Comparative Effectiveness Research for Two Medical Home Models for Attention Deficit Hyperactivity Disorder

• ADHD Symptoms [ Time Frame: 6 mo ] [ Designated as safety issue: No ]
  Swanson, Nolan and Pelham scale (SNAP-IV)
• ADHD Symptoms [ Time Frame: 12 mo ] [ Designated as safety issue: No ]
  Swanson, Nolan and Pelham scale (SNAP-IV)
• Patient Medication Adherence [ Time Frame: 6 mo ] [ Designated as safety issue: No ]
  Timely prescribed refills of ADHD medications - assessed through the EHR - will provide an accurate picture of medication adherence from the perspective of prescription writing. In addition, we will administer the validated Medication Adherence Scale, which has good reliability among parents of urban children with asthma
• Patient Medication Adherence [ Time Frame: 12 mo ] [ Designated as safety issue: No ]
  Timely prescribed refills of ADHD medications - assessed through the EHR - will provide an accurate picture of medication adherence from the perspective of prescription writing. In addition, we will administer the validated Medication Adherence Scale, which has good reliability among parents of urban children with asthma

• ODD Symptoms [ Time Frame: 6 mo ] [ Designated as safety issue: No ]
  SNAP-IV
• Social Skills [ Time Frame: 6 mo ] [ Designated as safety issue: No ]
  Social Skills Rating System
• Time to Symptom Improvement [ Time Frame: 12 mo ] [ Designated as safety issue: No ]
  Based on follow-up ADHD symptom scales administered at regular intervals by our care managers, we will quantify the time between initial diagnosis and definitive improvement - conventionally defined by a 25% symptom reduction from baseline
• ODD Symptoms [ Time Frame: 12 mo ] [ Designated as safety issue: No ]
  SNAP-IV
• Social Skills [ Time Frame: 12 mo ] [ Designated as safety issue: No ]
  Social Skills Rating System

The purpose of this study is to compare the effectiveness of two care models on ADHD outcomes: one, a model of basic care management and structured communication with specialists, consistent with conventional descriptions of a patient-centered Medical Home; and another, which combines the Medical Home with theory-based care management strategies to address common reasons for ADHD treatment failure.

• Behavioral: Collaborative Care Plus
  Traditional collaborative care + systematic addressing of ADHD comorbidities, parental mental health issues, and adherence to treatment plans
• Behavioral: Traditional Collaborative Care
  Traditional collaborative care, in which care managers serve as intermediaries between primary care physicians and specialists

• Active Comparator: Collaborative Care Plus
  Collaborative care model with specific theory-based elements to address common reasons for ADHD treatment failure
  Intervention: Behavioral: Collaborative Care Plus
• Active Comparator: Traditional Collaborative Care
  Traditional collaborative care, in which care managers serve as intermediaries between primary care physicians and specialists
  Intervention: Behavioral: Traditional Collaborative Care

Inclusion Criteria:

• Child is being evaluated for a potential diagnosis of ADHD by a primary care pediatrician at one of our sites.
• Child is 6 to 12 years of age
• Family plans to remain in the Boston area for the duration of the follow-up period
• Mother is comfortable in English or Spanish

Exclusion Criteria:

• Child already has a confirmed diagnosis of ADHD
• Child already receives ongoing specialty care in one or more of the following clinics: pediatric psychiatry, developmental behavioral pediatrics

• Codman Square Health Center
• Dorchester House Health Center