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Methodology for conducting the children's attention-deficit hyperactivity disorder telemental health treatment study
Ann Vander Stoep1, Kathleen Myers
1aDepartment of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Insights
Telemental Health (TMH) effectively provided ADHD care to children in underserved areas. This study offers a model for reducing mental health care access disparities.
Area of Science:
- Child and Adolescent Psychiatry
- Digital Health Interventions
- Rural Mental Health
Background:
- Children in rural communities face significant barriers to evidence-based mental health care.
- These populations are often underrepresented in clinical research, limiting treatment generalizability.
Purpose of the Study:
- To describe lessons learned from the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health (TMH) Treatment Study (CATTS).
- To test the effectiveness of TMH in improving outcomes for children with ADHD in underserved rural areas.
Main Methods:
- A randomized controlled trial involving telepsychiatry sessions and in-person caregiver behavior training.
- Utilized a secure website for telepsychiatrist decision support and collaboration with local therapists.
- Online questionnaires administered to parents and teachers for ADHD symptom and outcome assessment.
Main Results:
- Successfully recruited 223 children referred by 88 primary care providers across seven communities.
- Demonstrated low attrition rates for treatment sessions and research assessments.
- TMH proved viable for delivering evidence-based care and therapist training, with recruitment boosted by offering control group consultations.
Conclusions:
- The CATTS trial successfully employed methods to include children from dispersed, underserved regions.
- The study provides a valuable model for future research aimed at reducing geographic disparities in mental health care access.
Background:
Children living in nonmetropolitan communities are underserved by evidence-based mental health care and are underrepresented in clinical trials.
Purpose:
In this article, we describe lessons learned in conducting the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health (TMH) Treatment Study (CATTS), a randomized controlled trial testing the effectiveness of TMH in improving outcomes of children with ADHD living in underserved communities.
Methods:
Children were referred by primary care providers (PCPs). The test intervention group received six telepsychiatry sessions with each session followed by an caregiver behavior training session delivered in-person by a local therapist. A secure website was used to support decision making by the telepsychiatrists and to facilitate real-time collaboration between the telepsychiatrists and community therapists. The control group received a single telepsychiatry consultation. Questionnaires tapping ADHD symptoms and other outcomes were administered to parents and teachers online through a secure portal from personal computers.
Results:
total of 88 PCPs in seven communities referred the 223 children who participated in the trial. Attrition in treatment sessions and research assessments was very low. Lessons learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and training to local therapists. Recruitment was enhanced by offering the control group a telepsychiatry consultation. Site-specific strategies were needed to meet recruitment targets.
Conclusions:
The CATTS trial used methods designed to optimize inclusion of children living in multiple dispersed and underserved areas. The study will serve as a model for other research projects aiming at reducing geographic disparities in access to quality mental health care.
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