Infant Institute - Research

LINKS

Tulane Institute of Infant and
Early Childhood Mental Health

Bucharest Early Intervention Project (BEIP)

This is a 4-year longitudinal randomized controlled trial of foster care as an intervention for children in institutions in Bucharest, Romania. One hundred and thirty children between the ages of 6 and 31 months were assessed at baseline and then randomized to routine institutional care or to placement in foster care. They are being compared to 65 never institutionalized children matched to them on age and gender. They are being assessed serially at 9, 18, 30 and 42 months of age with regard to their caregiving environments, cognitive, language, social communication, social interaction, attachment, temperament, discrimination of facial discrimination of emotion and EEG asymmetry. The study will attempt to examine effects of alternative forms of care for abandoned and neglected children, timing of intervention effects for different domains of development, and relationship between caregiving characteristics and outcomes.

PI: Charles H. Zeanah, M.D.
Co-investigator: Anna T. Smyke, Ph.D.
Source of Support: MacArthur Foundation Research Network on “Early Experience and Brain Development”
Period of Support: 2000-2004
Direct Costs: $688,000

Documenting the Economic Development Impact of Investing in the Child Care Industry in Louisiana

Recent research studies have demonstrated the immediate economic development impact that results from child care. The significance of the child care sector as an engine of economic development is perhaps best understood if looking at child care as an essential component of infrastructure that is needed to allow the economy to flourish. Just as roads, electricity, and mass transit are needed to make a workforce and industry efficient and productive, so to is child care needed. This study, in collaboration with the Louisiana Office of Family Support and the LSU Division of Economic Development, will detail the economic impact of child care in Louisiana in an effort to build support for public and private investment in the child care sector.

PI: Geoff Nagle, Ph.D.
Co-investigator: Dek Terrell, Ph.D.
Source of Support: Department of Social Services – Office of Family Support
Period of Support: 2004-2005

Early Trauma Treatment Network

This study, conducted by the Early Trauma Treatment Network (ETTN), is designed to develop an assessment protocol and effective treatments to help traumatized infants and toddlers. The ETTN is evaluating a manualized treatment method called infant-parent psychotherapy for an ethnically and culturally diverse group of children aged birth to six who have experienced interpersonal violence and sudden loss. The ETTN collaborative includes the University of California at San Francisco's Child Trauma Research Project, as well as three other sites that also conduct early trauma treatment, service delivery, and training: Infant Team at Tulane University Health Sciences Center, Child Witness to Violence Project at Boston Medical Center, and Child Violence Exposure Program at Louisiana State University Health Sciences Center.

Infant-parent psychotherapy is a theoretically based, multimodal approach to treatment that has empirical evidence of its effectiveness. It has been used with preschoolers from diverse ethnic backgrounds who witnessed domestic violence and who, following treatment, showed significant improvement in their trauma-related symptoms and readiness to learn. The ETTN is expanding the use of the infant-parent psychotherapy manual at all four sites to include children aged birth to six witnessing or experiencing interpersonal violence or life threat and traumatic loss, including children removed from their biological parents and placed in foster care. The project involves evaluation of the effectiveness of the treatment for children with different levels and specific types of exposure to trauma, and for traumatized children from different ethnic and socioeconomic backgrounds. The ETTN sites are pooling their experience in assessing traumatic stress to develop a uniform assessment protocol measuring severity of trauma, severity of child's traumatic stress, areas of developmental competence, child-caregiver(s) quality of relationship, caregiver(s) traumatic stress status, and their individual functioning. This assessment protocol will be used to guide treatment and service implementation and to evaluate treatment effectiveness.

PI: Charles H. Zeanah, M.D.
Project Coordinator: Julie A. Larrieu, Ph.D.
Source of Support: Substance Abuse and Mental Health Services Administration
Period of Support: 2001-2004
Direct Costs: $213,000

Healthy Beginnings

Supported by a grant from the Institute for mental Hygiene, this project represents a unique partnership between Tulane University, the Louisiana Office of Public Health, the Louisiana Office of Mental Health, the Orleans City Health Department, and the Children's Bureau of Greater New Orleans. The project supports the provision of mental health services in one of the city health department clinics in New Orleans, including the development of a systematic approach to assessment, clinic and home-based service delivery, interdisciplinary involvement in provision of services, and treatment outcome data. The project also includes training of mental health clinicians from the Children's Bureau and the Office of Mental Health in infant mental health with supervision from experienced Institute faculty, and the provision of 35 hours of didactic training in infant mental health for the nursing and health care staffs at all Orleans City Health Department clinics.

PI: Paula Zeanah, Ph.D., M.S.N. and Julie Larrieu, Ph.D.
Co-investigator: Shana Bellow, Ph.D. and Letia Bailey, L.C.S.W.
Sources of Support: Institute for Mental Hygiene, Louisiana Office of Public Health, Louisiana Office Mental Health
Period of Support: 2000-2005
Direct Costs: $500,000

Maltreatment Follow-up Study

The primary goal of this study is to examine the psychiatric and developmental status of 5 to 9 year-old children who were placed in foster care prior to 48 months of age and whose families received services from the Tulane/Jefferson Parish Infant Team. Data on the developmental course of very young foster children is minimal and rarely controls for age, severity of abuse and eventual placement. This study controls for these confounds and uses a matched community comparison group. This study uses multiple measures, methods and reporters to assess the children’s behavior, peer relations, family relations, and academic and social competence.

