Community and Service

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.  

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. This study examines the use of seclusion and restraint for acute aggressive 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 using retrospective data on the clinical treatment of adolescents and the management practices for aggressive behavior. Data on 298 adolescents were collected from the medical records at two of the state residential treatment facilities.  In addition, we have conducted a qualitative component that entailed interviewing staff about their experiences in identifying, preventing, and managing adolescents who become aggressive. We have used longitudinal models to examine patterns in seclusion and restraint use over the course of a residential stay.  Three publications, one manuscript currently in review, and one in preparation have been generated from this work. This research will inform future policies and procedures around the best practice approach to manage aggressive behavior among adolescents in residential treatment.

Publications:

Barnett SR, dosReis S, Riddle MA, Maryland Youth Practice Improvement Committee.  Improving the management of acute aggression in state residential and inpatient psychiatric facilities for youth.  Journal of the American Academy of Child and Adolescent Psychiatry.  2002; 41(8):897-905.

dosReis S, Barnett SR, Riddle MA, Maryland Youth Practice Improvement Committee.  Recommendations for managing acute aggressive behavior of children and adolescents in residential and inpatient treatment facilities.  Psychiatric Services. 2003; 54(10):1357-1363.

Personalizing Child Mental Health Services for Families

Principal Investigator: Susan dosReis, Ph.D.

This study seeks to develop a tool that will help clinicians identify strategies that work best to engage and retain parents in mental the mental health care of their child with attention-deficit/hyperactivity disorder (ADHD).  The aims of the research are to 1) develop a tool to integrate parental care-seeking groups with clinicians’ engagement strategies; 2) evaluate the feasibility of using the tool in clinical practice; and 3) determine which engagement strategies work best for certain families based on engagement and treatment adherence at 12 months.  The first phase of this research is underway.  It involves monthly focus groups with clinicians to develop the tool.  The long-term objective is to integrate clinical treatment planning decisions with individual families' preferences.  From this perspective, future studies can investigate how children and their families may benefit from customized community mental health treatments.

Learn more about Child and Adolescent Community Psychiatry at Johns Hopkins