Maternal and Child Health Research Program

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Advancing Applied MCH Research

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Evaluation of an urban-based collaborative care model for ADHD

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Project Number: R40 MC 08964-03
Grantee: Children's Hospital of Philadelphia
Department/Center: Pediatrics/Child Development
Project Date: 2/1/2008

Final Report

Submitted

Principal Investigator

Thomas Power, Ph.D.
Professor
Joseph Stokes, Jr. Research Institute 3615 Civic Center Boulevard
Philadelphia, PA  19104-4318
Phone: (215) 590-7447
Email: power@email.chop.edu

Age

  • Middle Childhood (6-11 years)

Race/Ethnicity

  • African American

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.

Publications

Listed is descending order by year published.

Eiraldi RB, Mautone JA, Power TJ. Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America. 2012 Jan;21(1):145-159.

Cassano MC, Lefler EK, Tresco KE, Mautone J A, Power TJ. Children with disruptive behavior: effective family and educational interventions. Consultant for Pediatricians. 2011;10,75-80.

Mautone JA, Lefler EK, Power TJ. Promoting family and school success for children with ADHD: strengthening relationships while building skills. Theory into Practice. 2011; 50(1); 43-51. PMCID: PMC3195402

Power TJ, Hughes CL, Helwig JR, Nissley-Tsiopinis J, Mautone JA, Lavin, H. Getting to first base: promoting engagement in family-school intervention for children with ADHD in urban, primary care practice. Sch Ment Health. 2010 Jun;2(2):52-61.

Tresco KE, Lefler EK, Power TJ. Psychosocial interventions to improve the school performance of students with attention-deficit/hyperactivity disorder. Mind & Brain: The Journal of Psychiary. 2010 PMCID: PMC2998237

Keywords

Coordination of Services, ADD/ADHD, Medical Home, Access to Health Care, School Outcomes & Services, Primary Care

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