Psychological and Behavioral Intervention in Multidisciplinary Pediatric Acquired Brain Injury Rehabilitation

Principal Investigator: Keith Slifer

Psychological and behavioral interventions are recognized as beneficial components of pediatric rehabilitation; however, there are few empirical studies evaluating a collaborative multidisciplinary approach to rehabilitation after acquired brain injury (Traumatic Brain Injury-TBI, concussion, brain tumor, stroke, etc.). While brain injured patients are at increased risk for externalizing and internalizing behavior and/or social problems secondary to injury, these patients are also less likely to self-refer for psychological treatment. Therefore, one possible way to reach this at-risk population is by providing psychological and behavioral services during multidisciplinary follow-up medical appointments. The current study will examine medical clinic records from a multidisciplinary pediatric neurorehabilitation follow-up clinic located at the Kennedy Krieger Institute.

The clinic is staffed by representatives from medicine, nursing, pediatric psychology, neuropsychology, education, and social work. With neuropsychology assessing cognitive sequelae of TBI and education evaluating patients' academic needs, pediatric psychology is able to focus on psychological and behavioral intervention. The role of the behavioral therapist/pediatric psychologist in this clinic includes assessing emotional and behavioral domains (i.e., mood, behavior, sleep, pain, and other psychosocial/family stressors); providing in-clinic direct psychological and behavioral intervention for managing emotional/behavioral problems; and recommending other psychological interventions as needed (i.e., offering continued outpatient behavior therapy, making referrals to local mental health providers, or arranging more frequent follow-up in the pediatric neurorehabilitation clinic).

The current study will systematically analyze neurorehabilitation follow-up clinic data regarding the role of the pediatric psychologist / behavior therapist in multidisciplinary outpatient rehabilitation after brain injury. Specifically, we will quantify the type and frequency of presenting problems addressed, and the types of recommendations provided for each. Quantitative data will be presented for frequency of psychological and behavioral concerns, associations with brain injury type and severity, and specific type of psychological and behavioral recommendations provided to patients and families. Review of medical charts will also provide quantitative data regarding relevant medical history (i.e., psychiatric medication usage), reported sleep functioning, and type of special education services during clinic visits.

Findings will provide insight into the vital role of psychological and behavioral therapists in outpatient neurorehabilitation clinics and inform recommendations and direction for clinicians in the field of pediatric brain injury rehabilitation. Data will be entered into the research data base by one of several behavioral therapists who provide clinical services in the follow-up clinic. The data will be entered with assignment of a participant number and no individually identifying personal information. This will be performed by the therapists either as soon as possible after the participants clinic attendance or at periodic database update intervals (e.g., every 3 or 6 months).