Feasibility and effectiveness of implementing an integrated care model for attention deficit hyperactivity disorder in primary care pediatrics

Abstract

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral health disorder with annual costs approaching $80 billion dollars in the United States alone. It is wellestablished that ADHD is best treated using a chronic care model but integrating such models into primary care is challenging. We report on the feasibility and effect of an integrated behavioral health approach to ADHD in pediatric primary care. Theory/Methods: We collected feedback from families and primary care providers to create an assessment profile following the principles of family-centric ADHD care. Validated scales measured parental stress, self-efficacy of parenting skills, treatment preferences, barriers and goals, child impairment, and externalizing and internalizing symptoms. Families completing the profile were invited to a 30-minute engagement session in the pediatric office by clinic staff (RN or LCSW) to identify treatment goals and services to help reach these goals. Adolescents had separate parent and teen sessions followed by a family session. This was implemented at a large academic primary care pediatric clinic. Results: Of 7150 patients aged 4-17 we identified 411 (5.7%) diagnosed with ADHD. 121 (29%) of these completed the initial profile and all were referred to the engagement session. Of invited families, 98 (81%) scheduled a session, and 82 (68%) completed one. Factors significantly associated with session attendance were elevated levels of child impairment and caregiver strain, a parent whose treatment goals focused on academics, lower self-efficacy of parenting skills, lower levels of medication stigma and fewer reported medication side effects. Current medication use was not predictive. Over 90% of attending families identified a new ADHD treatment for their child with high desirability and readiness to initiate this treatment (mean score=8.9 on a 1-10 Likert). Participants completing an engagement session had more medical office visits for ADHD (excluding the engagement session) over the next 6 months than those who did not (p