Health and Wellness
The Stanford Health and Wellness Study is a three-year longitudinal, multi-method research evaluation of a district-wide yoga- and mindfulness-based curriculum currently being implemented in a K-8th grade school district, the Ravenswood City School District in East Palo Alto, California. The purpose of the research is to measure the impact of the curriculum on students’ social, emotional, and cognitive functioning and academic performance over time by evaluating progress at three time points (baseline, one-year follow-up, and 18-month follow-up).
Investigators and Partners
Stanford University research teams
Participating Stanford University research teams include the Early Life Stress and Pediatric Anxiety Program (Dr. Victor Carrion, PI), the Stanford Cognitive & Systems Neuroscience Lab (Dr. Vinod Menon, PI), the Stanford Sleep Lab (Dr. Ruth O’Hara, PI).
Many thanks to our partners!
Stanford Youth Solutions
A Randomized Controlled Trial of Cue-Centered Treatment (CCT), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), and Treatment as Usual (TAU)
This is a three year study that will examine three treatment conditions for traumatized youth: CCT, TF-CBT, and TAU which is comprised of flexible integrated services offered at Stanford Youth Solutions, a community mental health agency in Sacramento. The purpose of the study is to determine what child characteristics predict better treatment outcomes, which phases of treatment are most effective, and to identify neuro-markers that may be predictors of better outcomes. Behavioral assessments along with neuroimaging (functional-near infrared spectroscopy (fNIRs)are being conducted at four time points: pre-, mid-, and post-treatment and at three month follow-up.
Investigators and Partners
This study is collaboration between Stanford Youth Solutions and Stanford University. The research team comprises the Stanford Early Life Stress and Pediatric Anxiety Program (Dr. Victor Carrion, PI, Dr. Flint Espil, Co-PI, and Dr. Hilit Kletter, CCT consultant), Center for Interdisciplinary Brain Sciences Research (Allan Reiss, neuroimaging consultant), Drexel University (Judith Cohen, TF-CBT consultant), and Iowa State University (Carl Weems, statistical consultant).
Clinical Outcomes Study
The Clinical Outcomes Study represents an effort to integrate research-driven assessment practices into clinical care and streamline the delivery of effective care to children and families that struggle with anxiety. Through examining the clinical characteristics of outpatients in the pediatric Anxiety Disorders Clinic at Lucile Packard Children's Hospital (LPCH) we intend to gain a more thorough understanding of the patient population and be able to quantify changes in symptom severity and/or functioning across treatment.
The optimal strategy for generating accurate, reliable psychiatric diagnoses is conducting pretreatment assessment utilizing a battery of standardized, empirically-validated measures (Wood, Garb, Lilienfeld, & Nezworski, 2002). Therefore, as part of our commitment to providing our patients cutting edge, scientifically-supported care, the Early Life Stress and Pediatric Anxiety Program (ELSPAP) is conducting comprehensive anxiety evaluations with patients currently awaiting treatment receipt in the context of an ongoing research study.
In addition to enhancing diagnostic accuracy, providing diagnostic assessment results to clinicians prior to initial patient consultation has demonstrated ability to save time and money, while also improving quality of care (Hawkins et al., 2004; Lambert et al., 2001). Specifically, studies examining the impact of providing assessment feedback have shown: 50 percent reduction in physician time required during initial patient consultation (Hughes et al., 2005); more symptom improvement (Jensen-Doss & Weisz, 2008); higher patient satisfaction (Kashner et al., 2003); and expedited application of appropriate treatment (Wood et al., 2002).
Through conducting baseline evaluations, ongoing outcome assessment, and generating tangible feedback reports, families and clinicians will benefit from access to data-driven feedback about children’s symptoms and treatment progress.
Once the evaluation is complete, a report is generated detailing the results of the assessments described above, which will be delivered to the family and the child’s treating clinician at LPCH. Families are also provided with psychoeducational materials regarding children’s identified areas of concerned and are encouraged to share results with other individuals involved in their child’s care at their discretion.
- Project Aims
- This process serves the following purposes:
- Provide detailed information regarding the specifics of each child’s symptom presentation, which can be useful for professionals when developing an individualized treatment plan to target each patient’s specific needs.
- Examine each child’s functioning in the context of national norms and developmental standards
- Monitor changes in symptom severity and functional outcomes throughout the course of treatment - ensuring families are receiving the highest quality of care.
- Engage in research efforts to identify and understand the most effective treatments for children with anxiety and related disorders.
- Use data collected through this project to determine what works best for whom?
- Collaborate with other institutions to coordinate similar research efforts and aggregation of data
- Produce mental health trainees who are skilled and efficient in diagnostic assessment
- Develop a sustainable training curriculum that can be translated to other settings
- Test the feasibility of adapting a traditional, more time-intensive assessment battery into an electronically delivered format
- Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1, 67–89.
- Hughes, C. W., Emslie, G. J., Wohlfahrt, H., Winslow, R., Kashner, T. M., & Rush, A. J. (2005). Effect of structured interviews on evaluation time in pediatric community mental health settings. Psychiatric Services, 56 (9), 1098 –1103.
- Kashner, T. M., Rush, A. J., Surís, A., Biggs, M. M., Gajewski, V. L., Hooker, D. J., ... & Altshuler, K. Z. (2003). Impact of structured clinical interviews on physicians' practices in community mental health settings. Psychiatric Services, 54(5), 712-718.
