This application addresses broad Challenge Area 15-MH-105, Strategies to support uptake of interventions within clinical and community settings: Develop and pilot comprehensive implementation strategies to support the broader uptake of interventions within clinical and community settings. Drawing upon behavioral change science and distance learning methods, this proposal Enhancing Pediatric Psychopharmacology in the Medical Home aims to test the relative impact of two interventions of differing intensity, both designed to increase primary care providers'(principally physicians') use of expert-recommended """"""""best practices"""""""" in the assessment and treatment of children and adolescents with ADHD. This study of strategies to change physicians'ADHD practices addresses an area of urgent public health need and keen interest, given concerns about ADHD under- and over-treatment, potential side effects of the drugs used to treat ADHD, and the failure to employ other interventions that might be required to optimize child and family outcomes. Importantly, findings from the NIMH Multimodal Treatment of Children with ADHD (MTA) Study (1999) indicate that carefully medication management is significantly more effective and cost-effective than usual care, yet available evidence indicates that most """"""""real-world"""""""" primary care clinicians have not incorporated these findings into their ADHD management practices. This application capitalizes on these new findings to address this area of great public health impact. Moreover, because basic behavior change methods and learning theory are incorporated into the interventions, findings from this study will be of great interest to other scientists and policy-makers struggling to close the research-practice gap. The proposal addresses the following 3 aims, readily achievable within 2 years:
Aim 1. To evaluate the immediate, 3-month, and 12-month impact of a novel training methods in child psychopharmacology on the knowledge, attitudes, skills, self- efficacy, and clinical practice behaviors of 60 primary care clinicians (PCCs) and pediatric residents who treat ADHD and related problems.
Aim 2. To gather pilot data and preliminary effect sizes comparing the impact of two randomly assigned intervention methods for encouraging PCCs to implement high quality assessment and treatment approaches in their practice settings with patients and families with ADHD, in preparation for a future R01.
Aim 3. To conduct exploratory analyses of moderators and mediators of PCC behavior change, including age/year of training, pre-existing self-efficacy beliefs about ADHD management, previous experience treating ADHD, readiness for change as a function of initial training, and clinicians'satisfaction with the projects'sustained clinician support and educational methods. Despite scientific advances over the last decade in our understanding of optimal management of ADHD, actual """"""""real-world"""""""" clinical practices of primary care clinicians have not kept up with this recent progress. The goal of the project is to test two different theory-based approaches to improving ADHD care, and to learn what types of interventions are most effective for clinicians'adoption of new ADHD practices. Because the study utilizes a number of novel adult education and basic behavioral science methods, study findings may not only lead to improvements in children's ADHD outcomes, but also may have important implications for design of effective educational interventions to close the science-to-service gap in other disease states.
This application addresses broad Challenge Area 15-MH-105, Strategies to support uptake of interventions within clinical and community settings: Develop and pilot comprehensive implementation strategies to support the broader uptake of interventions within clinical and community settings. Drawing upon behavioral change science and distance learning methods, this proposal Enhancing Pediatric Psychopharmacology in the Medical Home aims to test the relative impact of two interventions of differing intensity, both designed to increase primary care providers'(principally physicians') use of expert-recommended """"""""best practices"""""""" in the assessment and treatment of children and adolescents with ADHD. This study of strategies to change physicians'ADHD practices addresses an area of urgent public health need and keen interest, given concerns about ADHD under- and over-treatment, potential side effects of the drugs used to treat ADHD, and the failure to employ other interventions that might be required to optimize child and family outcomes. Importantly, findings from the NIMH Multimodal Treatment of Children with ADHD (MTA) Study (1999) indicate that carefully medication management is significantly more effective and cost-effective than usual care, yet available evidence indicates that most """"""""real-world"""""""" primary care clinicians have not incorporated these findings into their ADHD management practices. This application capitalizes on these new findings to address this area of great public health impact. Moreover, because basic behavior change methods and learning theory are incorporated into the interventions, findings from this study will be of great interest to other scientists and policy-makers struggling to close the research-practice gap. The proposal addresses the following 3 aims, readily achievable within 2 years:
Aim 1. To evaluate the immediate and 6-month impact of a novel training methods in child psychopharmacology on the knowledge, attitudes, skills, self-efficacy, and clinical practice behaviors of 60 primary care clinicians (PCCs) and pediatric residents who treat ADHD and related problems.
Aim 2. To gather pilot data and preliminary effect sizes comparing the impact of two randomly assigned intervention methods for encouraging PCCs to implement high quality assessment and treatment approaches in their practice settings with patients and families with ADHD, in preparation for a future R01.
Aim 3. To conduct exploratory analyses of moderators and mediators of PCC behavior change, including age/year of training, pre-existing self-efficacy beliefs about ADHD management, previous experience treating ADHD, readiness for change as a function of initial training, and clinicians'satisfaction with the projects'sustained clinician support and educational methods.
