Getting to First Base: Promoting Engagement in Family–School Intervention for Children with ADHD in Urban, Primary Care Practice

Caregivers' perspectives on the contextual influences within family management for ethnically diverse children with ADHD

PURPOSE

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting over 9% of children in the United States. Family caregivers are often responsible for the management of their child's ADHD. Contextual influences, such as healthcare providers, systems, and resources, are factors contributing to the ease or difficulty of family management. The purpose of this article is to qualitatively describe the major contextual influences that impact family management for ethnically diverse children with ADHD.

DESIGN AND METHODS

This analysis is part of a mixed methods study using a concurrent nested design (QUAL + quant) to understand the phenomenon of family management from a contextual and socioecological perspective. In this analysis, cross-sectional data from caregivers of children with ADHD (N = 50) within a large northeastern city in the United States were collected, analyzed, and interpreted in the qualitative descriptive tradition. Semistructured interviews were conducted with participants to understand the contextual influences within family management. Conventional content analysis resulted in the emergence of barrier and facilitator domains and subdomains.

RESULTS

Caregivers were predominantly female (98%) and between 24 and 61 years with a mean age of 37.54 (SD = 1.18). Caregivers identified their children as Black or African American (56%), White (26%), Multi-Racial (16%), Hispanic or Latinx (8%), and Asian (2%). Contextual influences within family management emerged as barrier or facilitator domains. Barrier domains included: (1) family, (2) healthcare systems, (3) educational systems, (4) stigma, and (5) financial, insurance, and policy issues. Facilitator domains included: (1) family and community, (2) healthcare providers, and (3) educational providers. Subdomains within each domain are expanded in the article.

PRACTICE IMPLICATIONS

Specialists in pediatric nursing should consider contextual influences within family management for ethnically diverse children with ADHD. As healthcare providers, it is important to recognize system-level barriers or facilitators for caregivers and their children and find creative ways to overcome obstacles and leverage strengths within families, communities, and care systems. Another important area for pediatric specialists to consider is understanding how stigma impacts children with ADHD. Policy-level engagement and advocacy should maximize the political will of nurses, families, and educators to create change within communities.

Bringing Inclusion Into Pediatric Primary Health Care: A Systematic Review of the Behavioral Health Treatment of Racial and Ethnic Minority Youth

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.

A comprehensive service delivery model for preschoolers with special educational needs: Its characteristics and effectiveness

BACKGROUND

The compartmentalization between early intervention services and early childhood special education programs is a worldwide phenomenon, which results in the fragmentation of services for preschoolers with special educational needs (SEN).

AIMS

To address this fragmentation of services, an intervention program in Hong Kong adopted a comprehensive service delivery model with six characteristics: 1) multidisciplinary approach, 2) integration of services across different contexts, 3) multimodal intervention with direct and indirect services, 4) capacity building for systems, 5) inclusive environment, and 6) high program intensity.

METHODS

The program evaluation was a quasi-experiment with a control group (n = 60) matched to the experimental group (n = 60).

RESULTS

At the end of the school year, the experimental group made significant improvement in most measures including cognitive skills, receptive language skills, expressive language skills, gross-motor skills, fine-motor skills, and self-direction skills. School heads in the experimental group also agreed that the program had empowered their teachers and reinforced their school systems.

CONCLUSION

Despite its exploratory nature, the study has shed light on the future directions of services for preschoolers with SEN. The comprehensive service delivery model offers a response to the fragmentation of services and reveals the importance of integration of services across different contexts with multidisciplinary approach.

Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health

Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.

Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example

Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers that can be applied in both primary care and school settings are described. The paper has a primary focus on children with ADHD, but the principles and strategies described are applicable to children with a range of mental health and health conditions.

Partnership in the Treatment of Childhood Mental Health Problems: A Pediatric Perspective

Pediatricians understand their role as promoting both the physical and mental health of children from birth until adulthood. Within the context of this long-term relationship, parents approach clinicians to address a full range of behavioral concerns ranging from variations of normal development to major mental illness. In this commentary that builds upon the earlier manuscripts in this collection, we explore the pediatrician's role in mental health care through the example of attention-deficit hyperactivity disorder (ADHD). ADHD is an ideal prototype for the exploration of partnership in mental health care because ADHD is the most common neurobehavioral disorder in childhood, it is commonly treated in primary care settings, multiple evidence-based treatments exist, personal values strongly influence the acceptability of treatment, treatment adherence is often poor, and effective treatment relies on the collaboration of pediatricians with families, schools, and the mental health system. Through the use of the Chronic Care Model for Child Health that emphasizes the importance of optimizing and coordinating systems of care for effective partnership, the following manuscript reviews the challenges and opportunities for pediatricians partnering with families and schools to address mental health problems. Strategies highlighted in the preceding papers are discussed within the context of this model.