搜索结果：Journal of clinical psychology in medical settings

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by inadequate or restricted food intake unrelated to body image or weight concerns. ARFID is frequently observed in patients with gastrointestinal disorders. Given the growing clinical interest, we conducted this systematic review to synthesize evidence, assessment approaches regarding ARFID-like symptomatology in adult patients with inflammatory bowel disease (IBD). A systematic search of MEDLINE, Scopus, Web of Science, PsycInfo was conducted in July 2025, yielding seven studies on ARFID in IBD. This review followed the framework outlined by Page (2021). Prevalence rates, assessment tools, associations with clinical, psychological factors were synthesized. Reported prevalence of ARFID-like behaviors ranged from 10.2 to 51.3%, reflecting differences in screening tools, cut-offs. Studies applying lower cut-offs (≥ 24) for the Nine Item ARFID Screen (NIAS) showed a weighted mean prevalence of 24, 2%, whereas stricter cut-offs (≥ 28) resulted in a a prevalence of 18, 6%, in line with the results from the Pica, ARFID, Rumination Disorder Interview-ARFID Questionnaire (PARDI-AR-Q). Higher ARFID levels were consistently linked to symptom-based clinical activity. Despite limited evidence, in some patients with normalized inflammatory markers, restrictive eating may persist, suggesting functional mechanisms beyond inflammation. Psychological distress, particularly anxiety, gastrointestinal-specific anxiety, was strongly associated with ARFID-like behaviors. The interplay between ARFID, symptom activity, psychological distress underscores the need for an integrated approach addressing gastroenterological, psychological, nutritional factors, aiming to improve ARFID screening, management in patients with IBD.

Healthcare professionals are expected and motivated to engage empathetically with patients, their families, yet how different components of empathy, coping traits interact to shape psychological responses remains unclear. This study examined these relationships in medical, nursing students to inform tailored educational interventions METHODS: Participants who completed two surveys 2 years apart (30 medical students and 88 nursing students) were included. Empathy traits were assessed using the Interpersonal Reactivity Index, coping traits using the Brief Coping Orientation to Problems Experienced Inventory, and psychological responses using the Professional Quality of Life Scale. Mixed-effects models for repeated measures analyzed the impact of empathy and coping traits. Latent profile analysis (LPA) classified participants by empathy and coping traits. Personal distress was significantly associated with increased secondary traumatic stress (STS) and burnout, and decreased compassion satisfaction. Empathic concern was associated with increased compassion satisfaction. Active coping and support seeking were associated with increased compassion satisfaction and reduced burnout, whereas indirect coping was associated with increased STS and burnout. LPA identified three distinct profiles of empathy and coping traits, showing significant differences in psychological responses. Differences in empathy and coping traits influence psychological responses in medical and nursing students. Tailored interventions that consider these traits may be more effective.

Graduate school admissions are competitive, and few studies have documented post-baccalaureate (post-bacc) training program outcomes. This paper describes a post-bacc training program at an academic medical center and aims to (a) characterize participants and program recruitment, (b) examine productivity and graduate school matriculation, and (c) assess change in key outcomes (e.g., publications), demographic characteristics, and program reflections. Seventy-nine post-baccs have completed the post-bacc training program since 2017. Publication data were obtained via institution record-keeping and public resources (e.g., PubMed). Starting in 2021, new post-baccs (n&#x2009;=&#x2009;28) completed entry and exit surveys (reporting demographics/academic history, awards/honors, publications/presentations, research skill confidence, and next steps). Of 79 post-baccs, 89% (n&#x2009;=&#x2009;70) matriculated to graduate or medical school (41% clinical psychology). The median number of publications during training was three. Publications, presentations, and confidence were higher at exit vs. entry (p's&#x2009;<&#x2009;.05). There were no differences based on underrepresented group status (p&#x2009;>&#x2009;.05). Program satisfaction was high. Findings demonstrate success preparing post-baccs for admission into advanced degree programs, improving research productivity/skill (regardless of underrepresented group status), and garnering high satisfaction among post-baccs. This program model can serve as a bridge, offering rigorous clinical research training for the future workforce of clinical psychologists and related professionals.

