Research for a Better Future
Innovation That Transforms Lives
Every discovery starts with a question. Our researchers and clinicians push boundaries, seeking answers that lead to better treatments and improved outcomes. Through collaboration and curiosity, we turn new ideas into real-world impact.
OTPT Bridges Clinical Care and Research for Rapid Impact
In September, the division of Occupational Therapy and Physical Therapy (OTPT) within the Department of Patient Services secured several research grants, a major success that will enhance the division's ability to integrate clinical care and research for improved patient outcomes.
There are currently seven PhD-trained researchers housed within OTPT, who also maintain active clinical roles. As frontline clinicians, these researchers encounter challenges and gaps in care firsthand, and their proximity to patient care ensures that their research questions are grounded in real-world clinical needs. With each new study, they aim to generate insights that can be translated back to their patients as quickly and responsibly as possible.
“We want to make sure we have an infrastructure that supports this model,” said OTPT’s Senior Clinical Director Mark Paterno, PT, PhD. “It’s important for us to contribute to the research mission of the organization, and we also see it as our mission to be leaders in education, as well as provide great care.”
Collaboration is at the heart of their success. OTPT researchers often work with each other, as well as the other 200 therapists in the division, to exchange ideas, help refine each other’s study designs and expedite solutions that set the stage for continuous growth and improvement. The researchers also rely heavily on the resources provided by the Division of Patient Services Research and other teams, like the Division of Biostatistics and Epidemiology, to address every aspect of their research projects, from study design and budgeting to data management.
Their collaborative efforts have greatly benefited the development of their infrastructure. Notably, the OTPT Research Registry has streamlined workflows for studies using retrospective chart data. With the registry, studies that once took four to six months to launch can now begin in just about a month.
"We continue to find ways to overcome roadblocks, helping our staff get things off the ground and providing support where needed," said Jason Long, PhD, director of the Motion Analysis Lab and OTPT’s scientific director.
Awarded Research Projects:
Amy Bailes, PT, PhD, a physical therapist and professor within the Department of Pediatrics, secured funding from the National Institute of Child Health and Human Development (NICHD) for her project, “Capturing and Characterizing the Variability in Physical Therapy Dose After Orthopedic Multi-Level Surgery in Ambulatory Children with CP.” This study aims to understand the variation in post-surgical physical therapy (PT) interventions for children with cerebral palsy (CP) following multi-level surgery. By capturing data on different types of PT across clinics, the project will identify the most effective strategies for improving gait and recovery outcomes.
Christy Zwolski, PT, DPT, PhD, a physical therapist and assistant professor within the Department of Pediatrics, was awarded a grant from Cincinnati Children’s Place Outcomes Research Award (PORA) Access to Care for her project, “Implementation of the Quad Squad Care Model: A Solution to Improve Access to Rehabilitation.” This project focuses on implementing a group therapy model for young athletes recovering from ACL injuries, addressing both physical and psychological needs while expanding access to rehabilitation.
Jenny Marie Dorich, PhD, OTR/L, an occupational therapist and assistant professor within the Department of Orthopaedic Surgery, received funding from the American Hand Therapy Foundation for her work on “Completing the Item Set Development of a Novel Patient Report Outcome Measure for Children with Upper Limb Impairment: The Upper Extremity Life Impact Measure – Youth (UE LIMY).” This study aims to refine and field test a patient-reported outcome measure that is designed to assess the treatment outcomes most meaningful to children with upper limb impairment.
Karen Harpster, PhD, OTR/L, an occupational therapist and associate professor in the Department of Pediatrics, was awarded a development gift fund from the Junior Co-Operative Society for her project, “Early Intervention for Infants with Cerebral Palsy: Let’s Move Program.” The program offers early therapy to infants diagnosed with cerebral palsy as young as 3 months old, providing families with tools and education to promote motor development during a crucial window of brain plasticity.
A Three-Phase Approach to Spiritual Care and Our Chaplains' Role in Pediatric Healing
A qualitative study conducted by Cincinnati Children’s researchers in the Center for Spiritual and Grief Care reveals how pediatric chaplains address religious and spiritual (R/S) struggles, a critical yet often overlooked aspect of patient care. Led by Salvador Leavitt-Alcántara, PhD, a staff chaplain and assistant professor, the study explores the dynamic, human and spiritual-centered approach chaplains take when offering spiritual care to pediatric patients and their families. The research team’s findings were published in the Journal of Health Care Chaplaincy.
