Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application

Abstract

Background Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Our institution developed an email-based software to collect ADHD information from parents and teachers, which delivered data directly to the clinician within the electronic health record (EHR).

Objective We sought to adapt our institution's existing EHR-linked system for ADHD symptom monitoring to support communication between parents and teachers and then to assess child characteristics associated with sharing of ADHD information.

Methods We updated our software to support automated sharing of ADHD information between parents and teachers. Sharing was optional for parents but obligatory for teachers. We conducted a retrospective cohort study involving 590 patients at 31 primary care sites to evaluate a system for sharing of ADHD-specific health information between parents and teachers. We used multivariable logistic regression to estimate associations between child characteristics and parental sharing. We further investigated the association between child characteristics and viewing of survey results delivered through the electronic communication system.

Results Most parents (64%) elected to share survey results with teachers at the first opportunity and the vast majority (80%) elected to share all possible information. Parents who elected to share usually continue sharing at subsequent opportunities (89%). Younger child age and performance impairments were associated with increased likelihood of sharing. However, parents viewed only 16% of teacher submitted surveys and teachers only viewed 30% of surveys shared by parents.

Conclusion This study demonstrates that electronic systems to capture ADHD information from parents and teachers can be adapted to support communication between them, and that parents are amenable to sharing ADHD information with teachers. However, strategies are needed to encourage viewing of shared information.

Keywords

attention-deficit/hyperactivity disorder - information dissemination - surveys and questionnaires - communications - other clinical informatics applications

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the CHOP's Institutional Review Board.