Despite the prevalence of chronic pain among patients presenting to primary care, access to evidence-based psychological intervention remains limited. Mobile health (mHealth) interventions offer scalable alternatives, but little is known about how specific engagement behaviors relate to clinical outcomes. This secondary analysis explored the value of distinct engagement components as predictors of pain outcomes&#xa0;across two pilot trials of an eight-week mHealth program for adults (N&#x2009;=&#x2009;39) with co-occurring chronic pain and hazardous drinking. Engagement indices included skills library access, skill reviews, homework surveys completed, videos opened and completed, and frequency of instant messaging coaching sessions. Pain outcomes were assessed with the Pain, Enjoyment of Life, and General Activity (PEG) scale at baseline and 12-16&#xa0;weeks post-baseline. Analyses included partial correlations controlling for trial and descriptive analyses from median split cross-tabulations to examine associations between engagement and achievement of clinical improvement in pain. Higher engagement with skills reviews, completion of homework surveys, and number of videos completed emerged as indices most highly associated with a greater likelihood of achieving&#x2009;&#x2265;&#x2009;30% pain reduction. Frequency of coaching sessions, however, did not appear to be linked with outcomes. Findings suggest that certain engagement behaviors--particularly videos completed--may be predictive of clinical benefit, underscoring the potential importance of depth and quality of engagement. These results highlight specific engagement indices that may be important to track and potentially enhance to improve clinical outcomes for mHealth interventions for chronic pain.

Innovative behavioral health interventions in medical settings are often constrained by financial and structural barriers within the U.S. health insurance system. Providers are caught between two billing pathways: DSM-based codes, which do not reflect health-focused interventions, and health and behavior codes, which remain inconsistently recognized and poorly reimbursed. This disconnect makes it difficult to sustain innovative care despite clear clinical benefit. Moreover, it stifles clinical advancements and contributes to health inequity. The Comfort Ability&#xae; Program (CAP) intervention, a family-based, group treatment for pediatric chronic pain, illustrates both the promise and the challenge of this landscape. The CAP intervention integrates CBT, ACT, MI, and behavior management strategies in a comprehensive one-day format. It has been adopted by more than 45 healthcare institutions worldwide and demonstrates improved outcomes and reduced barriers to care. However, despite clinical success and scalability, CAP faces many reimbursement obstacles in the U.S., reflecting broader systemic issues. This manuscript reviews psychology billing reforms, outlines system-level challenges working within medical settings, and discusses real-world implications for providers striving to deliver integrated, patient-centered care. We propose concrete steps to support clinicians in navigating current barriers while advocating for system-level reforms that can sustain innovation in behavioral health delivery.

Binge eating disorder and loneliness have both been identified as risk factors for developing Type 2 Diabetes (T2DM), and thus require attention and intervention. The interpersonal model of binge eating proposes that interpersonal problems lead to binge eating via the mediating pathway of negative affect. However, it is unclear whether the interpersonal construct of loneliness may serve a similar function. The current study aimed to test a loneliness model of binge eating in a T2DM population. Study participants (n&#x2009;=&#x2009;192; mean age&#x2009;=&#x2009;48.68&#x2009;&#xb1;&#x2009;14.85; 52.1% female gender) completed an online survey including measures of loneliness (UCLA Three-item Loneliness Scale and direct loneliness question), negative affect (Patient Health Questionnaire-4) and binge eating (Binge Eating Disorder Screener-7). We used structural equation modelling to assess the model and analysed mediation effects. The loneliness model of binge eating showed excellent model fit, and negative affect fully mediated the relationship between loneliness and binge eating (95% CI: 0.33, 0.90). Our findings indicate that interventions addressing loneliness may also be effective in reducing binge eating behaviours, contributing to the growing body of research emphasising the impact of loneliness on those living with T2DM.

