RESEARCH - Other Topics

Child Psychiatry Consultation to the Pediatric
Emergency Department

Principal Investigator: Emily Frosch, MD

Over the last 10 years, we have been tracking demographic and clinical characteristics on all consultations completed by child psychiatry residents in the Pediatric Emergency Department (PED). In addition to an overall marked increase in total volume of cases seen in the PED which parallels the national trend, there has been a marked increase in use of the PED by patients who have prior mental health service events--e.g. prior PED visits, prior hospitalizations, prior suicide attempts, and ongoing outpatient care. The aim of the current project is to clarify which patients are using which services so that we can better develop more targeted interventions both prior to PED use and in the PED and further characterize which patients are seeking care in that setting. It is our hypothesis that there has not been an increase in the number of patients for whom the term "emergency" is typically applied--suicide attempt and psychosis, but rather the increase in use of the PED will be accounted for by aggressive/disruptive youth who have exacerbations of chronic problems.

Child Psychiatry Consultation in Pediatric Primary Care

Principal Investigator: Emily Frosch, MD

The Harriet Lane Clinic (HLC) provides primary pediatric care to 7,000 kids each year, in over 20,000 visits. Most of those families are from the local East Baltimore area and face a number of obstacles to accessing care. Part of the HLC vision is to provide a "one stop shopping" model of care for these youngsters and families. Grants from Straus and Blaustein Foundations now support both a full time mental health screener as well as a part time treatment provider. The primary aim of the project is to track clinical and demographic characteristics of the patients that the screener sees and which cases land in the CMHC so that we can better identify who needs which type of referral at the front end to optimize the chances that the patient and families make a connection to mental health services. In addition, we surveyed the pediatric housestaff about their knowledge/skills/attitudes about mental health issues in their patients prior to providing the screening/referral service. We will be following up on that survey to see if there is any change in knowledge/skills/ attitudes with the new teaching/consultation services in place.  

Do Human Line Drawings Promote Children’s
Accurate Reporting of Touching

Principal Investigator: Maggie Bruck, Ph.D.

Although human line drawings (HLDs) are commonly used by medical, mental health, and educational professionals who interview children about suspected sexual abuse, there is little scientific information about their validity. The major objective of this proposal is to determine, within a cognitive developmental framework, the benefits and risks of using HLDs in interviews with 4-8-year-old children who are questioned about past events that involved "touching." In one set of studies the event involves a play activity and in the second set of studies the event involves a medical examination. The results of these studies will be important for professionals who interview children about sexual abuse or about their bodies in general. They will provide scientific information about the risks and benefits of a technique for young children who often do not readily provide important information when asked for it. In addition, guidelines for the most effective uses of the instrument will be provided. This study is not soliciting volunteers.

Maryland State Public Mental Health Initiative for
 Reducing Seclusion and Restraint Use Among Adolescents

Principal Investigator: Susan dosReis, Ph.D.

The research is a collaboration between JH Child & Adolescent Psychiatry; UM Child & Adolescent Psychiatry; Maryland Mental Hygiene Administration. The aims of the study are to evaluate the use of seclusion and restraint for agressive behavior among adolescents in public psychiatric residential and inpatient facilities and to explore the child characteristics that are correlated with the use and frequency of interventions. It is a naturalistic study that involves retrospective data on the clinical treatment of adolescents and the management practices for aggressive behavior. These data have been collected from the medical records at two of the state residential institutes for children and adolescents (RICA), which are residential treatment facilities. We have data on nearly 300 adolescents who were admitted from 2000 through 2004. In addition, we have conducted a qualitative component that entailed interviewing staff about their experiences in identifying, preventing, and managing adolescents who become aggressive. Two publications and one manuscript currently in review have been generated from this work. The long-term outcome of this work is to determine if a seclusion/restraint reduction protocol, which was developed by researchers and clinicians in this collaborative group, results in a reduction in the use of these interventions. This research will inform future policies and procedures around the best practice approach to manage aggressive behavior among adolescents in residential treatment.

Publications:

Barnett, S. R., dosReis, S., Riddle, M. A., & MYPIC. (2002). Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youths. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 879-905.

dosReis, S., Barnett, S., Love, R. C., Riddle, M. A., & MYPIC. (2003). A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities. Psychiatric Services, 54(10), 1357-1363.

Relationships of Metacognition and Suggestibility
in Middle Childhood

Principal Investigator: Maggie Bruck, Ph.D.

This project examines the development of metasuggestibility (awareness that a person’s report or memory of their personal experiences can be tainted by another person’s statements or suggestions) in middle childhood and the degree to which this metacognitive skill is causally related to children’s suggestibility in the middle childhood years. The research also examines if training children to be aware of suggestion in interviews can reduce their own suggestibility. The results of her studies will have important implications for constructing scientifically validated interviews that produce the most accurate reports from children and for constructing instruments to detect children who are prone to suggestive factors. These instruments can be adapted for use in schools, mental health, medical, and forensic contexts. This study in not soliciting volunteers.