This competing continuation extends our parent study (Effectiveness of Therapy for Behavior Problems in Primary Care;MH63272) by seeking to more efficiently and effectively treat children with a disruptive behavior problem (DBP) in the pediatric primary-care setting. Our enhanced treatment program, Doctor- Office Collaborative Care (DOCC), reflects a care management approach that incorporates the child's pediatrician through integrated in-house services and resources coordinated by a clinical care manager. Physician clusters from six primary care offices will be randomized to either DOCC or Treatment-as-Usual (TAU). Patients of these PCPs will simply receive the intervention condition of their respective PCPs. Background information will be collected to examine group comparability on the same three covariates as used in the original parent study (ADHD, any other comorbid disorder, prior MH treatment). Based on the findings of our parent study and year-long pilot study, several developments are incorporated herein: 1) Adaptation of the chronic care model and participatory management theory to create an evidence-based collaborative care delivery system designed to enhance training, implementation, and sustainability, 2) revised clinical content that includes medication management for ADHD, brief anxiety management, and attention to parental distress/referral, 3) technological advances to facilitate efficient processes of care, monitoring, and communication, and 4) an improved methodology that includes new samples, measures, and settings. Both intervention process (implementation) and outcome (effectiveness) data will be assessed across four timepoints: 1) intake, 2) discharge, 3) 1-year follow-up, and 4) 2-year follow-up. Assessment will include a multi-method (e.g., individualized and standardized rating scales, office medical records, provider reports), multi-informant (child, parent, care manager, pediatrician) approach to evaluate effects on key child behavioral and emotional outcomes (symptom severity, diagnoses), and functional/health status (impairment). We will also explore the impact of DOCC on child services/systems use, parental functioning, and physician beliefs/practices supportive of collaborative care. Analyses will be conducted using Hierarchical Linear Modeling and Analyses of Variance. The ultimate goal for this research is to establish the viability of an integrated mental health service delivery system within the pediatric primary care setting.
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