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Psychological and Behavioral Intervention in Pediatric Acquired Brain Injury

Principal Investigator:
Keith
Slifer

Psychological and behavioral interventions are recognized as beneficial components of pediatric rehabilitation; however, there are few empirical studies evaluating the benefits of providing these interventions during 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 in association with multidisciplinary medical appointments.

The current study will examine medical clinic records for patients seen in and referred from multidisciplinary pediatric specialty neurorehabilitation clinics that serve patients who have experienced TBI (e.g. Neurorehabilitation Follow-up clinic, Concussion clinic, etc.) at any of the Kennedy Krieger Institute facilities. These clinics are staffed by representatives from medicine, nursing, pediatric psychology, neuropsychology, etc.

The role of the behavioral therapist/pediatric psychologist in these clinics 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 specialty clinic).

This study will be a retrospective record review of children and young adults who were seen in one of the brain injury outpatient clinics from January 1, 1999- December 1, 2014. The current study will systematically analyze 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 specialty clinics and inform recommendations and direction for clinicians in the field of pediatric brain injury rehabilitation. Data will be retrieved by one of several behavioral therapists who provide clinical services in the respective clinics. Once these data are collected, we will create a database that is de-identified of all protected health information.

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