Dennis Drotar - US grants

The research has the following objectives: 1. To develop a family-oriented model of diagnosis and outreach intevention for failure-to-thrive infants and their families. 2. To assess the effectiveness of this treatment model through objective measures of the physical and psychological progress of these infants and their families. 3. To identify the features of parent-child interaction which best predict physical and psychological progress. Failure-to-thrive infants and their family will receive a comprehensive care pattern organized in two separate phases, hospitalization and aftercare, and managed by an interdisciplinary team. This team approach will facilitate family involvement in the diagnostic and treatment process and coordination between medical and psychosocial services. Following hospitalization, the study group will receive a family-oriented mental health intervention focused on the remediation dysfunctional family interactions and reinforcement of adaptive features of parent-infant relationships. The effectiveness of treatment will be evaluated through detailed observations of parent-child interaction and systematic follow-up of infants' physical growth, intellectual, social, and family functioning.

DESCRIPTION (provided by applicant): The purpose of this predoctoral graduate research training program is to train students to conduct clinical, outcome evaluation and applied research with pediatric populations. Graduates are trained to become researchers in the field of pediatric psychology, to work with physicians and members of other professions in collaborative research and to make original research contributions to the field of pediatric psychology. To help them achieve these goals, students have ready access to a wide range of pediatric populations, faculty mentorship and technical assistance for the conduct of research projects at Rainbow Babies and Children's Hospital, which is nationally recognized for its research programs. Key features of the training program include: 1) an intensive research training curriculum, including skill-based courses in research design and program evaluation, scientific presentations, and preparing manuscripts for publication; 2) opportunity to work with diverse research populations; 3) active involvement and mentoring of experienced research faculty from the Case Western Reserve University School of Medicine. Students and graduates have developed scientific contributions concerning mental health and health outcomes of children with chronic health conditions that have been recognized in the peer-reviewed literature and many have begun to establish careers as researchers in departments of pediatrics in schools of medicine. The program addresses the need to train researchers to conduct interdisciplinary clinical research that integrates biologic and psychological approaches in the study of pediatric populations, especially children with chronic health conditions. Students' research addresses critical questions related to health and mental health of pediatric populations.

DESCRIPTION (provided by investigator): Children and adolescents who are unable to adhere to their medical regimen for the management of chronic illness present considerable challenges to health care providers and researchers. Pediatric asthma is a chronic illness where the consequences of non-adherence are particularly detrimental and widespread, especially among economically disadvantaged minority children and their families. Studies of intervention of asthma management are needed for this population. While some controlled intervention research that address barriers to asthma care has yielded promising results, research has been limited by weakness in methodology and generalizability. Non-randomized designs, small sample sizes, lack of objective outcome measures, lack of diversity in patient populations, modest, short-lived improvements in adherence have been limitations. Moreover, research has not evaluated tailored intervention strategies to specific barriers to adherence experienced by economically disadvantaged minority children and families, which may be necessary to develop powerful, clinically relevant interventions. Consequently, new models of behavioral interventions are needed to promote and sustain long-term adherence to asthma treatment among diverse patient populations. To address this need, the primary aim of the proposed study is to test the efficacy of a problem solving intervention that is tailored to the observed adherence behaviors and identified barriers to increasing adherence in African American children and adolescents with asthma, and families. Patients will be randomized to either a Tailored Problem Solving Intervention, or a control group who will receive Family Education Intervention. The primary study outcome will be adherence with prescribed therapy as measured by electronic monitors throughout the study period. Secondary measures will include disease specific morbidity, and symptoms, pulmonary functioning and functional outcomes including health-related quality of life, days of hospitalization, and school absences We hypothesize that adherence with prescribed treatment regimens for pediatric asthma will be enhanced by the use of a problem solving intervention that focuses on reducing barriers to adherence with therapy. The data that will be generated from this study will improve scientific understanding of interventions that are effective in promoting adherence to treatment in pediatric asthma in economically disadvantaged minority children and families.

DESCRIPTION: (provided by applicant): The purpose of this postdoctoral graduate research training program is to train Ph.D. and M.D. fellows to become leaders in the field of child behavioral research. Graduates will be trained to make original research contributions to this field. To help achieve these goals, fellows will have ready access to a wide range of pediatric populations, faculty mentorship, and technical assistance for the conduct of research projects at Rainbow Babies and Children's Hospital, which is nationally recognized for its research programs, and Case Western Reserve University's School of Medicine. Key features of the training program include: 1) an intensive research training curriculum, including skill-based courses in research design, data analysis, grant writing, specific presentations, and preparing manuscripts for publication; 2) opportunities to work with and ready access to diverse research populations; 3) a supportive institutional and collaborative environment in which disciplinary research and research training are highly valued; and 4) active involvement and mentoring of experienced interdisciplinary research faculty whose research focuses on the core themes. These core themes include: a) studies of risk factors and child health and developmental outcomes; b) research on basic psychological processes that relate to child health; c) pediatric behavioral and health genetics; d) psychosocial and pharmacological interventions to promote health and mental health in high-risk populations; and e) bioethics, including research on ethics in pediatric populations. Fellows' research will address critical scientific questions related to health and psychological outcomes of pediatric populations. Fellows will be trained to develop scientific contributions concerning child behavioral health and to establish careers as researchers in academic settings, including schools of medicine. The program addresses the need to train researchers to conduct interdisciplinary clinical research that integrates biological and psychological approaches in the study of pediatric populations, including children with chronic health conditions.

DESCRIPTION (provided by investigator): Children and adolescents who are unable to adhere to their medical regimen for the management of chronic illness present considerable challenges to health care providers and researchers. Pediatric asthma is a chronic illness where the consequences of non-adherence are particularly detrimental and widespread, especially among economically disadvantaged minority children and their families. Studies of intervention of asthma management are needed for this population. While some controlled intervention research that address barriers to asthma care has yielded promising results, research has been limited by weakness in methodology and generalizability. Non-randomized designs, small sample sizes, lack of objective outcome measures, lack of diversity in patient populations, modest, short-lived improvements in adherence have been limitations. Moreover, research has not evaluated tailored intervention strategies to specific barriers to adherence experienced by economically disadvantaged minority children and families, which may be necessary to develop powerful, clinically relevant interventions. Consequently, new models of behavioral interventions are needed to promote and sustain long-term adherence to asthma treatment among diverse patient populations. To address this need, the primary aim of the proposed study is to test the efficacy of a problem solving intervention that is tailored to the observed adherence behaviors and identified barriers to increasing adherence in African American children and adolescents with asthma, and families. Patients will be randomized to either a Tailored Problem Solving Intervention, or a control group who will receive Family Education Intervention. The primary study outcome will be adherence with prescribed therapy as measured by electronic monitors throughout the study period. Secondary measures will include disease specific morbidity, and symptoms, pulmonary functioning and functional outcomes including health-related quality of life, days of hospitalization, and school absences We hypothesize that adherence with prescribed treatment regimens for pediatric asthma will be enhanced by the use of a problem solving intervention that focuses on reducing barriers to adherence with therapy. The data that will be generated from this study will improve scientific understanding of interventions that are effective in promoting adherence to treatment in pediatric asthma in economically disadvantaged minority children and families.