CARE Research Project: Mental Health Assessment and Treatment of Children

Title of Research: Mental Health Assessment and Treatment of Children

Name of Investigator(s): Harolyn M. E. Belcher, M.D., M.H.S.

Dr. Belcher is Director of Research, Kennedy Krieger Family Center (KKFC) and anAssociate Professor at the Johns Hopkins School of Medicine

Brief Description of Summary Research, including Goals and Objectives:
In 1985, the KKFC began as an outpatient program of KKI in response to the many unmet mental health assessment and treatment needs of children living in out-of-home placements. Many of the children treated at the KKFC have a history of cumulative trauma through neglect, physical/sexual abuse, exposure to domestic and community violence and parental substance abuse. Treatment services are provided through center-based, home-based, school and Head Start Programs. Specialty clinics include the Birth to Five Program (specializing in working with children birth to five years of age and their caregivers), CHERISH (targeting children with drug and trauma exposure, ages 2 to 8 years), STAR (Safety Treatment Advocacy Recovery) Clinic (treating children who have been sexually abused and their non-offending parent or caregiver), SMART (Safety Mentoring Advocacy Recovery Treatment) Clinic (providing services for sexually reactive abusers under the age of 11), The Family Clinic (designed to address the negative and entrenched interpersonal patterns of families affected by multi generational sexual and physical abuse, substance abuse and out-of-home placement) and The Group Therapy Clinic (which has developed more than 15 theme-centered, curriculum-based groups to help children and adolescents manage the effects of traumatic stress), to name a few. The multi-disciplinary staff of the Center has expertise in working with mild to severe and/or chronically traumatized children and families. The Center’s 97 staff and faculty include child psychiatrists, child psychologists, clinical social workers, case managers, psychiatric rehabilitation counselors, respite specialists, family advocates, nurses, early childhood educators, recreational therapy assistants, and administrative support staff. The Center’s service continuum reaches 1,100 children annually through services including outpatient psychiatric, psychological and mental health assessment and treatment, respite care, psychiatric rehabilitation and case management, and also through its Treatment Foster Care Program and Early Head Start Center.

  1. Clinical Outcome Study: This study involves baseline, 6 month and one year assessments of families in treatment at the Family Center. The research extern will learn how to conduct standardized questionnaires including the Child Behavior Checklist (CBCL), Parent Stress Index (PSI), Trauma Symptom Index (TSI), University of California, Los Angeles Post Traumatic Stress Index (UCLA PTSD). Data input skills will also be reinforced. The extern may target a specific area of the outcome assessment to analyze for their research project. Data from a clinical database established in 1996 is also available for analysis. Mentored abstract and manuscript development will also be available.
  2. CHERISH (Children Healing from Exposures through promoting Resiliency, Initiative, Safety, and Health relationships) Program was developed to evaluate the use of evidence-based mental health programs for children with intrauterine drug exposure and maltreatment. Psychological tests are conducted on the caregiver and child (by Neuropsychology), in addition to the CBCL, PSI, TSI, UCLA PTSD at baseline, 3 months, and discharge. The research extern may accompany the family during psychological testing. The extern will conduct standardized questionnaires and input accompanying data. Data analysis opportunities, abstract, and manuscript development will also be part of the research experience.
  3. KKFC-DES Reliability Study The KKFC-DES was developed to address some of the weaknesses in the current assessment instruments for children exposed to violence, including the overemphasis on diagnosis and the lack of emphasis on how the child was functioning daily. The KKFC-DES is divided into seven domains: (1) attachment, (2) self-regulation, (3) developmental competencies, (4) functioning in systems, (5) perceptions of permanency, (6) psychobiological functioning, and (7) capacity for narration of trauma. The KKFC-DES is a clinician-administered questionnaire that is performed during the mental health visit. The majority of the 66 responses are elicited from the child’s caregiver. Several questions, listed below, are asked of children whose developmental age is four years or greater. Responses are scored on a Likert scale, from “almost never” to “almost always”. Following the initial reliability testing of the first version of the KKFC-DES, clinicians and caregivers provided feedback on the comprehension level of the items, the structure of the measure, and the clinical utility of the interview. A revised version of the KKFC-DES was developed to improve comprehension and domain correlations. The proposed study will analyze the responses elicited on the revised KKFC-DES to establish the internal consistency and reliability of the revised KKFC-DES using an additional 50 caregiver-child dyads currently under treatment with six senior clinicians at the KKFC and their caregivers.

Scope of Duties for Research Student:
This placement will provide direct experience with structured clinical interviewing, parent and child behavioral and emotional questionnaires, test scoring and data entry. Duties may include conducting a literature review, database management, and preliminary data analysis. More advanced students may also have the opportunity to participate in manuscript preparation and/or dissemination of research findings at professional meetings and conferences. 

Level of Student Education and Major/Disciplines Desired:
Students majoring in psychology, social work, public health, sociology, biology, pre-med, or other related disciplines are recommended for this research experience. Coursework in social/behavioral sciences and research methodology is also recommended. Data input experience is desirable. Undergraduate juniors, seniors, or graduate students preferred.