- Jensen-Doss, A., & Weisz, J. R. (2008). Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics. Journal of Consulting and Clinical Psychology, 76(5), 711.
- Hawkins, E. J., Lambert, M. J., Vermeersch, D. A., Slade, K. L., & Tuttle, K. C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308-327.
- Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159 –172.
- Miller, P. R. (2001). Inpatient diagnostic assessments: 2. Interrater reliability and outcomes of structured vs. unstructured interviews. Psychiatry Research, 105, 265–271.
- Shear, M. K., Greeno, C., Kang, J., et al (2000). Diagnosis of nonpsychotic in community clinics. American Journal of Psychiatry, 157, 581-587.
- Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children (ADIS-C/P). San Antonio, TX: Psychological Corporation.
- Swets, J. A., R. M. Dawes, R. M., & Monahan, J. (2000). Better decisions through science. Scientific American, 283, 82-87.
- Wood, J. M., Garb, H. N., Lilienfeld, S. O., & Nezworski, M. T. (2002). Clinical assessment. Annual Review of Psychology, 53, 519–543.
If you have any questions about the Anxiety Outcomes Research Project or would like to be contacted regarding involvement in our study, please contact Lindsay Trent, PhD at (650) 498-8272
Functional Near-Infrared Spectroscopy (fNIRS)
In collaboration with the Center for Interdisciplinary Brain Science Studies (CIBSR), The Early Life Stress and Pediatric Anxiety Program is studying fNIRS as a neuroimaging technique.fNIRS examines dynamic hemoglobin concentration as a reflection of subcortical brain activity. This study is exploring the clinical potential of using a pre-treatment fNIRS measurement to predict treatment outcomes in youth with generalized anxiety disorder (GAD) or posttraumatic stress symptoms (PTSS) compared to healthy controls (HC).
NIRS is far less invasive and expensive than fMRI, and its clinical potential has yet to be fully explored.
Technology Assisted Interventions
The Virtual Reality and Stress Reduction research project explores innovative ways to incorporate emerging virtual-reality (VR) technology into pediatric mental healthcare. The group aims to determine how pre-existing therapeutic interventions may benefit from virtual reality presentations and how patients respond to the incorporation of VR tools into the services they are already receiving.
What potential therapeutic tools can be unlocked through the clinical use of VR? Findings from this research will contribute to an expanding initiative to develop novel, technologically-based interventions for children who experience stress related psychopathology.
Neural Correlates of Behavior Therapy for Tic Disorders
This study is an attempt to examine potential predictors of outcomes among youth (ages 12-17) receiving behavior therapy for tic disorders. Tic Disorders, including Tourette’s Disorder, occur in 1 out of every 1000 youth, and are considered lifelong disorders. For many individuals, these tics do not cause any problems or distress, but for others they may be severe enough to warrant intervention. The approach with the most scientific backing to date is the Comprehensive Behavioral Intervention for Tics, or CBIT. This approach is rooted in behavioral therapy principles, and teaches individuals with tics to become more aware of when their tics are occurring and then use tic management strategies.
Although CBIT is effective for the majority of individuals who participate in therapy, there are still many questions surrounding why and how the approach works. The goal of this study is to examine the areas of the brain implicated in ticcing and how activation in these areas might change after receiving CBIT. Results from this study would not only help us better understand potential treatment mechanisms, but would also be an important first step in our goal of understanding the underlying circuitry of tic disorders more generally.
Beginning in July of 2017, we will begin enrolling youth with tic disorders (n = 12) and, for comparison purposes, youth without any history of tic disorders (n = 12). All participants will complete a series of computerized assessment measures while their brain activity is being measured using Functional Near-Infrared Spectroscopy (fNIRS), a noninvasive imaging approach similar to electroencephalogram (EEG). Participants will complete these assessments on two separate occasions, and results will be compared between time points and groups.
Investigators and Partners
This study is made possible through a grant awarded to Dr. Flint Espil (PI) by the American Academy of Neurology, the American Brain Foundation, and the Tourette Association of America. The research team comprises Dr. Espil and other ELSPAP staff as well as collaboration with the Center for Interdisciplinary Brain Sciences Research (Dr. Allan Reiss, neuroimaging consultant), and Comparative Medicine (Dr. Joseph Garner, neuroimaging and biostatistics consultant).
The Spectrum Pilot Grant
The Spectrum Pilot Grant for Population Health Sciences from the Stanford Center for Clinical and Translational Research and Education to support ongoing partnership with One East Palo Alto’s Behavioral Health Advisory Group Ambassador Team (BHAGAT). BHAGAT provides support and crisis response services to students and families at Ronald McNair Academy in the Ravenswood City School District. The purpose of this grant is to work with BHAGAT to develop and implement a training and consultation program to facilitate BHAGAT ambassador access to resources from the PracticeWise Managing Adaptive Practice (MAP) approach. Drs. Matlow and Espil will seek to adapt MAP materials to provide resources as appropriate for the support services provided by BHAGAT members. This collaboration will include efforts to capture and measure the impact of BHAGAT services in the McNair community. In addition, as part of the current grant and partnership, Drs. Matlow and Espil plan to convene an advisory group of community members and BHAGAT stakeholders to inform service needs and training program development.