Download INTRODUCTION BACKGROUND MODEL

The Watson Institute
Serving the Needs of Children with Medical and Neurological Disorders
Christy Emmons Basista, Psy.D., Sharon Arffa, Ph.D. and Lindsy Yarger, M.A.
INTRODUCTION
MODEL
TREATMENT
Children with significant medical and
neurological conditions often present with
complex behavioral and psychological
needs. These needs can be severe and
compromise their medical treatment and
their ability to function autonomously in
least restrictive settings. For example, a
child with a neurological disease may
suddenly develop aggression, paranoia,
apathy, extreme emotional lability, and
socially inappropriate behavior. Effective
treatment is possible, but requires
expertise in brain-behavior relationships
and behavioral medicine in addition to
more traditional behavioral and cognitive
behavioral procedures.
This BHRS program is designed to meet the needs of
children with physical and neurological disease that have
significant co-existing psychiatric morbidity, including, but
not limited to, disorders such as:
Disruptive Behavioral Disorder, NOS
Attention Deficit Hyperactivity Disorder
Mood and Anxiety Disorders
Autism Spectrum Disorders
Somatoform Disorder
Personality Change secondary to medical conditions.
In addition to the traditional wraparound
model, this program utilizes Ph.D. level
Behavioral Specialist Consultants who
incorporate understanding of brain-behavior
relationships, behavioral medicine,
empirically validated treatments, and
extensive process and outcome evaluation
into the case consultation and staff training.
BACKGROUND
Compared to orthopedic injuries,
children with neurological compromise
have three times the rate of new
psychiatric disorder (Brown et al. 1981;
Rutter et al. 1983).
Psychiatric issues are more likely as
the severity of cognitive, family, and
psychosocial difficulties increase
(Sachs, 1991; Taylor et al 2002).
Behavioral disposition may actually
worsen over time in severe injury
(Fletcher et al. 1995).
Positive environmental and therapeutic
conditions are protective factors in
recovery from neurological illness
(Taylor, et al 2002).
Behavioral and cognitive-behavioral treatments that
emphasize a neuropsychological and behavioral medicine
understanding and clinical approach will be applied in an
individualized treatment program which abides by the
CASSP principles. Treatment modalities will include, but not
be limited to, psychoeducation, behavioral management,
cognitive behavioral intervention, environmental
management, school and community consultation, pain
management, and positive coping strategies.
Evidence based treatment methodologies
are emphasized for targeting emotional and
behavioral symptoms.
A “culture of evaluation” is created by
encouraging use of multiple outcome
measures throughout treatment.
Specialty training provided in brain injury and
rehabilitation follows recommendations by
the Brain Injury Foundation.
CONCLUSIONS
Cognitive
Behavioral
Affective
Treatment is uniquely designed to intervene in this
synergistic cycle of cognitive, behavioral, and affective
factors to promote optimal adjustment.
By incorporating knowledge of brainbehavior relationships into the
understanding of the child and family’s
strengths and needs, the current program
aims to provide more effective services
within the least restrictive environment
possible. In doing so, the program aims to
decrease the prevalence of persistent
psychiatric disturbances in children with
medical and neurological illnesses.