Behavioral Treatment for Emotional Disturbance
Recruiting in Palo Alto (17 mi)
Overseen byKatherine E Grimes, MD, MPH
Age: < 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Cambridge Health Alliance
Disqualifiers: Over 17.5 years, Not MassHealth, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The Family Connections study, is intended to disrupt disparities in mental health treatment access for children at-risk for childhood trauma (ACEs) and/or serious emotional disturbance (SED). "Family Connections" will use mobile clinical and family support teams to improve mental health outcomes. This clinical innovation, nested in an integrated system-of-care will be piloted for children, ages 3-18 yrs., with SED who receive primary care through Cambridge Health Alliance.
Will I have to stop taking my current medications?
The trial information does not specify whether participants need to stop taking their current medications.
What data supports the effectiveness of the treatment Behavioral Treatment for emotional disturbance?
Research shows that behavioral treatments can effectively change targeted behaviors in psychiatric patients and improve their overall functioning. For example, a study on chronic male psychiatric inpatients found that behavior modification techniques were successful in changing inappropriate behaviors and that these positive effects lasted for 6-12 months after treatment.
12345Is behavioral treatment for emotional disturbance safe for humans?
The safety of behavioral treatments can vary depending on the specific methods used. Some treatments, like physical restraints, may cause injuries or psychological trauma, while medications like ketamine and droperidol have been studied for safety in emergency settings for severe behavioral disturbances.
678910How does the Behavioral Treatment for Emotional Disturbance differ from other treatments?
The Behavioral Treatment for Emotional Disturbance is unique because it involves training occupational therapists to deliver specific behavioral techniques during therapy sessions, ensuring consistent and accurate treatment. This approach is interdisciplinary and focuses on regular, structured sessions, which may not be a feature of other treatments for emotional disturbances.
311121314Eligibility Criteria
The Family Connections trial is for children aged 3-18 with potential mental health or substance use issues, identified by primary care physicians at CHA sites. Participants must have a positive mental health screen or parental/PCP concern and be enrolled in MassHealth. It's not suitable for those outside this age range or care network.Inclusion Criteria
I am between 3 and 17.5 years old.
My primary care doctor from a CHA site referred me for a child mental health or substance use assessment.
I or my child screened positive for mental health/substance use, or there's concern from a parent or doctor.
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive the Family Connections intervention using mobile clinical and family support teams
6 months
Regular visits as part of the intervention
Follow-up
Participants are monitored for changes in clinical functioning and family perceptions of care
6 months
Follow-up assessments at 6 months and 12 months
Participant Groups
This study tests a mobile clinical and family support team approach to improve mental health outcomes for at-risk children with serious emotional disturbances (SED). The intervention includes integrated systems of care provided by the Cambridge Health Alliance.
2Treatment groups
Active Control
Group I: Active Comparator: Family Connections InterventionActive Control1 Intervention
Group II: Treatment as UsualActive Control1 Intervention
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Cambridge Health AllianceCambridge, MA
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Who Is Running the Clinical Trial?
Cambridge Health AllianceLead Sponsor
References
Behavioral consultation with difficult to treat psychiatric patients. [2019]Behavioral procedures have proven efficacious in the ward-wide treatment of psychiatric inpatients. These procedures are often recommended and administrated by behaviorally oriented staff who work as consultants. While numerous published reports show that behavioral consultation is effective for changing patients' targeted behavior, few data show whether it affects recidivism and other general indicators of patients' functioning. The present report describes group and case study data for 7 patients regarding the effects of behavioral consultation on frequency and duration of hospital admissions, distress upon readmission, proportion of time spent at regressive versus autonomous privilege levels, and other molar indices of patients' functioning.
Toward impacting medical and psychiatric comorbidities in persons with intellectual/developmental disabilities: an initial prospective analysis. [2020]The purpose of this study was to determine the effectiveness of psychiatric medical services, counseling, and behavioral treatments for adult patients with intellectual disabilities plus behavioral disorders and/or emotional distress.
An interdisciplinary behavioral treatment program for depressed geriatric rehabilitation inpatients. [2019]Depression is known to be associated with increased functional dependence both in the community and in a hospital setting. An innovative interdisciplinary behavioral treatment of depression protocol is described here. Occupational therapists were trained to deliver a protocol of behavioral treatment techniques during their individual occupational therapy treatment sessions. Methods of training the occupational therapists and a description of the treatment are provided in this article. These methods insure that behavioral treatment is delivered accurately and regularly. An outline of each session is provided, and two case examples are described. Early results indicate that this form of treatment can be reliably and accurately carried out.