A second goal of this study is to examine the developmental differences of children who have been in foster care based on case outcome (i.e., children who are returned to their biological parents, children returned to a relative who is not their parent, and children who are adopted after parental rights have been terminated or voluntary surrender) in order to guide policy development of the foster care system.

PI: Neil W. Boris, M.D.
Co-investigator: Sherryl Scott Heller, Ph.D.
Source of Support: Louisiana Office of Community Services
Period of Support: 2000-2006
Direct Costs: $500,000

Evaluation of the Promoting Adolescents To Change Children’s Health Program (PATCCH)

The PATCCH program is a randomized preventive intervention trial, targeting impoverished young mothers and their infants in partnership with specific Early Head Start programs in Baton Rouge, Louisiana. It is a federally-funded project, supported by the Administration of Children and Families. This trial pits an established model of group parenting education against a recently developed group parenting therapy protocol. Subjects are being recruited from two Early Head Start programs linked to High Schools and serving young mothers. The women and infants in both interventions will be assessed serially beginning before the intervention and ending 6 months after the intervention. The interventions are weekly groups--which will be held at the Early Head Start centers.

Multiple measures are being used to address multiple outcomes of both mothers and their infants. In particular, established interactive videotaped measures that assess the young child’s attachment to their mother will be followed. Data on other important indicators of child and parent functioning and development will be gathered through a series of questionnaires (see attached measure descriptions). It is expected that the results of this study will address the central question of whether the group therapy intervention is more effective in promoting parent knowledge, attitudes and behavior than the parent education curriculum.

PI: Neil W. Boris, M.D.
Co-investigator: Sherryl Scott Heller, Ph.D.
Source of Support: Administration of Children and Families
Period of Support: 2002-2006
Direct Costs: $800,000

Validity of Reactive Attachment Disorder

This is a 1-year BSTART NIMH-funded grant to explore the validity of the current DSM-IV criteria for Reactive Attachment Disorder. Abused and neglected toddlers will be compared to high- and low-risk toddlers in areas of social competence and attachment and other behaviors. Interview, observational, and questionnaire methods will be used to establish the procedural, criterion, and discriminant validity of the diagnosis of Reactive Attachment Disorder.

PI: Brian Stafford, M.D., M.P.H.
Co-Investigator: Charles Zeanah, M.D.
Source of Support: National Institute of Mental Health
Period of Support: 2002-2005
Direct Costs: $50,000

Posttraumatic Stress Disorder in Preschool Children

This research study is a multidimensional assessment of young children and their symptomatic responses to experiencing severe psychological trauma. We plan to enroll over 250 children from 3 through 6 years of age who have either experienced acute injury or witnessed chronic domestic violence. The purpose of the project is to better understand the psychiatric symptoms, how they differ with developmental changes at this age, how the caregiver’s response mediates the child’s response, and understand the psychophysiological changes that young children undergo following trauma in this sensitive age period. This knowledge will be helpful to clinicians who treat these children, researchers who need better understanding of them, and policy makers who support programs to prevent and or treat these conditions.

PI: Michael S. Scheeringa, M.D., M.P.H.
Co-investigators: Charles H. Zeanah, M.D. and Frank W. Putnam, M.D.
Source of Support: National Institute of Mental Health
Period of Support 2003-2008
Direct costs: $775,000

Manualization Project for Treatment of 0-5 Year-Old Children

This project aims to standardize in a manual the complicated treatment pathways for 0-5 year-old children presenting for outpatient mental health treatment. This evidence-based manual will standardize the procedures for intake, assessment, and treatment. Treatment pathways will comprehensively cover clinical problems of the child, the parent, and the parent-child relationship. Once the manual is finalized, it will be tested for effectiveness on 25 cases. The treatments will be monitored for treatment fidelity, compliance issues, and parent acceptance of the treatment.

PI: Michael S. Scheeringa, M.D., M.P.H.
Source of Support: Office of Mental Health, State of Louisiana
Period of Support: 2004-2006 (tentative)
Direct costs: $109,000

OTHER RESEARCH PROJECTS

Early Withdrawal and Failure To Thrive

Emotional and behavioral withdrawal by the infant has been recognized as an early sign of failure to thrive. Failure to thrive is associated with insecure attachment and lasting deficits in growth, cognition, and socio-economic functioning. Infant withdrawal is often observed in failure to thrive. It may be the infant withdrawal occurs prior to growth deceleration. Brief withdrawal is a normal mechanism in mother-infant interaction when observed at the micro-analytic level in normal populations. Sustained infant withdrawal is observed when mothers are depressed and is a key symptom of infant depression. This pilot project hopes to determine if behavioral withdrawal, assessed by the Alarm Distress Baby Scale (ADBB), during a routine immunization can be used as a warning sign of early failure to thrive or developmental delay. We hope to identify infants at risk or in the early stages of failure to thrive, perhaps prior to growth decline, and intervene to avoid further developmental and growth delays.

PI: Astrid Berg, MBChB, FFPsych, MPhil ( University of Cape Town)
Co-investigators: Brian Stafford, M.D., M.P.H.