Scientific Advisory Counsel (SAC) review
Behavioral Medicine and Clinical Psychology had a Scientific Advisory Counsel (SAC) review this year. The external reviewers cited BMCP as unique in the country for the breath of clinical services and level of NIH funding within a division of behavioral medicine. In FY13 BMCP was once again second in the institution for external funding. We were also cited as one of the most collaborative divisions in terms of clinical services and research funding.
New Clinical and Research Program Dedicated to CBDI
Ahna Pai, Ph.D. became the Director of the Patient and Family Wellness Center in the Cancer and Blood Diseases Institute (CBDI). The Wellness Center is a new psychosocial clinical and research program dedicated to advancing the behavioral, emotional, cognitive, and spiritual outcomes of patients served through the CBDI and their families. Dr. Pai is a nationally recognized researcher in transplantation, oncology, and adherence. She currently has two R01 grants. The first is a prospective study of adherence to the outpatient oral and intravenous medication regimen in children who have received hematopoietic stem cell transplants. The second is a randomized clinical trial of a clinic-based intervention to improve adherence in adolescents and young adults with kidney transplants. Children, adolescents and young adults with oncological, hematological, and immunological diseases face many challenges including the disruption of family routines, management of highly complex and prolonged treatment regimens, and uncertain prognoses. Dr. Pai plans to hire nine clinical faculty to develop innovative services where children, adolescents and young adults can receive ongoing psychosocial care as part of their medical treatment. In addition, Dr. Pai will recruit and hire three research faculty to conduct state of the art, innovative research in adherence, adolescence and young adulthood, health care delivery, and cost-effectiveness.
Dissemination of Evidenced-Based Care for ADHD
Jeffery Epstein, Ph.D., director of the Center for ADHD, working with the Center for Technology Commercialization, signed a licensing agreement with Optimal Medicine Inc. to distribute an internet-based software program called myADHDportal.com. myADHDportal.com is a comprehensive website that integrates training in proper ADHD care for physicians, electronic collection of ADHD rating scales, and integrated interpretive algorithms to assist physicians in diagnosing and treating ADHD in accord with evidence-based guidelines. This innovative software includes automated tracking of medication and parent and teacher ADHD ratings and e-mail notifications to physicians when there are significant changes in patient functioning, or side effects of medication. The software also includes functionality to facilitate communication between physicians, parents, and teachers in order to optimize the care of children with ADHD; thus optimizing health and educational outcomes. Several quality improvement modules are integrated into the software that lead physicians through quality improvement procedures to embed best practices into their clinical setting. An NIH-supported clinical trial has demonstrated that the use of myADHDportal.com improves the level of ADHD care delivered by community-based physicians. Though our licensing partnership with Optimal Medicine Inc., we will be able to spread this technology developed and tested at CCHMC to enhance evidence-based care of children with ADHD worldwide.
Dissemination of Evidence-Based Treatment for Depressed Mothers in Home Visiting
With Every Child Succeeds, Robert T. Ammerman, Ph.D. has developed a program to disseminate an innovative and tested treatment for depressed mothers participating in home visiting services. These mothers are at great risk for depression, and depression impacts their children and prevents them from fully benefiting from home visiting programs. Using grants from NIH and The Health Foundation of Greater Cincinnati, In-Home Cognitive Behavioral Therapy was evaluated in a clinical trial and found to be highly effective. Through Moving Beyond Depression™ (MBD), the treatment is being disseminated to other home visiting programs around the country. Treatment programs have been established in Kentucky, Connecticut, and Kansas, and a contract is in place to bring the approach to Massachusetts. As there are up to 200,000 mothers in home visiting programs nationally who also suffer from depression, MBD has the potential to greatly impact the lives of new mothers and their children and optimize outcomes for both.