Assistive technologies have the potential to enhance the quality of life of older adults and their caregivers. However, long-term adoption in real-life settings remains limited, and the non-technological factors influencing sustained use are not fully explored. This study investigates how socio-demographic, psychological, and caregiving-related variables affect the acceptance and usability of assistive technologies over time. Seventy-eight community-dwelling older adults participated in a one-year pilot evaluating a socialization platform and a health/environmental monitoring system. Usability (SUS) and acceptance (Almere Model constructs) were assessed at baseline, 6&#xa0;months, and 12&#xa0;months. Baseline socio-demographic and psychosocial variables were used to derive user profiles through k-means clustering. Linear mixed-effects models examined profile-dependent longitudinal trajectories, complemented by regression-based models testing independent predictors. Two distinct baseline profiles were identified, differing in age, digital skills, technostress, loneliness, and perceived support. Profile membership predicted divergent longitudinal trajectories across usability and multiple acceptance domains. The digitally resilient profile demonstrated higher usability and more favourable changes over time. Across regression models, technostress and loneliness consistently emerged as robust negative predictors, independent of time and scenario. Attrition analyses did not reveal systematic baseline differences between completers and dropouts. Technology acceptance among older adults is structured by baseline psychosocial and digital configurations rather than exposure alone. Integrating baseline profiling with longitudinal modelling provides a framework to understand heterogeneity in gerontechnology adoption and highlights modifiable factors that may support sustained engagement.

Chronic pain and eating problems frequently co-occur, with disordered eating behaviors such as emotional eating, food restriction, and appetite fluctuation contributing to adverse outcomes. However, there are no validated screening tools specifically designed for assessing eating problems in chronic pain populations. This study aimed to validate two brief eating disorder measures, the Eating Attitudes Test-8 (EAT-8) and Eating Disorder Examination-Questionnaire-8 (EDE-Q8), for English-speaking adults presenting for chronic pain treatment. Participants included 173 adults seeking treatment at a pain evaluation service. Participants completed the EAT-8 and EDE-Q8 alongside self-report clinical measures. Demographic and clinical data were extracted from medical records. Statistical analyses assessed internal reliability, construct validity, and differences in eating disorder measures by BMI and eating disorder history. Both the EAT-8 and EDE-Q8 demonstrated acceptable internal reliability (McDonald's omega&#x2009;&#x2265;&#x2009;0.7) and strong construct validity, with significant correlation between the two measures (r&#x2009;=&#x2009;0.77). Scores varied significantly by BMI and eating disorder history, with higher scores observed among participants with obese BMI or a history of eating disorders. However, less than 20% of participants felt the measures fully captured their experiences, suggesting potential gaps in assessing eating problems specific to chronic pain. The EAT-8 and EDE-Q8 are valid and reliable tools for identifying disordered eating behaviors in chronic pain patients. However, these measures may not capture the full spectrum of eating problems unique to this population. Future research should refine screening tools to better assess eating behaviors as they relate to chronic pain.

Emerging work characterizing youth with chronic pain increasingly recognizes a large cohort of youth with co-occurring chronic pain and autism. This development has prompted questions about how to adapt Intensive Interdisciplinary Pediatric Pain Treatment (IIPTs) and the group-based treatments commonly used in these settings to improve accessibility, acceptability, and utility for autistic participants. There is a need for clinically oriented literature that IIPT programs and clinical trialists can use to guide adaptation efforts. Given long-term risks of inadequately treated pediatric pain, we argue it is clinically and ethically important to identify reasonable autism-informed adjustments within existing IIPT frameworks, even as more empirical work unfolds to inform nuance. In this narrative review, we synthesize evidence from pediatric pain psychology and autism intervention literatures to identify overlapping mechanisms and opportunities for adaptation, with a specific focus on group-based CBT/ACT-oriented treatments delivered in IIPTs. We summarize emerging clinical characteristics of autistic adolescents enrolled in IIPTs, bridge autism and pediatric pain group treatment literature, map that literature onto pediatric pain targets and autism-informed IIPT group design considerations and provide practical examples of IIPT group modifications extended from the existing data and the authors' clinical experience delivering group-based pain psychology services to autistic youth in IIPTs. We also highlight constraints of group formats for autistic youth and emphasize flexible pathways of care.

