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 Columbus Children's Research Institute.  Dr. Kelleher is also Professor in the Department of Pediatrics of the Ohio State University College of Medicine and School of Public Health.

Korelitz JJ, Zito JM, Gavin NI, Masters MN, McNally D, Irwin DE, Kelleher K,

Bethel J, Xu Y, Rubin J, Mattison DR.

Asthma-related medication use among children in the United States.

Ann Allergy Asthma Immunol. 2008 Mar;100(3):222-229.

Greenhouse JB, Kaizar EE, Kelleher K, Seltman H, Gardner W. Generalizing from Clinical Trial Data: A Case Study. The Risk of Suicidality Among Pediatric Antidepressant Users. Stat Med. 2008;27:(11).

Schoenwald SK, Chapman JE, Kelleher K, Hoagwood KE, Landsverk J, Stevens J, Glisson C, Rolls-Reutz J; Research Network on Youth Mental Health. A survey of the infrastructure for children's mental health services: implications for the implementation of empirically supported treatments (ESTs). Adm Policy Ment Health. 2008 Mar;35(1-2):84-97.

Cuellar AE, Kelleher KJ, Kataoka S, Adelsheim S, Cocozza JJ.

Incarceration and psychotropic drug use by youth.

Arch Pediatr Adolesc Med. 2008 Mar;162(3):219-224.

Stevens J, Kelleher KJ, Gardner W, Chisolm D, McGeehan J, Pajer KA, et al. Trial of computerized screening for adolescent behavioral concerns. Pediatrics. 2008 Jun;121(6):1099-1105.

Janicke DM, Harman JS, Kelleher KJ, Xhang J. The association of psychiatric diagnoses, health service use, and expenditures in children with obesity-related health conditions. J Pediatr Psychol. 2008

[epub ahead of print]

Bridge JA, Greenhouse JB, Weldon AH, Campo JV, Kelleher KJ. Suicide trends among youths aged 10 to 19 years in the United States. 1996-2005. JAMA. 2008;299(3):283-284. [research letter].

Nwomeh BC, Hayes J, Caniano DA, Upperman JS, Kelleher KJ. A parental educational intervention to facilitate informed consent for emergency operations in children. Journal of Surgical Research, 2008 Feb 4; [Epub ahead of print]

Horwitz SM, Hoagwood KE, Garner A, Macknin M, Phelps T, Wexberg S, Foley C, Lock JC, Hazen JE, Sturner R, Howard B, Kelleher KJ. No technological innovation is a panacea: A case series in quality improvement for primary care mental health services. Clin Pediatr (Phila). 2008 Sep;47(7):685-92.

Chen G, Sinclair S, Smith G, Kelleher KJ, Pajer KA, Gardner W, Xiang H. Personality disorders and nonfatal unintentional injuries among U.S. adults. Inj Prev. 2008;14:180-184.

Glisson C, Schoenwald SK, Kelleher K, Landsverk J, Hoagwood KE, Mayberg S, Green P, The Research Network on Youth Mental Health.  Therapist Turnover and New Program Sustainability in Mental Health Clinics as a Funciton or Organizaitonal Culture, Climate, and Service Structure. Adm Policy Mental Health. 2008 March;35(1-2):124-133.

Hoagwood KE, Green E, Kelleher K, Schoenwald S, Rolls-Reutz J, Landsverk J, Glisson C, Mayberg S; Research Network on Youth Mental Health. Family advocacy, support and education in children's mental health: results of a national survey. Adm Policy Ment Health. 2008 Mar;35(1-2):73-83. Epub 2007 Nov 13.

Hazen AL, Connelly CD, Edleson JL, Kelleher KJ, Landverk JA, Coben JH,

Barth RP, McGeehan J, Rolls JA, Nuszkowski MA. Assessment of Intimate Partner Violence by Child Welfare Services. Child Youth Serv Rev. 2007 Apr;29(4):490-500.

Kemper KJ, Kelleher K, Olson AL. Implementing maternal depression screening. Pediatrics. 2007 Aug;120(2):448-449; author reply 449-50.

Grupp-Phelan J, Delgado SV, Kelleher KJ. Failure of psychiatric referrals from the pediatric emergency department. BMC Emerg Med. 2007 Aug 15;7:12.

Pajer KA, Kelleher K, Gupta RA, Rolls J, Gardner W. Psychiatric and medical health care policies in juvenile detention facilities. J Am Acad Child Adolesc Psychiatry. 2007 Dec;46(12):1660-1667.

Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management.

Pediatrics. 2007 Nov;120(5):e1299-312. Review.

Heneghan AM, Chaudron LH, Storfer-Isser A, Park ER, Kelleher KJ,

Stein RE, Hoagwood KE, O'Connor KG, Horwitz SM. Factors associated with identification and management of maternal depression by pediatricians.

Pediatrics. 2007 Mar;119(3):444-454.

Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein RE; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management.

Pediatrics. 2007 Nov;120(5):e1313-26. Review. Erratum in: Pediatrics. 2008

Jan;121(1):227.

Xiang H, Sinclair SA, Yu S, Smith GA, Kelleher K. Case ascertainment in pediatric traumatic brain injury: challenges in using the NEISS.

Brain Inj. 2007 Mar;21(3):293-9.

Sices L, Harman JS, Kelleher KJ. Health-care use and expenditures for children in special education with special health-care needs: is dual classification a marker for high use?

Public Health Rep. 2007 Jul-Aug;122(4):531-40.

Julian TW, Kelleher K, Julian DA, Chisolm D. Using technology to enhance prevention services for children in primary care.

J Prim Prev. 2007 Mar;28(2):155-65. Epub 2007 Feb 6.