The need for new models for delivering mental heath services within primary care (PC) has been recognized for two decades, yet federal funding to address this need has been lacking. Telemental health (TMH) programs are being implemented nationally to address inequities in access to mental health services, but little scientific evidence is available regarding their efficacy, particularly with children. The goal of the proposed research is to test the efficacy of a TMH service delivery model for improving care and outcomes for children with a prevalent psychiatric condition who are treated by primary care physicians (PCPs) in 5 underserved communities in the Pacific Northwest. The research proposed is a randomized controlled trial of PCP care augmented by TMH-delivered evidence- based treatment of children (N=250) 7-11 years old diagnosed with attention-deficit hyperactivity disorder (ADHD) versus treatment as usual by the PCP. Hispanic children will comprise 30% of the study sample. The experimental condition will consist of 6 pharmacotherapy sessions delivered by child psychiatrists through videoconferencing in conjunction with the referring PCP who will prescribe medications and 6 sessions of parent behavioral training delivered in-person by a community therapist supervised by a telepsychologist. The control condition will consist of treatment as usual with the PCP augmented by a single telepsychiatric consultation, which is current standard care in the participating communities. For children in both experimental and control conditions, hyperactivity, inattentiveness, oppositionality/defiance, and functional impairment, as well as parental stress, burden, and empowerment will be assessed 5 times from baseline to 25-week follow- up. In the experimental group, adherence to treatment protocols will be carefully monitored for families, telepsychiatrists, local community therapists, and PCPs. If under the experimental delivery model, improvements in clinical outcomes are demonstrated, and if an evidence-based treatment protocol can be implemented with fidelity, then TMH health service delivery models could be deployed with confidence to help rectify the severe geographic maldistribution of pediatric mental health services and to build new models of collaborative care within PC. This telemental health (TMH) investigation holds promise for improving the nation's public health and welfare in three ways. First, TMH offers children and families suffering with emotional and behavioral disorders help that cannot be found locally by redistributing specialty mental health care from urban centers to underserved communities. Second, TMH offers secondary and tertiary prevention by reaching children's in need prior to the full evolution of mental illness and its associated impairments. Third, TMH offers primary care physicians, teachers, and other professionals'assistance in their efforts to care for our nation's children.