Despite benefits for patients, families, and healthcare professionals, psychology remains only partially integrated into hospital care. A brief, practical questionnaire for routine use could help understand staff perceptions and support psychologists' integration. This study aimed to (a) develop and validate the Psychologist in Hospital Questionnaire (PHQ), an 18-item self-administered Italian instrument designed to assess staff perceptions of psychologists' roles in three domains: support for patients and families, integration into care pathways, and support and training for staff; (b) examine whether domain scores reflect professional and organizational differences. Between December 2024 and May 2025, all healthcare professionals were invited to complete the PHQ in a general hospital in Southern Italy. The instrument's psychometric structure was tested via confirmatory factor analysis (CFA), and its internal consistency was assessed with Cronbach's &#x3b1;. Differences in PHQ scores across professional and organizational variables were examined. CFA, performed on a sample of 347 participating staff, supported the three-factor structure with good fit indices and high internal consistency (&#x3b1;&#x2009;=&#x2009;0.80-0.89). Psychologists were most valued for supporting and training staff, followed by supporting patients and families. Greater awareness of psychologists' support was observed among staff in units with regular access to psychologists and in medical units, supporting construct validity. The PHQ is a reliable 18-item tool suitable for routine evaluation of staff perceptions of psychologists' roles. Its use may guide hospital service planning and foster organizational models that strengthen psychologists' presence in healthcare teams.

Sickle cell disease (SCD) is a hemoglobin disorder impacting red blood cell and resulting in difficult-to-control pain, which significantly impacts quality of life and psychological wellbeing. There are barriers preventing patients living with SCD from receiving psychological care, and limited work demonstrating best psychological pain care practices. We describe two innovative approaches for incorporating psychological care in two clinics (i.e., pediatric and adult) serving patients living with SCD in a Southeastern United States health system. The first is psychological screening and referral to psychotherapy program. The second is a mindfulness program offering bedside interventions, retreats, and individual sessions. These innovative treatment approaches emphasize adapting psychological care to address care barriers (e.g., access to care, cultural stigma). Adaptable, patient-centered psychological approaches may positively impact pain and decrease healthcare utilization in clinics serving patients managing SCD. Case studies highlight the importance of flexibility and adaptation in service delivery. Both programs are feasible in demonstrating uptake, coordinating across programs, and working with medical providers. Future research and clinical efforts should continue developing adaptable, culturally sensitive psychological approaches to target pain in patients living with SCD, improve quality of life and psychological wellbeing in patients managing SCD, and positively impact health systems.

BACKGROUND: With China&#x2019;s rapidly aging population, addressing the health management of mild cognitive impairment (MCI) in community settings has become crucial for dementia prevention. This study focuses on developing an integrated primary care intervention (IPC) within primary care system to support home-dwelling older adults with MCI and explore the underlying barriers based on the Consolidated Framework for Implementation Research (CFIR) to the implementation and further scale up of the IPC intervention. METHODS: This study employs a hybrid effectiveness-implementation research type II design. The randomized controlled trail will be conducted to evaluate the IPC intervention for older adults with MCI through primary care networks. The intervention group receiving 16-week family doctor contract services (including online cognitive training, enhanced health management, and usual care) and the control group receiving usual care only. Effectiveness will be measured through changes in participants&#x2019; cognitive function (primary outcome), self-efficacy and quality of life (secondary outcome), complemented by cost-effectiveness analysis. Implementation factors will be examined through the CFIR before and during the intervention process. DISCUSSION: This study is expected to demonstrate the effectiveness and implementation of the IPC intervention in managing older MCI adults within primary care setting. The implementation analysis will identify key factors for scaling up the intervention within China&#x2019;s primary care system, including necessary policy adjustments and training requirements for primary care providers. The findings will provide both practical guidance for China&#x2019;s dementia prevention strategies and contribute to global knowledge about implementing community-based cognitive health interventions in primary care settings. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2500099744. Registered 27 March 2025.

