Implementing ADHD Assessment and Intervention in Pediatric Primary Care

1. Session #F4a Saturday, October 12, 2013 Implementing ADHD Assessment and Intervention in Pediatric Primary Care Parinda Khatri, PhD Kara Johansen, PsyD Director of Integrated Care Behavioral Health Consultant Cherokee Health Systems Cherokee Health Systems Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives • Clinical Model Overview • Rationale • Implementation • Lessons Learned

4. + Our Mission… To improve the quality of life for our patients through the integration of primary care, behavioral health and substance abuse treatment and prevention programs. Together…Enhancing Life

5. Cherokee Health Systems Number of Employees: 622 Provider Staff: Psychologists – 43 Master’s level Clinicians - 70 Case Managers - 33 Primary Care Physicians – 28 Psychiatrists – 10 Pharmacists – 10 NP/PA (Primary Care) – 30 NP (Psych) – 12 Dentists - 2

6. Cherokee’s Blended Behavioral Health and Primary Care Clinical Model Embedded Behavioral Health Consultant on the Primary Care Team Real time behavioral and psychiatric consultation available to PCP Focused behavioral intervention in primary care Behavioral medicine scope of practice Encourage patient responsibility for healthful living A behaviorally enhanced Healthcare Home

7. Why ADHD? • Most common psychiatric disorder in children • Common presenting concern in Pediatrics • Concern is usually driven by parent, caregiver, or school • Good evidence base practice recommendations exist • Good fit with integrated primary care team

8. Key Components of Primary Care Based Inter-Professional Collaborative Interventions • Team Based Assessment • Collaborative Goal Setting • Team Treatment Planning • Skills Enhancement • Follow Up and Support • Promotion of self-efficacy • Access to Resources • Continuity of Coordinated Quality Clinical Care

9. Pediatric Healthcare Team Pediatric Medical Providers Behavioral Health Consultants Nurses Case Manager Patient Service Representatives

10. Evidence Based Recommendations • American Academy of Pediatrics Guidelines • American Academy of Child and Adolescent Psychiatry • Institute for Clinical Systems Improvement Guideline

11. Summary : Key Recommendations • Multi-modal Assessment Parent, Teacher, Self- Report, Observation • Multi-modal Interventions Family, Child, and School Based • Monitoring Regular Follow Ups, Progress Reports, Annual Re-assessment

12. Knox County Pediatrics – Dameron Avenue

13. Dameron Ave Pediatric Clinic Urban clinic setting in Knoxville, TN Pediatric primary care, BHC, and case management services Largely uninsured and TennCare patients Mostly low income and unemployed patients, very few homeless On most days, staffed by 3 PC providers, and 1 BHC Local mobile crisis access, several inpatient/residential facilities, and community health organizations within the surrounding counties Community has need for integrated pediatric services for patients with limited transportation and awareness of community resources

14. Work Flow

15. Medical or Well-Visit • Results in consult if the following: • Parent report of symptoms in the home • Teacher report of behavioral problems at school • History of problems at school • Family history of ADHD • Return Phase II F/U Visit • Review assessment results and clarify diagnosis • Provide education regarding ADHD • Discuss treatment options • Consult with PCP and start treatment • Discuss treatment adherence • BHC Consult – Phase II • (Same Visit or F/U Visit) • Provide BASCs (parent, teacher, and self) • Introduce case manager • Obtain school releases for classroom observation/teacher interview • Schedule an appointment with PCP and BHC • BHC Consult – Phase I • Clinical Intake • Provide education regarding effective behavior management strategies • Explain ADHD assessment process Clinical Flow Return for F/U Medical Visit

16. Things We Learned Along the Way Team Based Approach Recognize that relationships with staff will be key to your clinical effectiveness. Meet with providers to learn about population served. Schedule with PCP time/days for initial and f/up appointments. Include all staff members in the roll-out process Trial and Error Mentality Provide opportunities for staff feedback Make modifications Be Creative Learn together Be flexible

17. kara.johansen@cherokeehealth.com parinda.khatri@cherokeehealth.com

18. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!