Peds-BRITE

About the Project

Pediatricians Building Resilience through Early Identification for Toddler Well-Being (Peds-BRITE) is a clinical trial focused on improving early identification and intervention for toddlers' mental health. First, we will use the DECIDE tool, a "risk calculator" that identifies children who may be at-risk for mental health challenges in preschool. The DECIDE tool will be given to families at their 24- and 30-month well-child visits with their primary care clinician.

Children who score in the high-risk range will be referred to Family Check-Up® Online (FCUOnline), a digital parenting program that teaches caregivers skills to support their child and themselves. The FCUOnline app is "promotive" and "preventive," meaning it teaches caregivers skills that can boost their child's early health and development before a diagnosis. Caregivers can use the FCUOnline app on their own, and they can work with a "FCUOnline Navigator," a behavioral health clinician who helps them use the app and apply the skills to their daily lives.

We will collect information from clinics and study participants to understand how clinicians and families use the DECIDE tool and FCUOnline. Using our innovative ROIO study design, we will use this information to optimize our procedures so that the DECIDE tool and FCUOnline reach as many families as possible.

DECIDE Tool

The DECIDE Tool uses child and family risks and assets to identify toddlers who are at risk for future mental health challenges by preschool age. The DECIDE Tool is centered on “irritability.” Irritability means responding with anger when being told “no” or not getting their way. It’s normal for children to have some levels of irritability, but high levels of irritability are a big predictor of future mental health challenges. The DECIDE tool measures other risks, like a child’s exposure to potentially harmful experiences like abuse or instability. On the other hand, the DECIDE tool also measures things that can prevent future mental health challenges, like a child’s self-regulation skills and positive family relationships.

The tool was developed using a community-engaged approach. We incorporated input from caregivers and clinicians to make sure caregivers would understand the questions, feel comfortable answering them, and have enough time to complete them in real-world settings.

The DECIDE tool is available in both English and Spanish, and will be completed by families at their 24- and 30-month well child visits. We will use an algorithm weighting the child’s risks and assets to produce a “risk score” that estimates the child’s chance of preschool-age mental health challenges. Children whose scores are above a high-risk threshold will be recommended for referral to FCUOnline.

However, clinicians and families are encouraged to use the child’s scores as well as family concerns and priorities to decide whether a referral for FCUOnline is warranted at any level of risk.

Family Check-Up® Online (FCUOnline)

FCUOnline is an evidence-based parenting program that is designed to strengthen positive parenting practices, build family routines, and reduce early risk for emotional or behavioral concerns before they become more severe. Caregivers can complete the FCUOnline through an app on their phone, tablet, or computer. The app includes brief surveys that are used to personalize the experience for each family. It includes five modules that will take about 15-20 minutes for caregivers to complete.

The FCUOnline app is paired with support from a FCUOnline Navigator. Navigators are behavioral health clinicians who use techniques like motivational interviewing to show families how to use the app and apply the strategies to their everyday lives. Sessions with the Navigator take place over telehealth, and caregivers can schedule as many sessions as they want, making the program flexible and feasible for families with varying schedules, geographic access, and caregiving demands.

The FCUOnline app and Navigator sessions are available in English and Spanish, and can be adapted to align with family priorities, cultural context, and parenting goals.

Peds-BRITE Team

Laurie Wakschlag, PhD(she/her/hers)

Project Co-Lead

Lauren (Laurie) Wakschlag, PhD, is the Principal Investigator of this study. Dr. Wakschlag is a developmental/clinical scientist and translational investigator. She has been PI of 10 NIH studies, largely focused on high risk prenatal and early childhood populations (over 5,000 participants). An overarching objective of Dr. Wakschlag’s research has been generating a “science of when to worry” in early childhood, creating developmentally sensitive tools that enable very early life detection of neurodevelopmental vulnerability to, and expression of, developmental psychopathology. Dr. Wakschlag will lead the oversight of all research activities for the preliminary data collection and ultimately for the Research Partnership.