• References

• 1 Sharma A, Couture J. A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother 2014; 48 (02) 209-225
• 2 Wolraich M, Brown L, Brown RT. , et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128 (05) 1007-1022
• 3 Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014; 43 (02) 434-442
• 4 Wolraich ML, Feurer ID, Hannah JN, Baumgaertel A, Pinnock TY. Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV. J Abnorm Child Psychol 1998; 26 (02) 141-152
• 5 Murray E, Charles C, Gafni A. Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice. Patient Educ Couns 2006; 62 (02) 205-211
• 6 Fiks AG, Mayne S, Debartolo E, Power TJ, Guevara JP. Parental preferences and goals regarding ADHD treatment. Pediatrics 2013; 132 (04) 692-702
• 7 Brinkman WB, Hartl Majcher J, Poling LM. , et al. Shared decision-making to improve attention-deficit hyperactivity disorder care. Patient Educ Couns 2013; 93 (01) 95-101
• 8 Lyon AR, Whitaker K, French WP, Richardson LP, Wasse JK, McCauley E. Collaborative care in schools: enhancing integration and impact in youth mental health. Adv Sch Ment Health Promot 2016; 9 (3-4): 148-168
• 9 Hoagwood K, Kelleher KJ, Feil M, Comer DM. Treatment services for children with ADHD: a national perspective. J Am Acad Child Adolesc Psychiatry 2000; 39 (02) 198-206
• 10 Zwi M, Jones H, Thorgaard C, York A, Dennis JA. Parent training interventions for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2011; (12) CD003018
• 11 DuPaul GJ, Gormley MJ, Laracy SD. School-based interventions for elementary school students with ADHD. Child Adolesc Psychiatr Clin N Am 2014; 23 (04) 687-697
• 12 Lange AM, Daley D, Frydenberg M, Rask CU, Sonuga-Barke E, Thomsen PH. The effectiveness of parent training as a treatment for preschool attention-deficit/hyperactivity disorder: study protocol for a randomized controlled, multicenter trial of the New Forest Parenting Program in Everyday Clinical Practice. JMIR Res Protoc 2016; 5 (02) e51
• 13 Wagner EH. The role of patient care teams in chronic disease management. BMJ 2000; 320 (7234): 569-572
• 14 Bilgrami Z, McLaughlin L, Milanaik R, Adesman A. Health implications of new-age technologies: a systematic review. Minerva Pediatr 2017; 69 (04) 348-367
• 15 Guevara JP, Feudtner C, Romer D. , et al. Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder. Pediatrics 2005; 116 (04) e512-e517
• 16 Wolraich ML, Bickman L, Lambert EW, Simmons T, Doffing MA. Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD. J Atten Disord 2005; 9 (01) 354-368
• 17 Power TJ, Blum NJ, Guevara JP, Jones HA, Leslie LK. Coordinating mental health care across primary care and schools: ADHD as a case example. Adv Sch Ment Health Promot 2013; 6 (01) 68-80
• 18 Reinke WM, Stormont M, Herman KC, Puri R, Goel N. Supporting children's mental health in schools: teacher perceptions of needs, roles, and barriers. Sch Psychol Q 2011; 26 (01) 1-13
• 19 Heuer B, Williams S. Collaboration between PNPs and school nurses: meeting the complex medical and academic needs of the child with ADHD. J Pediatr Health Care 2016; 30 (01) 88-93
• 20 Corkum P, Bessey M, McGonnell M, Dorbeck A. Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2015; 7 (01) 49-74
• 21 Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 2003; 28 (08) 559-567
• 22 Chang LY, Wang MY, Tsai PS. Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: a meta-analysis. Pediatrics 2016; 137 (03) e20152749
• 23 Brinkman WB, Epstein JN. Promoting productive interactions between parents and physicians in the treatment of children with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2011; 11 (04) 579-588
• 24 Hart CN, Kelleher KJ, Drotar D, Scholle SH. Parent-provider communication and parental satisfaction with care of children with psychosocial problems. Patient Educ Couns 2007; 68 (02) 179-185
• 25 Patel A, Medhekar R, Ochoa-Perez M. , et al. Care provision and prescribing practices of physicians treating children and adolescents with ADHD. Psychiatr Serv 2017; 68 (07) 681-688
• 26 Power TJ, Michel J, Mayne S. , et al. Coordinating systems of care using health information technology: development of the ADHD care assistant. Adv Sch Ment Health Promot 2016; 9 (3-4): 201-218
• 27 Fiks AG, Grundmeier RW, Biggs LM, Localio AR, Alessandrini EA. Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics 2007; 120 (04) 707-714
• 28 Fiks AG, Zhang P, Localio AR. , et al. Adoption of electronic medical record-based decision support for otitis media in children. Health Serv Res 2015; 50 (02) 489-513
• 29 Tham E, Swietlik M, Deakyne S. , et al; Pediatric Emergency Care Applied Research Network (PECARN). Clinical decision support for a multicenter trial of pediatric head trauma: development, implementation, and lessons learned. Appl Clin Inform 2016; 7 (02) 534-542
• 30 Michel J, Utidjian LH, Karavite D. , et al. Rapid adjustment of clinical decision support in response to updated recommendations for palivizumab eligibility. Appl Clin Inform 2017; 8 (02) 581-592
• 31 Fiks AG, Mayne S, Karavite DJ, DeBartolo E, Grundmeier RW. A shared e-decision support portal for pediatric asthma. J Ambul Care Manage 2014; 37 (02) 120-126
• 32 Fiks AG, Mayne SL, Karavite DJ. , et al. Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT. Pediatrics 2015; 135 (04) e965-e973
• 33 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Simon JO. The myADHDportal.com Improvement Program: an innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol 2013; 1 (01) 55-67
• 34 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics 2011; 128 (05) e1201-e1208
• 35 Epstein JN, Kelleher KJ, Baum R. , et al. Impact of a web-portal intervention on community ADHD care and outcomes. Pediatrics 2016; 138 (02) e20154240
• 36 Baum RA, Epstein JN, Kelleher K. Healthcare reform, quality, and technology: ADHD as a case study. Curr Psychiatry Rep 2013; 15 (07) 369
• 37 Fiks AG, Mayne SL, Michel JJ. , et al. Distance-learning, ADHD quality improvement in primary care: a cluster-randomized trial. J Dev Behav Pediatr 2017; 38 (08) 573-583
• 38 Fiks AG, Mayne S, Hughes CC. , et al. Development of an instrument to measure parents' preferences and goals for the treatment of attention deficit-hyperactivity disorder. Acad Pediatr 2012; 12 (05) 445-455
• 39 Cisco Registered Envelope Service. San Jose, CA: Cisco Systems, INC.; 2017
• 40 Schatz NK, Fabiano GA, Cunningham CE. , et al. Systematic review of patients' and parents' preferences for ADHD treatment options and processes of care. Patient 2015; 8 (06) 483-497
• 41 Eiraldi RB, Mazzuca LB, Clarke AT, Power TJ. Service utilization among ethnic minority children with ADHD: a model of help-seeking behavior. Adm Policy Ment Health 2006; 33 (05) 607-622
• 42 Bussing R, Zima BT, Gary FA, Garvan CW. Barriers to detection, help-seeking, and service use for children with ADHD symptoms. J Behav Health Serv Res 2003; 30 (02) 176-189
• 43 Child Trends. Parental involvement in schools; 2013. Available at: https://www.childtrends.org/?indicators=parental-involvement-in-schools . Accessed November 29, 2018
• 44 Hill N, Taylor L. Parental school involvement and children's academic achievement: pragmatics and issues. Curr Dir Psychol Sci 2004; 13 (04) 161-164
• 45 Gardner B, Phillips LA, Judah G. Habitual instigation and habitual execution: definition, measurement, and effects on behaviour frequency. Br J Health Psychol 2016; 21 (03) 613-630
• 46 Schomaker J, Meeter M. Short- and long-lasting consequences of novelty, deviance and surprise on brain and cognition. Neurosci Biobehav Rev 2015; 55: 268-279
• 47 Kwahk K-Y, Ahn H, Ryu YU. Understanding mandatory IS use behavior: how outcome expectations affect conative IS use. Int J Inf Manage 2018; 38 (01) 64-76
• 48 Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010; 10 (01) 113
• 49 Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems?. Med J Aust 2007; 187 (7, Suppl): S35-S39
• 50 Tao D, Xie L, Wang T, Wang T. A meta-analysis of the use of electronic reminders for patient adherence to medication in chronic disease care. J Telemed Telecare 2015; 21 (01) 3-13
• 51 Coleman MT, Pasternak RH. Effective strategies for behavior change. Prim Care 2012; 39 (02) 281-305