RESUMEN

U.S. history is fraught with examples of systemic racism-at all ecological levels and within all geopolitical contexts. Whether scholars historically punctuate these phenomena through white racial framing begun in the 1600s or the Black civil rights movement of the 1960s, research across disciplines brings into focus a twenty-generation story of injustice. These phenomena present a paradoxical struggle within healthcare systems populated by professionals who have made a "conscious commitment to equity and helping those in need." However, both healthcare systems and embedded care providers operate in relation to organizational structures that frequently reify racist policies. As natural and professional agents of change, medical family therapists are especially positioned to examine how regulatory systems at every level influence institutional racism within the medical and mental health fields. In this manuscript we examine health system policies and practices using the lens of C.J. Peek's Four Worlds: Clinical, Operational, Financial, and Training. Examples of institutional racism are discussed and recommendations for approaches to change are provided.

RESUMEN

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.

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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.

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Prior research indicates that couples who cope with chronic illness from a relational "we" orientation experience more positive outcomes than couples that cope individually; however, little prior research identifies clinical processes that promote reciprocity or how societal gender processes are involved. This grounded theory analysis of 25 videotaped therapy sessions with six heterosexual couples coping with chronic liver disease (LD) used a feminist-informed relational lens to focus on the clinical processes involved in shifting from an individual to a relational orientation. Findings identified three contextual barriers to attaining a "we orientation": (a) autonomy discourse, (b) illness-related power, and (c) gendered power. Analysis detailed therapist actions that decreased the impact of barriers to reciprocity and fostered relational coping. Clinical implications attend to complex intersections among gender, caregiving, and contextual barriers to reciprocity.

Investigaciones anteriores indican que las parejas que hacen frente a una enfermedad crónica desde una orientación relacional basada en el "nosotros" tienen resultados más positivos que las parejas que la enfrentan individualmente; sin embargo, existen escasas investigaciones previas que identifiquen los procesos clínicos que promueven la reciprocidad o la manera en la que están implicados los procesos de género social. Este análisis de teoría fundamentada de 25 sesiones de terapia videograbadas con seis parejas heterosexuales que enfrentan una enfermedad hepática crónica utilizó una óptica relacional fundamentada en el feminismo para centrarse en los procesos clínicos relacionados con el paso de una orientación individual a una relacional. Los hallazgos identificaron tres obstáculos contextuales para lograr una "orientación basada en el nosotros": (a) el discurso de autonomía, (b) el poder relacionado con la enfermedad, y (c) el poder asociado al género. El análisis detalló las medidas del terapeuta que redujeron el efecto de los obstáculos para la reciprocidad y fomentaron el afrontamiento relacional. Las implicancias clínicas tratan de las intersecciones complejas entre el género, el cuidado y los obstáculos contextuales para la reciprocidad.

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The incarcerated population is considered an underserved population, specifically in regard to their ability to access and receive mental health services. There is a gap in existing literature addressing the mental health needs of incarcerated individuals who also suffer from chronic illnesses. The purpose of this case study is to provide an exploration of how medical family therapy and structural family therapy can be integrated to inform the treatment of incarcerated individuals and their families who are experiencing a physical health illness. A case application will be provided to highlight how the integrated approach can be utilized to conceptualize and treat those incarcerated and their families. Treatment was shown to be effective as evidenced by the outcomes of an incarcerated mother with HIV and her daughter.

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Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients' needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers' knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients' lives.

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Mentally ill family members can have a formidable impact on the families in which they reside. Family physicians can intervene in powerful ways when they are sensitive to those who are mentally ill and their families and can provide much needed compassionate support.

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The researchers examined the spiritual coping, family communication, and family functioning of 95 participants in 34 families by an online survey. Multilevel linear regression was used to test whether individuals' and families' higher endorsement of more use of spiritual coping strategies to deal with a member's cancer would be associated with higher scores on family communication and family functioning, and whether better communication would also be associated with higher family functioning scores. Results revealed that spiritual coping was positively associated with family communication, and family communication was positively associated with healthier family functioning. The researchers provide suggestions for further research.

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BACKGROUND: A collaborative health-care relationship is considered critical in managing chronic illness like diabetes. Poorly controlled diabetes can greatly diminish one's quality of life and lead to severe complications or even death. RATIONALE: Understanding how to improve the relationship between patients and their providers supports improved diabetes health outcomes. OBJECTIVE: We conducted a grounded theory study to examine the types of relationships that diabetic patients and their spouses prefer to form with their health-care providers. RESULTS: The analysis of in-depth interviews with 18 diabetic couples reveals four major relationship preferences that differ by the nature of caregiving and decision-making power demonstrated by the physician. CONCLUSION: Using illustrative examples, we show how the type of health-care relationship couples prefer is explained by their connection with one another and suggest implications for practitioners that expand current collaborative models of care.

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Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.