Researchers at Seattle Children’s seek solutions to the cultural, societal and systemic issues that impact the health and well-being of children
Children and teens who may never seek care at Seattle Children’s may nonetheless be healthier because of research happening here. Scores of our faculty and researchers are engaged in behavioral research aimed at making a difference in the everyday lives of children today.
Working in the community, our researchers seek to address the challenges to health and well-being faced by children and their families, and to provide actionable strategies that factor in real-life barriers.
Their work extends the bench-to-bedside research continuum to the curbside. The curbside work of three of Seattle Children’s researchers is featured here.
Integrating mental health into primary care health settings
Adolescent medicine specialist Dr. Laura Richardson believes all the healthcare needs of teens and tweens – including those dealing with mental health – should be served in the settings in which they are already being seen.
“We’ve done a disservice by separating mental health from physical health,” Richardson says. “Treatment approaches should engage the whole person and recognize that emotions and mental health are inextricably entwined with physical health. If medical providers feel empowered to help patients earlier, patients may not need more intensive mental health interventions.”
In 2014, Richardson and Dr. Cari McCarty received three grants to continue developing an application to screen adolescents for health risk behaviors in the primary care setting. Besides making the application web-based rather than tablet-based, they are adding self-help components for the patients taking the assessment and investigating how primary care providers can use motivational strategies to help teens make healthier choices.
I feel there’s a slow change in the conversation we are having around mental health. There is more awareness that mental health is part of who we are.
- Dr. Laura Richardson
A second thrust of Richardson’s research involves helping youth and parents access mental health services in the primary care setting that go beyond psychiatric medications or psychotherapy. She was lead author of an article in the Journal of the American Medical Association (JAMA) showing that teens newly diagnosed with depression did better when a care manager was part of their primary care team.
The care manager educated teens and their families about depression and treatments, helped them choose treatment, coordinated with the primary care provider to provide treatment, and checked in regularly to see how things were going. The randomized clinical trial showed that teens receiving this collaborative care approach improved more than those in a control group of newly diagnosed teens who received the typical approach of referral to a specialist.
“I feel there’s a slow change in the conversation we are having around mental health,” says Richardson. “There is more awareness that mental health is part of who we are. Even in this era of decreased mental health funding I am encouraged by results that show kids getting better.”
Culturally acceptable solutions that address health disparities
More than 30% of kids and adolescents in the U.S. are obese or overweight, and many don’t get the recommended minimum of 60 minutes of daily moderate-to-vigorous physical activity. These issues disproportionately affect racial/ethnic minorities and socioeconomically disadvantaged populations – who, not surprisingly, tend to be at high risk for chronic diseases.
Dr. Jason Mendoza and his team are working to help eliminate disparities in health and disease risk for children of color and low-income families. One thrust of his research is studying whether promoting physical activity in schools and communities can help mitigate health disparities for these populations and lower individuals’ risk of developing chronic diseases.
“Some of the big diseases that affect adults – like type II diabetes, hypertension, cardiovascular disease – start in childhood,” notes Mendoza. “We know that certain health behaviors can lower one’s risk for these diseases and others can raise it. These behaviors begin to develop in childhood and track strongly from adolescence into adulthood. We’re asking whether we can help kids form healthy habits earlier in life to reduce their lifelong chronic disease risk.”
One study underway examines whether a walking school bus program (where adults supervise groups of children as they walk to school) can help kids get enough exercise to improve their health and well-being. These programs are popular throughout the U.S., but unique issues in communities of color or low-income areas can make them harder to develop and sustain.
Results from a pilot study showed that the walking school bus Mendoza’s team developed and supervised did improve participants’ health behaviors. And a five-year study will reveal if those results can be replicated in a longer, more sustained program.
“I’m very encouraged by our preliminary findings. Even though kids weren't forced to walk every day, we were able to significantly increase their daily physical activity, which should lower their risk of chronic disease and obesity,” says Mendoza.
Reducing exposure to chemicals during early development
Dr. Sheela Sathyanarayana investigates the connection between environmental exposures and children’s health. She specifically studies endocrine-obstructing chemicals that affect hormone levels in the body, potentially leading to disease later in life. She’s mostly concerned with early exposure, from the prenatal period to early childhood.
Sathyanarayana explores where these chemicals come from and how they get into our bodies, with an eye toward finding ways to reduce exposure in the absence of laws or regulations that protect people from them.
“Our food supply is one of the biggest sources of endocrine-disrupting chemicals. But our research has shown it’s not just in the food choices people make,” she says. “It starts upstream in plastics being used to make and process foods, like the conveyor belts and plastic bins used for storage and shipping.”
Sathyanarayana developed the study Preventing Environmental Exposures in Pregnancy (PEEP), a tablet-based intervention that provides education modules and quizzes to help individuals understand how to limit their exposure. Initial results showed that participants had lower concentrations of endocrine-obstructing chemicals after working with PEEP. She hopes a larger study will be funded this year.
As her findings have shaped her thinking, Sathyanarayana now works to change policy – and she encourages new researchers to think broadly about their role in creating systemic change.
“Good scientists need to speak out about their research and explain results to the general population in a clear, easy to understand manner,” she says. “Experts need to participate on state and federal committees focusing on research translation. That’s how policy is made; that’s how government works.”