Evaluation of an urban-based collaborative care model for ADHD
Project Number: R40 MC 08964-02 Project Date: 2/1/2008 Grantee: Children's Hospital of Philadelphia Department/Center: Pediatrics/Child Development
Final Report
Pending
Principal Investigator
Thomas Power Ph.D., Professor, Children's Hospital of Philadelphia Pediatrics/Child Development, Joseph Stokes, Jr. Research Institute 3615 Civic Center Boulevard Philadelphia, Pennsylvania 19104-4318 power@email.chop.edu
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder that poses substantial public health concerns. Children with this disorder are at high risk for school failure and drop out, psychopathology, injury, and serious health problems. Evidence-based interventions for children with ADHD may be relatively ineffective with families residing in low-income, urban settings, who are disproportionately represented among ethnic minority groups. Families from these settings often face significant barriers to care that make it difficult for them to sustain their involvement throughout the duration of intervention. This 3-year intervention study builds upon our research demonstrating the effectiveness of collaborative care for children with (ADHD) that involves integrating the family, school, and health systems.
Strategic Research Issue I: Public health systems as they apply to MCH populations based on demographic, epidemiological, and/or other factors. This project is designed to integrate health, mental health, and educational services through the child’s medical home for children with or at risk for ADHD who reside in low-income settings.
Strategic Research Issue II: MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations. This project will investigate the effects of a collaborate model of family-centered care on reducing barriers to care and improving the feasibility of service delivery to low-income families from urban settings, most of whom are African American.
Strategic Research Issue IV: Promoting the healthy development of MCH populations. This project will examine the effects of a collaborative, multi-systemic, community-based approach to care on the development of children with or at risk for ADHD in home and school settings.
Unique features of the collaborative care approach used in this study, which is known as Partnering to Achieve School Success (PASS) are that it: (a) is based in a primary care center (PCC; child’s medical home); (b) serves primarily low-income families residing in a large urban setting; (c) targets children with ADHD early in their schooling (kindergarten through grade four) as a method of providing early intervention; (d) has a primary focus on engaging and re-engaging families in intervention by linking families with an advocate (i.e., a clinical assistant); (e) addresses directly barriers to care; and (f) provides components of treatment in response to a family’s readiness, willingness, and ability to receive care.
After a 5-month period of refinement, the intervention will be evaluated using an adapted, quasi-experimental design. A majority of eligible families served through one large, CHOP-affiliated primary care center (PCC) will receive PASS and a majority of families served through another large, CHOP-affiliated PCC will be in the comparison group (COMP) that receives treatment as usual and supplemental family and provider education. Some families in the first PCC will receive COMP and some families in the second PCC will receive PASS to provide partial control for potential site differences. Outcomes will be assessed at mid-treatment (3 months after initiation) and post-treatment (6 months after initiation) across three domains: beliefs about service use (acceptability, barriers to care, feasibility), family functioning (child behavior at home, parenting behavior, and parental responsiveness to child), and school functioning (school performance, teacher-student relationship, family-school relationship). The resources allotted for this grant are not sufficient to collect follow-up data.
