists within academic health centers.

Leadership training helps position faculty to guide various aspects of health care and health professions education at academic medical centers. With the increasing complexity of these responsibilities, it is essential that academic medical centers provide leadership skill-development opportunities to faculty. This work describes the structure of two internal mid-career faculty leadership development programs that were created to cultivate future institutional leaders from within the organization. These year-long programs were each established in 2017 and have been implemented annually. Both programs use a developmental approach with project-based, experiential learning so that leadership skills are applied immediately and meaningfully. Internal leadership programs support context-specific skills, while creating a community of leaders and a culture of leadership across the institution. Multidisciplinary participants bring diverse perspectives, and intra-institutional interactions foster collaborations. Internal, longitudinal training also supports comprehensive development more than is typically possible with short-term, external leadership programs. Other organizations can use these program descriptions and insights to develop similar internal, mid-career leadership training opportunities. While the broader academic medicine community benefits from faculty advancement whether training is within the institution or elsewhere, internal leadership training promotes context-specific development at individual, interpersonal, and institutional levels.

Mentoring plays an integral role in the success of faculty. This study explores faculty access to formal and informal mentorship and how mentorship impacts faculty engagement. Data are from 2020 to 2023 administrations of the StandPoint Faculty Engagement Survey. We compare clinically active faculty with a PhD or other health doctorate (OHD) in departments of psychiatry and neurology (Doctoral-PN) with both faculty with an MD or equivalent degree in those departments (Physician-PN), and with faculty with a PhD or OHD in other clinical departments (Doctoral-Other). Psychologists who are active in clinical care are represented in these departments although their representation likely varies by institution. Forty-four percent of Doctoral-PN faculty received formal mentoring and 65% received informal mentoring. Those receiving formal mentoring were more satisfied with professional development opportunities and reported increased understanding of promotion than those who were not. They were also more satisfied with their department and would recommend their medical school to others. The literature to date acknowledges the challenges to professional growth and advancement faced by Doctoral-PN faculty, including psychologists, practicing in academic health centers. This paper adds to previous research by presenting data on organizational outcomes associated with mentoring for these faculty.

Trends in faculty demographic composition, promotion success, and retention are important considerations in Academic Health Centers (AHC). This paper reviews the design, implementation, and utility of a faculty promotion and tenure (P&T) database (PROMO/TE©) over 12 years in a large southwestern academic health center. Review of the system design, portfolio creation, P&T tracking, interface with other faculty databases, and lessons learned will be offered. PROMO/TE© was developed to improve the P&T packet creation, application, and review process in one College and was expanded to other colleges at the AHC. The PROMO/TE© system is integrated with Workday® and FACFACTS© to track trends in recruitment, attrition, and P&T trends across gender, underrepresented minorities, and other subgroups. PROMO/TE© has several advantages including improving communication, transparency, uniformity, and efficiency in the P&T packet creation, application, and review process. Increased cost savings ($217,198 annually) were noted with elimination of hard copy packets and decreased time spent. The first college reviewed 743 dossiers in the PROMO/TE© system since its creation in 2012 and there has been on average a 10% increase in P&T approvals since its inception. PROMO/TE© facilitates and tracks trends in the P&T process and has many benefits as well as significant cost savings. PROMO/TE© serves as a potential model for other institutions.

Off-campus (volunteer, community-based) clinical faculty, upon whom medical schools heavily depend, are an integral component of medical education. However, challenges hinder their involvement in medical school governance and other activities, including inadequate communication, lack of recognition, high clinical demands that may preclude teaching, and time-consuming non-clinical tasks. While faculty appointments offer benefits like free CME, access to library resources, and email communications, faculty often prioritize potential contributions to their teaching roles over these benefits. Our medical school launched a new initiative to tackle these issues head-on. We established an Office of Faculty Engagement (OFE) that leverages engagement strategies to enhance communication, broaden access to campus resources, and provide tailored rewards for clinicians. We rebranded volunteer clinical faculty as Off-Campus Faculty (OCF) to foster a more interactive relationship and innovative measures, including personalized welcome emails, a dedicated point of contact for OCF, a user-friendly website, regular orientations, faculty development programs, recognition and appreciation events, and exclusive awards. From August 2021 to December 2023, we contacted 587 OCF members; 85 faculty members experienced improved communication. This innovative approach streamlines and personalizes interactions with OCF, enhances their satisfaction, and represents a transformative opportunity to engage and involve OCF in medical education.

