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Lui JHL, Danko CM, Triece T, Bennett IM, Marschall D, Lorenzo NE, Stein MA, Chronis-Tuscano A. Screening for parent and child ADHD in urban pediatric primary care: pilot implementation and stakeholder perspectives. BMC Pediatr 2023; 23:354. [PMID: 37442955 PMCID: PMC10339482 DOI: 10.1186/s12887-023-04082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/18/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND ADHD commonly co-occurs in children and parents. When ADHD is untreated in parents, it contributes to negative child developmental and treatment outcomes. Screening for parent and child ADHD co-occurrence in pediatric primary care may be an effective strategy for early identification and treatment. There is no data on whether this screening model can be implemented successfully and there exists limited guidance on how to effectively approach parents about their own ADHD in pediatric settings. Even greater sensitivity may be required when engaging with families living in urban, low SES communities due to systemic inequities, mistrust, and stigma. METHODS The current pilot study described the first 6 months of implementation of a parent and child ADHD screening protocol in urban pediatric primary care clinics serving a large population of families insured through Medicaid. Parents and children were screened for ADHD symptoms at annual well-child visits in pediatric primary care clinics as part of standard behavioral health screening. Independent stakeholder group meetings were held to gather feedback on factors influencing the implementation of the screening and treatment strategies. Mixed methods were used to examine initial screening completion rates and stakeholder perspectives (i.e., parents, primary care office staff, pediatricians, and behavioral health providers) on challenges of implementing the screening protocol within urban pediatric primary care. RESULTS Screening completion rates were low (19.28%) during the initial 6-month implementation period. Thematic analysis of stakeholder meetings provided elaboration on the low screening completion rates. Identified themes included: 1) divergence between provider enthusiasm and parent hesitation; 2) parent preference versus logistic reality of providers; 3) centering the experiences of people with marginalized identities; and 4) sensitivity when discussing parent mental health and medication. CONCLUSIONS Findings highlight the importance of developing flexible approaches to screening parent and child ADHD in urban pediatric health settings and emphasize the importance of cultural sensitivity when working with marginalized and under-resourced families. TRIAL REGISTRATION NCT04240756 (27/01/2020).
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of Maryland, College Park, MD, USA.
- Department of Psychology, Concordia University, 7141 Sherbrooke West, PY-146, Montreal, QC, Canada.
| | - Christina M Danko
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Tricia Triece
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Ian M Bennett
- Family Medicine and Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donna Marschall
- Whole Bear Care, Children's National Hospital, Washington, DC, USA
| | - Nicole E Lorenzo
- Department of Psychology, American University, Washington, DC, USA
| | - Mark A Stein
- Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health. J Clin Med 2022; 11:jcm11216468. [PMID: 36362698 PMCID: PMC9654487 DOI: 10.3390/jcm11216468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed.
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Lewis FJ, Rappleyea D, Didericksen K, Sira N, Byrd J, Buton A. Bringing Inclusion Into Pediatric Primary Health Care: A Systematic Review of the Behavioral Health Treatment of Racial and Ethnic Minority Youth. J Pediatr Health Care 2021; 35:e32-e42. [PMID: 34083102 DOI: 10.1016/j.pedhc.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Currently, pediatric behavioral health care accounts for one of the fastest growing health care expenditures. Children representing racial and ethnic minority groups are still found to experience significant behavioral health needs. Primary health care represents the first level of contact with the health care system. METHOD The purpose of this systematic review was to synthesize articles discussing the behavioral health needs and treatment of racial and ethnic minority in primary care settings. RESULTS Results yielded 40 articles meeting the inclusion criteria. Themes included: provider screening, provider selected treatments, prevalence and need, and stigma and patient-provider communication. CONCLUSIONS Themes were discussed through the Ecological Systems Theory lens. Study limitations included its exclusion of intellectual disabilities like Autism Spectrum Disorder, lack of literature utilizing large minority samples, and lack of attention to the intersection between race and/or ethnicity alongside other demographics of concern like gender, age, social class, and geographical location.
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Banks A. Black Adolescent Experiences with COVID-19 and Mental Health Services Utilization. J Racial Ethn Health Disparities 2021; 9:1097-1105. [PMID: 33909283 PMCID: PMC8080856 DOI: 10.1007/s40615-021-01049-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022]
Abstract
Background COVID-19 is disproportionately impacting communities of color. Black adolescents are among the most vulnerable to COVID-19, have high mental health service needs, and have low mental health services utilization. During this time of great physical threat due to COVID-19, it is equally important to understand and support the mental health of Black adolescents. Method This study collected open-ended survey item responses from adolescents (12–17 years old) that identified as Black, living in a city in the Southeastern United States (n = 33). Grounded theory was used to analyze the data, revealing details of the lived experience of these Black adolescents during the COVID-19 pandemic. Results Black adolescents reported that COVID-19 has been both positive and negative for them. Family is of utmost importance to them, as are their peers, whom they do not get to interact with due to changes in the operation of schools. Despite experiencing stress, adaptive responses to COVID-19 are reported. Black adolescents continue to cite issues with mental health services and providers. Financial issues were a common theme for these youth, blocking access to services and causing issues in the home environment. Conclusions Mental health service providers must address the service access and quality issues repeatedly reported by Black adolescents. Direct action must be taken to facilitate an increase in Black adolescents mental health services utilization and satisfaction. Changes are needed at the individual and macro levels to alter the experience of one of our most vulnerable groups. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01049-w.