“While previous research has shown that religious and spiritual challenges are linked to health outcomes in pediatric care—such as increased anxiety, depression and difficulties with treatment adherence—there has been little understanding of how chaplains handle these struggles in real-world clinical settings,” says Salvador. “This study fills that gap by examining the nuanced, iterative process used by chaplains at Cincinnati Children’s to guide families through spiritual crises.”
The research team started by conducting in-depth interviews with 12 board-certified or board-certification-eligible chaplains. Through these conversations, the researchers discovered that chaplains follow a three-phase, fluid process to address R/S struggles:, Assessing, Processing and Intervening. “These phases allow chaplains to tailor their spiritual care to the unique needs of each patient and family, making spiritual support an essential component of holistic healthcare,” Salvador notes.
Assessing
The first phase, Assessing, focuses on gathering information and building relationships with patients and families. Chaplains begin by establishing trust through personal connection, often taking the time to hear patients’ spiritual histories and asking open-ended questions to identify potential spiritual struggles. “This foundational step is crucial, as many patients are hesitant to discuss spiritual or religious concerns until a strong rapport is built,” he says. “Chaplains also consider how the hospital experience intersects with these struggles, as patients and families often feel isolated or disconnected from their faith during medical crises.”
Processing
In the second phase, Processing, chaplains synthesize the information gathered during assessment with their own professional knowledge and experience. Many rely on both theological and psychological frameworks to understand the patient’s spiritual struggles. As they process this information, chaplains work to set goals for their interventions. “These goals often center on helping patients find peace, meaning or comfort in their situations, and normalizing their feelings of doubt or frustration,” reveals Salvador. “For example, chaplains may challenge a patient’s belief that their illness is divine punishment or reframe how they view their relationship with God or their faith community.”
Intervening
The final phase, Intervening, involves taking action based on the assessment and processing phases. Chaplains employ a range of interventions, from offering companionship and validation to facilitating religious rituals like prayer, sacraments or other spiritual practices specific to the patient’s faith. Interventions are highly personalized, with chaplains often working in collaboration with the patient to determine what will be most helpful. A key aspect of this phase is the chaplain’s role in advocating for the patient’s spiritual needs within the broader healthcare team, ensuring that the patient’s beliefs are respected in their treatment plan and that teams understand the impact of religious/spiritual struggle on patients’ medical decision-making or coping abilities.
Leveraging Patient Advocacy
One of the most striking findings from the study is the importance of the chaplains’ role in interpreting and advocating for the spiritual needs of patients. Often, R/S struggles influence medical decisions or create conflict within families or between families and healthcare providers. “By acting as intermediaries, chaplains help healthcare teams understand how spiritual beliefs shape the patient’s experience and decision-making process, which can lead to better outcomes and a more integrated approach to care,” Salvador says. Despite the success of these interventions, chaplains face several challenges, such as time constraints and differences in theological beliefs and cultural experiences. Yet, through adaptability and ongoing dialogue, several chaplains are able to overcome these barriers, ensuring that every patient receives the spiritual support they need.
Next Steps
The study highlights the need for more formal tools to evaluate the effectiveness of chaplain interventions. “Currently, chaplains rely on subjective indicators—such as patients’ emotional responses and feedback—to gauge the success of their interventions,” notes Salvador. “Developing objective measures could help chaplains refine their approach and demonstrate the impact of spiritual care on patient well-being.”
Salvador Leavitt-Alcántara, PhD
Improving Early Intervention for Head Start Preschoolers
Early childhood is a critical time for learning and development, shaping a child’s future health, behavior and success in school. Yet, for children in Head Start programs—federally funded preschool programs designed to support children in families with low income—developmental delays are sometimes missed or not addressed as early as they could be.
One in six children younger than 5 years of age has a developmental delay (DD), which, as the child grows, will shift diagnostically to one or more developmental disabilities, including autism spectrum disorder, intellectual disability, language disorder or attention-deficit/hyperactivity disorder. Without early support, these children are often left with worsened outcomes.