There is a lack of broader, systematic research examining differences in health-related quality of life (HRQoL) among elderly hypertensive populations across urban and rural settings. This study evaluates these disparities and identifies key influencing factors among urban and rural settings. Data were extracted from the Northern China Lifestyle Medicine Cohort (NCLM-Cohort. ChiCTR2500096200; Registration date:2025/01/20) study, which covers four Provinces. Tobit regression and logistic regression analyses were used to assess the relationships between variables and Health Utility Value (HUV), Visual Analogue Scale (VAS) scores, and reported EQ-5D-5L (5L) issues reported in urban and rural participants. The Shapley value decomposition method, which is based on logistic regression analysis, was employed to quantify the weights of each influencing factor. Propensity score matching (PSM) was used to minimize potential confounding bias. A total of 7,062 participants (21.24% urban and 58.16% female) were included. The urban HUV (median 1.000) was greater than the rural HUV (median 0.942), and reported fewer health issues. After PSM, there were net differences in urban-rural HUV (0.009) and reported self-care (7.63%), usual activities (3.37%), and pain/discomfort issues (11.57%). Physical activity was the protective factor for HRQoL and contributed most significantly to decline reporting 5L issues. Medication adherence and the duration of hypertension had conflicting effects on urban-rural HRQoL. Urban HRQoL was driven primarily by clinical and health factors and educational factors, whereas rural HRQoL was influenced predominantly by modifiable health behaviors and economic factors. Compared with rural counterparts, urban participants demonstrated superior HRQoL and fewer health issues, indicating a significant urban-rural health disparity. To address this gap, policymakers should implement differentiated intervention strategies: Urban interventions should integrate mental health services into primary care and strengthen hypertension-related health literacy. For rural populations, policies must prioritize infrastructure development and economic subsidies, and healthcare providers should support them in maintaining adequate sleep and good medication adherence.

Inherited cardiac conditions (ICC) require lifelong management and raise significant psychological challenges. Patients with suspected ICCs typically begin their journey with a clinical diagnosis in cardiology, an often-distressing experience that leaves them feeling vulnerable. Yet, psychological care remains inconsistently integrated into cardiogenetics, while fields such as oncogenetics, reproductive genetics, and neurogenetics have integrated psychological support much earlier. These latter fields are driven by ethically complex decisions like prophylactic surgery, pregnancy termination, and predictive testing for conditions such as Huntington's disease. Consequently, psychologists in those fields are routinely involved across all stages of genetic testing, offering emotional support and guiding decision-making. Despite growing openness to biopsychosocial approaches, cardiogenetics has traditionally prioritized symptom management, medical interventions, and risk stratification, with less attention for emotional and psychosocial needs.As a result, patients with ICCs may remain vulnerable to distress, grief, and uncertainty, especially when a genetic risk (carriership of a pathogenic variant in an ICC gene) is discovered, following events like the sudden cardiac death of a relative. Many carriers struggle with guilt, fear of passing on a pathogenic variant, and challenges in family communication, all of which can impact adherence to medical advice.Drawing on international experiences of disparities observed across countries and centres, this viewpoint calls for the structured integration of psychologists in cardiogenetic care teams, emphasizing their role in patient-centred communication, informed decision-making, and long-term psychological support.

The goal of this project was to examine the impact of the Behavioral Health Consultant Continuing Education course on training licensed behavioral health professionals to provide clinical services utilizing the primary care behavioral health (PCBH) model for behavioral health integration. Three cohorts of learners participated in a 10-month long course concentrated on competency development within the PCBH model over a 3-year period. This course focused on preparing licensed behavioral health professionals to function as behavioral health consultants (BHCs) in primary care settings in rural and urban areas. The course was held in person and virtually. Learners completed pre- and post-BHC competency development surveys. Post-course surveys were completed to evaluate satisfaction with the content and impact of the course on PCBH skill development. The results indicate that the program yielded improvements over time, with benefits evident across modules and cohorts. While localized differences existed, they were relatively small and did not significantly impact the overall pattern of learning gains. These findings strongly support the program's effectiveness in enhancing knowledge and skills among participants. Overall, this demonstrates an approach to building and evaluating continuing education content for behavioral health professionals within the PCBH model. Virtual and in-person courses developed using adult learning frameworks for busy behavioral health professionals show promise as an approach that institutions of higher education and health care organizations can adopt to improve the clinical practice of BHCs in primary care settings.