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Affiliation(s)
- Andrae Banks
- Department of Social Work, North Carolina Central University, 1801 Fayetteville Street, Durham, NC, 27707, USA.
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Williamson AA, Milaniak I, Watson B, Cicalese O, Fiks AG, Power TJ, Barg FK, Beidas RS, Mindell JA, Rendle KA. Early Childhood Sleep Intervention in Urban Primary Care: Caregiver and Clinician Perspectives. J Pediatr Psychol 2021; 45:933-945. [PMID: 32430496 DOI: 10.1093/jpepsy/jsaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/14/2020] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES. METHODS Semi-structured interviews were conducted with (a) 23 caregivers (96% mothers; 83% Black; 65% ≤125% U.S. poverty level) of toddlers and preschoolers with insomnia or insufficient sleep and (b) 22 urban primary care clinicians (physicians, nurse practitioners, social workers, and psychologists; 87% female; 73% White). Guided by the Consolidated Framework for Implementation Research, the interview guide assessed multilevel factors across five domains related to intervention implementation. Qualitative data were analyzed using an integrated approach to identify thematic patterns across participants and domains. RESULTS Patterns of convergence and divergence in stakeholder perspectives emerged across themes. Participants agreed upon the importance of child sleep and intervention barriers (family work schedules; household and neighborhood factors). Perspectives aligned on intervention (flexibility; collaborative and empowering care) and implementation (caregiver-to-caregiver support and use of technology) facilitators. Clinicians identified many family barriers to treatment engagement, but caregivers perceived few barriers. Clinicians also raised healthcare setting factors that could support (integrated care) or hinder (space and resources) implementation. CONCLUSIONS Findings point to adaptations to evidence-based early childhood sleep intervention that may be necessary for effective implementation in urban primary care. Such adaptations could potentially reduce significant pediatric sleep-related health disparities.
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Affiliation(s)
- Ariel A Williamson
- Children's Hospital of Philadelphia.,Perelman School of Medicine, University of Pennsylvania
| | - Izabela Milaniak
- Department of Psychology, University of Pennsylvania.,Nemours/Alfred I. duPont Hospital for Children
| | - Bethany Watson
- Department of Psychology, University of Pennsylvania.,Bellevue/New York University
| | | | - Alexander G Fiks
- Children's Hospital of Philadelphia.,Perelman School of Medicine, University of Pennsylvania
| | - Thomas J Power
- Children's Hospital of Philadelphia.,Perelman School of Medicine, University of Pennsylvania
| | | | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania
| | - Jodi A Mindell
- Children's Hospital of Philadelphia.,Department of Psychology, Saint Joseph's University
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Foronda CL, Muheriwa SR, Fernandez-Burgos M, Prather S, Nersesian P. Medication Adherence of Latino Children and Caregivers: An Integrative Review. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:207-213. [PMID: 31888391 DOI: 10.1177/1540415319896623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There are significant disparities in medication adherence among underserved minority groups such as Latinos. Adherence to medication is a primary determinant of treatment success. Little is known about medication adherence among Latino children. This integrated review aims to describe what is known about medication adherence among Latino children and explore barriers and facilitators to medication adherence. METHOD This review was guided by Whittemore and Knafl's method of integrative review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RESULTS Of the 20 articles reviewed about medication adherence among Latino children, the analysis of these articles revealed four major themes: (1) low adherence, (2) low adherence associations, (3) child outcomes, and (4) effective interventions. CONCLUSION Health practitioners should consider medication adherence associations and interventions when collaborating with the family caregiver to improve child outcomes.
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Zhao L, Cross-Barnet C, McClair VL. Prescription Drug Use and Cost Trends Among Medicaid-Enrolled Children with Disruptive Behavioral Disorders. J Behav Health Serv Res 2018; 45:550-564. [PMID: 29572707 DOI: 10.1007/s11414-018-9605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disruptive behavior disorders (DBDs) are the most common mental health conditions in children. These conditions profoundly affect healthcare utilization and costs. Service use, costs, and diagnostic trends among pediatric Medicaid beneficiaries provide information regarding healthcare quality and potential for smarter spending. Using nationwide Medicaid administrative data, this study investigates diagnoses, prescription drug fills, and payments in 49 states and D.C. from 2006 to 2009 in Medicaid beneficiaries age 20 and under. Psychotherapeutic drug prescriptions and payments were calculated as a proportion of prescription totals. Results were considered by age, gender, race, and state. The results show a trend of increasing DBD diagnosis. Among prescription claims for children with diagnosed DBD, psychotherapeutic drug claims represented 30-40% of prescription claims but over half of prescription costs. This study indicates increasing clinical and financial needs for Medicaid-enrolled children with DBDs. Medicaid could potentially foster reforms in pediatric DBD treatments, particularly regarding medication use.
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Affiliation(s)
- Lirong Zhao
- Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, 7500 Security Blvd., Mail Stop: WB-06-05, Baltimore, MD, 21244, USA.
| | - Caitlin Cross-Barnet
- Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, 7500 Security Blvd., Mail Stop: WB-06-05, Baltimore, MD, 21244, USA
| | - Vetisha L McClair
- Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, 7500 Security Blvd., Mail Stop: WB-06-05, Baltimore, MD, 21244, USA
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