Session #F4a
Saturday, October 12, 2013
Implementing ADHD Assessment
and Intervention in Pediatric
Primary Care
Parinda Khatri, PhD
Director of Integrated Care
Cherokee Health Systems
Kara Johansen, PsyD
Behavioral Health Consultant
Cherokee Health Systems
Collaborative Family Healthcare Association 15th Annual Conference
October 10-12, 2013
Broomfield, Colorado U.S.A.
Faculty Disclosure
We have not had any relevant financial relationships
during the past 12 months.
© 2013 Cherokee Health Systems
All Rights Reserved
Objectives
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Clinical Model Overview
Rationale
Implementation
Lessons Learned
© 2011 Cherokee Health Systems
All Rights Reserved
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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
Cherokee Health
Systems
Together…Enhancing Life
Cherokee Health Systems
Number of Employees: 622
Provider Staff:
Psychologists – 43
Primary Care Physicians – 28
Master’s level Clinicians - 70
Psychiatrists – 10
Case Managers - 33
Pharmacists – 10
NP/PA (Primary Care) – 30
NP (Psych) – 12
Dentists - 2
Cherokee Health
Systems
Together…Enhancing Life
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
Cherokee Health
Systems
Together…Enhancing Life
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
Cherokee Health
Systems
Together…Enhancing Life
Key Components of Primary Care Based InterProfessional Collaborative Interventions
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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
Cherokee Health
Systems
Together…Enhancing Life
Pediatric Healthcare Team
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Pediatric Medical Providers
Behavioral Health Consultants
Nurses
Case Manager
Patient Service Representatives
Cherokee Health
Systems
Together…Enhancing Life
Evidence Based Recommendations
• American Academy of Pediatrics Guidelines
• American Academy of Child and Adolescent
Psychiatry
• Institute for Clinical Systems Improvement
Guideline
Cherokee Health
Systems
Together…Enhancing Life
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
Cherokee Health
Systems
Together…Enhancing Life
Knox County
Pediatrics –
Dameron Avenue
Cherokee Health
Systems
Together…Enhancing Life
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
Cherokee Health
Systems
Together…Enhancing Life
Overview of
process
Scheduling
PCP
Cherokee Health
Systems
Together…Enhancing Life
Medical
BHC
Interview
BASCs
Observation
Intervention
Call Center
Assessment
Initial Call
Work Flow
Behavioral
Medication
Follow up
Medical or Well-Visit
Clinical Flow
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
BHC Consult – Phase I
•Clinical Intake
•Provide education regarding
effective behavior management
strategies
•Explain ADHD assessment process
Return for F/U
Medical Visit
Cherokee Health
Systems
Together…Enhancing Life
Return Phase II F/U
Visit
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
•Review assessment results and
clarify diagnosis
•Provide education regarding
ADHD
•Discuss treatment options
•Consult with PCP and start
treatment
•Discuss treatment adherence
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
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Provide opportunities for staff feedback
Make modifications
Be Creative
Learn together
Be flexible
Cherokee Health
Systems
Together…Enhancing Life
kara.johansen@cherokeehealth.com
parinda.khatri@cherokeehealth.com
Cherokee Health
Systems
Together…Enhancing Life
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!