Loneliness and low social support are associated with negative health outcomes among adults with asthma or COPD. Although social support is correlated with loneliness, low social support is neither necessary nor sufficient for the experience of loneliness. This study compares the relative association of loneliness and social support on symptom exacerbation (i.e., acute deteriorations in respiratory health) and acute health service utilization (i.e., hospitalizations, emergency department visits) among 206 adults with asthma and 308 adults with COPD. Separate logistic regression models were used to simultaneously examine the association of loneliness and social support with each outcome. Among adults with asthma, loneliness was associated with greater odds of hospitalization (AOR = 2.81, 95%CI [1.13, 7.02]), while low social support was not (AOR = 1.44, 95%CI [0.78, 2.65]). However, neither loneliness nor social support were associated with any other acute health service use or symptom exacerbation among adults with asthma. Among adults with COPD, loneliness, and greater social support were associated with increased odds of symptom exacerbation (AOR = 1.67, 95%CI [1.03, 2.69]; AOR = 1.36, 95%CI 1.02, 1.83]) and hospitalization (AOR = 3.46, 95%CI [1.65, 7.24]; AOR = 1.92, 95%CI [1.15, 3.22]), but only social support was significantly associated with ED visits (AOR = 1.72, 95%CI 1.12, 2.66]). These findings support prior research demonstrating that loneliness and social support are related but separate determinants of patients' physical symptoms and service utilization.

There is growing recognition of the profound mental health challenges faced by the 53 million U.S. family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.

Virtual reality (VR) and hypnosis (H) are useful pain management tools, but the potential benefit of their combination (VRH) has yet to be studied. This study examines the user experience of VRH, compared to H and VR alone, using interviews following an experimental study examining the effect of the three interventions on pain perception. Following a within-subjects repeated measures experimental design, 16 participants received the three interventions during which they received painful electrical stimuli. Following each intervention, explanatory interviews were conducted to allow participants to elaborate on their user experience. A thematic analysis was conducted on the data collected. Three themes emerged from the interviews: (1) satisfaction: participants mostly had positive feelings toward the three modalities, with the most beneficial effects on relaxation expressed for H. (2) Body perception and attention focus: immersion in the VR and VRH conditions was appreciated. Participants described their perceptions of pain perception during the 3 conditions. (3) Device acceptability: H was the most liked, followed by VRH, and then VR alone. Intention of use was reported following the same order. The data collected highlighted participants' opinions of these different interventions and suggested adjustments for future development of the VRH intervention in pain management.

Caregiving is a complex occupation, with a significant impact for informal caregivers (IC). Stress-process models propose a framework that considers that this impact depends on primary and secondary stressors, but also on the IC situation appraisal. This work aimed to verify: whether being, or not, an IC of an individual with dementia influenced the relationship between family functioning and burnout; the association between neuropsychiatric symptoms of the individual with dementia and IC burnout and whether the IC burden and perceived family functioning had a mediating role in such relationship. This cross-sectional study investigated differences in family functioning and its association with burnout between IC and non-IC. For IC specifically, the study examined a mediation model to explore the possibility of neuropsychiatric symptoms indirectly affecting IC burnout through the impact on family functioning and burden. Measures included the Copenhagen Burnout Inventory, the McMaster Family Assessment Device, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Results showed an association between poorer family function and high burnout, specifically in IC. They also showed that burden mediated the relationship between neuropsychiatric symptoms and burnout. The findings offer a significant contribution to the growing knowledge about the relationship between stressors associated with informal caregiving in dementia context, such as neuropsychiatric symptoms and its outcomes, like burnout.

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Childhood experiences, both positive and negative, play a crucial role in shaping individual development. Extensive research has demonstrated that adverse childhood experiences (ACEs) have long-lasting negative effects on physical, mental, and social health. Over the last two decades, many studies have found a strong link between ACEs and poor health outcomes in adults. However, there is less understanding of how positive childhood experiences (BCEs) might lead to better health in adulthood, particularly in overcoming adversity. This study aims to explore how BCEs impact adult physical and mental health and how they might mitigate the harmful effects of ACEs. Resilience theory served as the theoretical framework for this research. A total of 177 participants aged 19 to 41 years completed an online survey evaluating their physical, social, cognitive, and mental health, including their ACEs and BCEs. Regression analyses were used to investigate the connections between BCEs, ACEs, and adult health. The results show that BCEs act as protective factors that enhance overall well-being and significantly reduce depressive symptoms and physical discomfort. Additionally, when ACE levels are moderate, positive childhood experiences can largely counteract the negative health effects of ACEs.