Equity-Centered Development of a Community Health Worker Intervention to Improve Engagement in Care for ADHD

Abstract

Objective: Barriers to engagement perpetuate inequities in ADHD care for children. Community Health Worker (CHW) interventions could improve treatment engagement and reduce inequities. We describe the development of a novel, manualized, 5-module CHW intervention for ADHD called START (SupporT for ADHD and Related Treatment) to increase engagement with ADHD care. Method: We developed START based on perspectives from racial and ethnic minoritized families with feedback from a community advisory board, and conducted a single arm, adaptive pilot feasibility study of START for primary caregivers of children aged 6 to 12 years with newly diagnosed ADHD. We collected process data, pre- and post-intervention survey data, and qualitative data via caregiver exit interviews. Results: Eighteen families enrolled, 15 completed START, and 16 completed study questionnaires. Median intervention duration was six sessions (IQR = 5–6) over 5 weeks (IQR = 4–8). All caregivers reported satisfaction with the quality of the intervention and materials provided and reported they would recommend START to another caregiver. Most caregivers reported that START made them more likely to consider medications (69%), therapy (75%), and school services (88%) for their ADHD. From pre- to post-intervention, median number of outpatient treatments increased from 1.0 (IQR = 1.5) to 2.0 (IQR = 0.5; p = .0034), ADHD knowledge increased (p < .0001), and median scores for 16 of 17 intervention objectives increased (p < .05). Conclusion: START showed excellent feasibility and acceptability and treatment utilization increased post-intervention. We refined START based on feedback from caregivers, including enhanced personalization and expanding to six modules, to prepare for testing in a clinical trial.