Evaluation of long-term therapeutic efficacy of behavior modification program with chronic male psychiatric inpatients. [2019]An experimental Behavior Modification Program (BMP) was carried out on fifteen diagnosed chronic schizophrenic male patients on a mixed-population open psychiatric unit in a VA Medical Center. Treatment consisted of positive-reinforcement and response-cost contingency procedures and was conducted for 85, 80, 75 and 70 sessions, respectively, for the fifteen patients. These psychiatric patients were recruited for treatment based on staff documentation and reports of gross verbal abuse, non-attendance at assignments, poor grooming skills, and excessive drinking behavior while circulating on the mixed-population open psychiatric ward. Three to four of the aforementioned inappropriate (target) behaviors were selected for each subject and were treated sequentially in a multiple baseline design. Both procedures were highly successful for the fifteen male psychiatric patients in changing three of their target behaviors, but only partially effective for eight of those patients with drinking behavior problems. Follow-up assessment of the participants in the study indicated that most of the positive effects of intervention persisted over 6-12 months post-treatment periods. Of the fifteen inpatients that participated in the BMP, fourteen have been discharged into community foster homes and one remains on the open psychiatric ward awaiting placement outside the hospital.
Adverse effects of poor behavior management of an inpatient's difficult behaviors. [2019]Behavior therapy has been shown to improve the functioning of institutionalized clients, but front-line staff often have difficulty implementing behavior therapy techniques. In the case described in this report, staff with inadequate training in behavior therapy inconsistently used negative and positive reinforcement in the attempt to reduce the aggressive behavior of an inpatient diagnosed as having schizophrenia, and the interventions were associated with an increase in assaults and related behavior. The case illustrates the effects of poor behavior management and the importance of data collection in evaluating clinical interventions.
Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department. [2022]We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation.
Management of behavioral emergencies. [2005]Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. A useful approach is differentiating emergencies that need nonpharmacological intervention, minimal pharmacological intervention, or maximal pharmacological intervention. Conditions that require nonpharmacological interventions include suicidal state, homicidal state, self-neglect state, abuse state, and conditions primarily requiring an organic workup. Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.
Structured team approach to the agitated patient in the emergency department. [2022]Behavioural disturbance and aggression in the ED is an increasing problem. The present study describes the characteristics of patients with acute behavioural disturbance and their emergent treatment in an ED with a structured team approach.
Parenteral sedation of elderly patients with acute behavioral disturbance in the ED. [2022]This study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol.
Experiences of Individuals Who Were Physically Restrained in the Emergency Department. [2020]Individuals with behavioral disorders are increasingly presenting to the emergency department (ED), and associated episodes of agitation can cause significant safety threats to patients and the staff caring for them. Treatment includes the use of physical restraints, which may be associated with injuries and psychological trauma; to date, little is known regarding the perceptions of the use of physical restraint among individuals who experienced it in the ED.
The effect of a self-management training package on the transfer of aggression control procedures in the absence of supervision. [2019]An aggression replacement and self-management training package reduced the frequency of aggressive behavior among four junior high adolescents identified as seriously emotionally disturbed (SED). During baseline sessions, the students were covertly filmed as they stood unsupervised in front of the school cafeteria. The four subjects engaged in aggressive behavior during 50% of the filmed intervals. These episodes involved provocation by other students, self-initiated provocation, or continuing interaction between students once an aggressive episode had begun. Treatment procedures included instruction, modeling, and role playing of aggression replacement skills. Self-management training included self-assessment, self-recording, and self-reinforcement. Following an 8-week period, subjects demonstrated substantial improvement in prosocial skills without supervision. During reversal-to-baseline conditions, aggressive behavior increased; however, reinstating treatment conditions brought a return to prosocial behavior. Outcomes suggest that aggressive replacement skills may transfer and sustain more adequately using self-management.
The counseling role of the child and youth worker in a treatment classroom. [2004]This paper describes a treatment classroom for emotionally disturbed adolescents. It examines staff roles and responsibilities, as well as the interventions and counseling techniques used to alter maladaptive behaviors and emotions. It also explores the functional relationship between education and counseling, and discusses the interactions and interdependence of client (the adolescent in treatment), milieu (the treatment class), and child and youth care worker.
Evidence-based treatment research: Advances, limitations, and next steps. [2022]This article highlights the development of evidence-based treatments (EBTs), the accomplishment their development reflects, and the limitations of current variations as a way of providing mental health services and care. Rather than review EBTs, I use the occasion to provide an overview of my work on the development of treatments for children referred clinically for aggressive and antisocial behavior. This work reflects a larger genre of intervention research that has developed treatments for a variety of disorders. After years of research and a healthy list of EBTs, where are we and where do we need to be? It is still the case that most people in need of services do not receive them, and disparities in providing services remain enormous. The vast majority of therapies, whether evidence based or not, use a model of delivery (one-to-one in-person treatment) that is inherently limited as a way of reaching the large swath of people in need of services. Multiple models of delivery of treatment are needed. The article underscores the importance of developing these models of delivery and optimizing that development by understanding better the mechanisms of therapeutic change. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Effects of an interdependent group contingency on the transition behavior of middle school students with emotional and behavioral disorders. [2018]An ABAB design was used to evaluate the effectiveness of an interdependent group contingency with randomized components to improve the transition behavior of middle school students identified with emotional and behavioral disorders (EBDs) served in an alternative educational setting. The intervention was implemented by one teacher with three classes of students, and the dependent variable was the percentage of students ready to begin class at the appropriate time. Data revealed significant improvements in student behavior, providing support for implementation of group contingencies for students with EBDs in alternative educational settings and an example of feasible procedures and data collection methods. (PsycINFO Database Record