NIH Funds Follow-up of Older Adolescents with Type 1 Diabetes
Adolescence is a time of heightened vulnerability and poor glycemic control in type 1 diabetes and is also a time when lifelong patterns of diabetes management are established. Relatively little is known about specific risk and protective factors that influence individual difference in trajectories of glycemic control over the course of adolescence. A multisite investigatory team led by Dennis Drotar, PhD., Behavioral Medicine and Clinical Psychology and including Larry Dolan, MD., Endocrinology, was funded by NIH in a renewal R01 to continue their follow-up of 230 adolescents with type 1 diabetes for five more years. This longitudinal study will identify modifiable psychological and illness management influences in trajectories of glycemic control in older adolescents with type 1 diabetes. Findings will guide the development of preventive interventions that 1) Are tailored to problematic glycemic control and health complications 2) Target empirically derived profiles of modifiable risk factors that influence treatment adherence and glycemic control and 3) Are delivered at the optimal time to prevent health complications during adolescents’ transition to adult care for type 1 diabetes. This is a great example of the collaborative, sustained, and programmatic science led by many faculty members in the Division of Behavioral Medicine and Clinical Psychology.
NICHD funds the 30-year follow-up of a cohort of females abused as children
Jennie Noll, PhD is the PI on a multisite R01 that extends a study that began in 1987 and has retained 96% of a sample of females who experienced substantiated sexual abuse. The study includes a demographically matched comparison group in an accelerated longitudinal, cross-sequential design spanning 6 previous timepoints (T1-T6). A multi-level, bio-psycho-social assessment was repeated three times in childhood/early adolescence (mean ages 11, 12 & 13), twice in late adolescence (mean ages 18 & 19), and once in early adulthood (mean age 24). Over 90% of offspring were assessed at T6 (mean age 4). Results from this unique study published thus far in developmental, psychological and medical journals have provided some of the most definitive evidence for the acute and long-term sequelae of sexual abuse. Because participates were able to be followed continuously throughout their lives, the findings have also produced unprecedented snapshots of the early developmental course of several important maladies including obesity, accelerated puberty, attenuated acquisition of cognitive abilities, and Hypothalamic Pituitary Adrenal (HPA) axis dysregulation.
This new grant will fund the 7th and 8th assessment points (T7-8), following the participants into their 30s and 40s in order to test the relative impact of early maldevelopment on later functioning in adulthood. Capitalizing on the adulthood period allows examination of key outcomes (such as physical health outcomes and adulthood autonomy) that were not fully detectable earlier in development. At T7-8, the majority of children of the original participants will be at ages when their mothers were first assessed, allowing the examination of intergenerational risk through the use of identical instrumentation and observation techniques. This study is significant because it will describe the impact of childhood sexual abuse on key adulthood outcomes of major public health concerns and the intergeneration effect on the offspring of women with a history of sexual abuse.
As a first step toward enhancing patient access to medical information and to better understanding how to engage adolescents and young adults in using a patient health portal, a research team led by Lori E. Crosby, Psy.D. designed and tested a sickle cell disease-specific version of My Chart. MyChart is a web-based patient health portal that contains personal health information from the user’s electronic medical record, EPIC, at CCHMC. MyChart for Sickle Cell Disease can be accessed via the internet and a mobile application for MyChart. To help patients become familiar with the portal, they were asked to complete four homework assignments (e.g. graphing a test result) over 6 weeks. The goal was to encourage patients to use the portal on a regular basis and test whether the patients would find the portal easy to use, beneficial, and if the portal would have an impact on patient’s health-related quality of life. The patients rated the portal as easy to use (average rating = 3.3 out of a 5-point scale) and useful for their overall health management (average rating = 4.3 out of a 5-point scale). Patients have viewed/used the following portal features most often: 1) Lab results, 2) Medications, 3) Messaging, and 4) Appointment Review. Patients logged in an average of 6.59 times over six months (range: 0-39). However, the most exciting finding is that patients who completed the homework assignments reported improvements in their health-related quality of life over a 6 month period. The goal is to spread the use of the patient health portal to additional patients with sickle cell disease within CCHMC and at other pediatric hospitals.