To compare the effectiveness of Cognitive Behavioral Therapy (CBT), Biofeedback and their combination on pain catastrophizing, sleep quality, and headache-related disability among patients with chronic daily headache (CDH).In a randomized controlled trial conducted at a tertiary care hospital in North India, 100 patients diagnosed with CDH were randomly assigned to four groups: CBT (n&#x2009;=&#x2009;25), Biofeedback (n&#x2009;=&#x2009;25), Combined CBT&#x2009;+&#x2009;Biofeedback (n&#x2009;=&#x2009;25) and Treatment-as-Usual (TAU; n&#x2009;=&#x2009;25). Assessments were conducted at baseline, post-intervention, and at a 2-month follow-up using the Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Migraine Disability Assessment Scale (MIDAS). Significant time effects were observed for all outcomes-pain catastrophizing (F&#x2009;=&#x2009;147.39, p&#x2009;<&#x2009;.001, &#x3b7;2&#x209a;&#x2009;=&#x2009;0.67), sleep quality (F&#x2009;=&#x2009;92.68, p&#x2009;<&#x2009;.001, &#x3b7;2&#x209a;&#x2009;=&#x2009;0.56), and headache-related disability (&#x3c7;2&#x2009;=&#x2009;99.10, p&#x2009;<&#x2009;.001). Time&#x2009;&#xd7;&#x2009;group interactions were also significant for PCS (p&#x2009;=&#x2009;.026) and PSQI (p&#x2009;=&#x2009;.048), indicating differential patterns of improvement across interventions. Post-hoc analyses revealed that the combined CBT&#x2009;+&#x2009;BFB group showed the greatest and most sustained improvements in pain catastrophizing and sleep quality. Headache-related disability decreased significantly in all intervention groups. CBT and Biofeedback are effective psychological interventions for managing chronic headache, with their integration producing superior and sustained outcomes. The findings highlight the utility of multimodal interventions that target both cognitive-emotional and physiological processes in chronic headache management.

Psychology training concentrates on psychological theory, clinical assessment, diagnosis, intervention, research, interpersonal skills, diversity and ethics. Emphasis is on increasing scientific and professional knowledge about human behavior and psychologists learn to support behavioral change, form and maintain relationships, teach others to improve coping skills, promote decision-making and personal potential, while supporting individual development. It is rare that psychologists are provided education on the business aspects of psychology, which focuses on coding, billing, productivity expectations and understanding how our work translates into collections for our academic health centers. This article outlines ways in which productivity is measured, discusses reimbursement for services, outlines billing and coding challenges, puts forth recommendations on how to best utilize time for maximum benefit and discusses the importance of advocacy for psychologists and our work in academic health centers.

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, 'Empathy is about truly connecting-the dominant healthcare professional view', included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, 'Empathy cannot be taught; it is something that you have', focussed on behavioural, outcome-oriented aspects; Factor 3, 'Empathy requires communication that goes both ways', prioritised behavioural and cognitive aspects; and Factor 4, 'Lack of empathy makes patients feel abandoned-the dominant patient view', reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically&#xa0;informed healthcare for FMS.

The way in which behavioral health providers (BHPs) in integrated primary care settings function and what is needed for their success has not been systematically examined. The present study used direct observation to capture integrated BHPs' clinical activities, workflows, and team interactions. Observations took place in seven integrated primary care clinics in a single health system. The model of integration combined components of the Primary Care Behavioral Health model and the Collaborative Care Model. A trained Research Service Professional (RSP) observed 13 BHPs each during one typical clinical day in an integrated primary care clinic. Data collection methods included surveys, process maps, time tracking, and field notes. We used quantitative and qualitative analysis to describe BHPs' activities. During the days observed, BHPs conducted 77 patient visits and many other activities, including supervising learners. BHPs' clinical time was divided among direct patient care (56%), administrative tasks (29%), and consultation with team members (15%). Process maps revealed similar workflows across BHPs/practices with differences in completing screening, rooming, and scheduling patients. BHPs supervising learners saw on average more patients per day than BHPs on their own (5.1 vs. 7.6). BHPs interacted with all practice team members, and most frequently with medical providers, social workers, care managers, and nurses. BHPs provide clinical care to primary care patients on a wide variety of concerns and spend time on other important team-based tasks. Recommendations for optimizing workflows, reimbursement models, and team-based care from these observations are provided.