J.D. Smith, PhD(he/him/his)

Project Co-Lead

J.D. Smith, PhD, is a clinical psychologist, with an emphasis on child, family, and health psychology, and as an implementation scientist focused on the development and application of novel methods. He co-leads the MHE Center overall and the Peds-BRITE project with Dr. Laurie Wakschlag and co-leads the Methods Incubation Core with Dr. Patricia Franklin. He is excited about the potential wide-scale impact of the Center’s approach on thousands of toddlers and their families. The interdisciplinary and deeply collaborative team science approach of the Center is also a stimulating and impactful aspect of this multi-university and health system partnership.

Matt Davis(he/him/his)

Project Co-Lead

Matthew Davis, MD, MAPP, is the Executive Vice President, Enterprise Physician in Chief, and Chief Scientific Officer at Nemours Children’s Hospital, Delaware, where he leads all clinical, academic, and research activities. As the Nemours Principal Investigator for the Peds-BRITE project, and Chair of the Steering Committee, Dr. Davis oversees the study and ensures its alignment with Nemours’ mission to advance child health through integrated clinical care and research. He also serves as Lead of the Community Engagement Workgroup, guiding collaboration across teams, supporting effective study implementation, and strengthening connections between researchers, clinicians, and the communities they serve. Dr. Davis is especially energized by work that links innovative science with real-world community impact, and Peds-BRITE reflects his commitment to advancing early mental health support and improving outcomes during children’s most formative years.

Kathryn Hoffses(she/her/hers)

Project Co-lead

Kathryn Hoffses, PhD, is a pediatric psychologist and researcher in primary care at Nemours Children’s Hospital, Delaware and Clinical Associate Professor of Pediatrics at Sidney Kimmel Medical College of Thomas Jefferson University. Dr. Hoffses research and clinical practice focus on understanding physician competence for treating pediatric behavioral health conditions, examining the impact of behavioral health services in pediatric primary care, and promoting access to behavioral health services. For the Peds-BRITE project, Dr. Hoffses serves as the Nemours Site Co-Principal Investigator and works closely with medical providers, behavioral health clinicians, and research team members at Nemours and Northwestern University. Dr. Hoffses has a passion for prevention and early intervention services and is excited to work with expert researchers and clinicians through the MHE Center to support positive mental health services for children and families across the country.

Jordan Lee, PhD, CCC-SLP(she/her/hers)

Peds-BRITE Scientific Director

Jordan Lee, PhD, CCC-SLP, is a speech-language pathologist and researcher in early identification and intervention for children with developmental disabilities. Dr. Lee is the Scientific Project Director for Peds-BRITE, so she works with the MHE Center’s clinical partners to make sure the study works for clinicians and caregivers at their clinics, while also giving our Center’s team strong data to answer research questions. Dr. Lee is excited about the ways that the Center could lead to important clinical changes that truly reach families and help them build a strong foundation for their child's development

Brittany Manning, PhD(she/her/hers)

Assessment Lead

Brittany Manning, PhD, CCC-SLP, is a postdoctoral fellow in Northwestern's Innovations in Developmental Sciences Institute. Dr. Manning is a developmental scientist, licensed speech-language pathologist and expert in assessments of young children. Her scientific work centers on the intersection of early language and mental health risk and the protective influence of responsive parenting. Dr. Manning is an expert in observational, direct, and caregiver-report measures of young children’s development and she will oversee developmental assessments for the Peds BRITE project.

Hodan Jibrell, MPH(she/her/hers)

Research Project Coordinator

Hodan Jibrell, MPH, is the MHE Center's Research Project Coordinator at Northwestern University. She has specialized training in maternal and child health, global health, and community-engaged research, with expertise in qualitative methods including data collection, analysis, and interpretation. In her role, she supports the design and implementation of early childhood mental health research and collaborates across teams to advance study goals. She is excited to contribute to work that centers families and communities while promoting accessible early mental health interventions.