Our work aims to improve the quality of pediatric health and mental health services for children afflicted by chronic medical or psychiatric conditions.  We study the development and implementation of clinical informatics, assessment tools and patient engagement strategies in enhancing outcomes for children, adolescents and their families.  We focus on care for high risk families in public sector and primary care services.  Specific projects include designing new automated patient evaluation and monitoring tools, clinician decision support and methods of evaluating outcomes.   

The goal of this five-year project is to advance our understanding of the relationships among antidepressant use, suicide, and suicidality. We will use cross-design synthesis, a new research strategy for combining data from studies with complementary designs, to evaluate and combine evidence from both randomized trials and non-experimental studies. Our primary synthesis will include randomized trials of antidepressants both with and without psychotherapy along with data from two larger studies that include antidepressant use. We are particularly concerned with the development and application of methods that will facilitate the combining of evidence from multiple data sources, including methods for adjusting studies for factors that affect their external validity, and methods for exploring the effects of biases that affect internal validity. Our approach will be based on the use of Bayesian hierarchical models. Bayesian hierarchical models are a solution to the problem of making inferences when syntheses require not only modeling of within and between study heterogeneity, but also the qualitative differences of study types. The Bayesian approach will also help facilitate sensitivity analyses for assessing the robustness of inferences to various model inputs. We will also develop accessible and user friendly statistical software programs to implement the methodology that we develop.

Cross-Design Synthesis: Combining Evidence (Kelly Kelleher)
Funding Period: 07/01/06 -- 06/30/11
Funding Agency: NIMH
Collaborating Investigator(s): William Gardner, Ph.D.; John Campo, M.D.; Jeffrey Bridge, Ph.D.

The Trial of Automated Risk Appraisal for Adolescents (TARAA) is a self-report health risk screening of youth’s use of alcohol and other drugs, symptoms and impairment for co-morbid mental disorders, and other at risk behavior assessment. TARAA is able to improve services for screening risk behaviors by utilizing technology and adaptive instrumentation in order to provide primary care clinicians with immediate reliable and valid results for each youth in order to overcome many routine screening and monitoring barriers in the office setting. Additionally, in order to ultimately improve monitoring of successful outcomes of at risk youth, TARAA utilizes telephone support services that promote optimal motivational and change behaviors for children aged 11 and older. Specifically, TARAA compares the care of the eight Nationwide Children's Hospital Primary Care Physician Close to Home Centers. Each site will be randomly assigned to start with six months on with automated risk appraisal for adolescents and telephone support services to usual care services and delayed screening results (i.e., the screening results of the control group will be mailed to the clinician). It is anticipated that over 5,900 youth will be screened in the first year. TARAA was developed by Kelly J. Kelleher, M.D., M.P.H. and William Gardner, Ph.D. Dr. Kelleher is a Physician, Director of the Center for Innovation in Pediatric Practice at the The Research Institute at Nationwide Children's Hospital, and Professor in the Department of Pediatrics at The Ohio State University. Dr. Gardner is a Psychologist, Investigator in the Center for Innovation in Pediatric Practice, and Professor of Pediatrics at the Ohio State University.

Dr. Kelleher is a pediatrician whose research interests focus on accessibility, effectiveness and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse or violence. He has a longstanding interest in formal outcomes research for mental health and substance abuse services. Dr. Kelleher is Director of the Center for Innovation in Pediatric Practice and Vice President of Health Services Research at The Research Institute at Nationwide Children's Hospital.  Dr. Kelleher is also Professor in the Department of Pediatrics of The Ohio State University College of Medicine.

Bridge JA, Greenhouse JB, Sheftall AH, Fabio A, Campo JV, Kelleher KJ. Changes in suicide rates by hanging/suffocation and firearms among young persons aged 10 to 24 years in the United States: 1992-2006.         J Adolesc Health. 2010 May;46(5):503-5.

Gardner W, Klima J, Chisolm D, Feehan H, Bridge J, Campo J, Cunningham N, Kelleher K. Screening, Triage, and Referral of Patients Reporting Suicidal Thought During a Primary Care Visit. Pediatrics, 2010 May;125(5):945-52.

Lofthouse N, Fristad M, Splaingard M, Kelleher K, Hayes J, Resko S. 2010. Web-Survey of Pharmacological and Non-Pharmacological Sleep Interventions for Children with Early-Onset Bipolar Spectrum Disorders. Journal of Affective Disorders. Vol. 120, no. 1-3. (January): 267-271.

O’Brien SH, Fan L, Kelleher KJ. Inpatient use of laxatives during opioid administration in children with sickle cell disease. Pediatr Blood Cancer. 2010 Apr;54(4):559-62. PMID: 20049931.

Penfold R, Kelleher K, Strange B, Pajer K, Wang W. Pediatric Uptake of a Newly Available Antipsychotic Medication. Pediatrics, In Press, 2010. [Epub ahead of print]

Kelleher KJ, Atkins M. Organizational capacity to deliver effective prevention and treatment services for children and adolescents. Administration and Policy in Mental Health and Mental Health Services Research. 2010, In Press.

Chisolm D, Klima J, Gardner W, Kelleher K. Adolescent Behavioral Risk Screening and Use of Health Services. Administration and Policy in Mental Health and Mental Health Services Research, (2009) 36(6):374-380.

Kelleher K, Greenhouse J, Bridge J, Gardner W, Klima J, McInerny T. Safety of Antidepressants. eLetter to editor. Pediatrics, 12 June 2009.

Chisolm DJ, Scribano PV , Purnell TS, Kelleher KJ. (2009) Development of a computerized medical history profile for children in out-of-home placement using Medicaid Data. Journal of Health Care for the Poor and Underserved 20(3):748-755.

Stevens J, Klima J, Chisolm D, Kelleher KJ. A Trial of Telephone Services to Increase Adolescent Utilization of Health Care for Psychosocial Problems. Journal of Adolescent Health. 2009, 45:564-570.

American Academy of Child and Adolescent Psychiatry Committee on Health care Access and Economics Task Force on Mental Health. Improving mental health services in primary care: reducing administrative and financial barriers to access and collaboration. Pediatrics. 2009 Apr;123(4):1248-51. No abstract available. Erratum in: Pediatrics. 2009 Jun;123(6):1611.