A recent study led by Karen Burkett, PhD, APRN, a pediatric nurse practitioner in the Division of Developmental and Behavioral Pediatrics and nurse researcher in Patient Services, identified key barriers that impede early identification and support for these children, and possible solutions that can help lessen these gaps in care.
Identifying the Gaps
The study brought together voices from Head Start parents, teachers and healthcare providers—with diverse representation across racial and ethnic groups—to better understand the challenges in detecting and addressing developmental delays. Findings revealed three major barriers:
- Breakdowns in communication between teachers and primary care providers often left families without clear guidance on next steps. Developmental assessments often happen in both educational and healthcare settings, but the families can be left out of the loop as to what the professionals in these sectors are planning to do for their child. Without communication between the two sectors, families often find themselves stuck in the middle, but without clear direction on where to go.
- Parental perception of socioeconomic bias and stigma left families hesitant to seek or follow through with professional recommendations. Parents in the study expressed the feeling of being stereotyped as poor across educational and healthcare settings and feeling judged, which led to more hesitancy to take action or disclose concerns about their child that could be perceived negatively by clinicians and teachers. Families also expressed that even if they were transparent about their child’s challenges, it was hard to build trust if they had a different provider at each visit.
- The daily challenges of poverty meant that families had to prioritize immediate needs over long-term developmental concerns. Parents already struggle with daily life, dealing with rigid work schedules and limited transportation. On top of that, the large amount of paperwork needed for their child’s evaluations and support systems can feel overwhelming, adding to their exhaustion.
These barriers can lead to delays in intervention, which are particularly pronounced for Black and Latino families who, on average, receive a developmental disability diagnosis 18 to 24 months later than White families.
Implementing Solutions Together
As seen above, when parents didn’t follow through with recommendations for their child’s development, it usually wasn’t because they didn’t care. Instead, the systems around them often made it harder—not easier—for them to get help.
Here’s what family, clinician and teacher participants said could make a difference:
- Cultural understanding and training: Teachers and doctors knew that families from different racial and economic backgrounds might need different kinds of support—but many weren’t sure how to talk about it in the right way. Increased training for providers in tailoring communication to different groups could help build trust and make sure everyone feels heard.
- More consistent healthcare support: Clinicians don’t always check for developmental delays after 30 months of age. Even when they do, not all children—especially those from lower-income or racially diverse families—get referred for help. To help mend this problem, stronger professional alliances between health and social sectors could help shepherd families through the process of evaluation and treatment at all stages of a child’s life. This could look like the creation of a family navigation program.
- Family navigation programs: Parents said they would benefit from someone who could guide them—especially someone who understands their background and can offer emotional support. A parent navigator could explain what the teacher or doctor is recommending, help schedule evaluations, encourage follow-through on appointments and plans, or explain any complex language or processes they might run into along the way.
- More training for teachers and doctors: By law, public schools have 45 days from the day of the request to complete an evaluation process and determine eligibility. Many teachers thought this burden fell largely on the parent, and many clinicians thought that school support was based only on medical diagnoses, not educational performance. Training for both groups on national and local processes could help them give better guidance to families.
- Sharing information across systems: With permission from parents, doctors and teachers could share screening results and updates. This way, they can give the same message and show parents they’re working as a team. New resources, such as the “Act Early” tools developed by the Centers for Disease Control (CDC), can help make this easier by allowing real-time sharing of results and plans.
What’s Next
Karen's recent research efforts and her ongoing collaborations with Nancy Roberto, MSN, APRN, senior director of the Advanced Practice Providers division, and Tanya Froehlich, MD, MS, division director of Developmental and Behavioral Pediatrics, have the potential to lead to even more progress in the area of accessing mental health services for young children using a family navigation program.
In early 2024, with their support, she and co-principal investigator Kelly Kamimura-Nishimura, MD, MS, submitted an R34 grant proposal to the National Institute of Mental Health to engage mental and behavioral health services for preschoolers at risk. The team received the award in August 2024, launching a study that will assess the impact of a family navigation program on young children in Head Start with mental health concerns.
In the meantime, Karen’s team has not only shared the results of their studies globally in peer-reviewed publications but also locally with select primary care offices, Head Start directors, disability coordinators and parent advisory councils to start improving the outcome for Head Start children.
Karen W. Burkett, PhD, APRN