Improving Care Management in Attention-Deficit/Hyperactivity Disorder: An RCT.

2021

2021 Jul 19

1098-4275

<p><strong>OBJECTIVES: </strong>To compare the effectiveness of care management combined with a patient portal versus a portal alone for communication among children with attention-deficit/hyperactivity disorder (ADHD).</p>

<p><strong>METHODS: </strong>Randomized controlled trial conducted at 11 primary care practices. Children aged 5 to 12 years old with ADHD were randomly assigned to care management + portal or portal alone. The portal included parent-reported treatment preferences and goals, medication side effects, and parent- and teacher-reported ADHD symptom scales. Care managers provided education to families; communicated quarterly with parents, teachers, and clinicians; and coordinated care. The main outcome, changes in the Vanderbilt Parent Rating Scale (VPRS) score as a measure of ADHD symptoms, was assessed using intention-to-treat analysis.</p>

<p><strong>RESULTS: </strong>A total of 303 eligible children (69% male; 46% Black) were randomly assigned, and 273 (90%) completed the study. During the 9-month study, parents in the care management + portal arm communicated inconsistently with care managers (mean 2.2; range 0-6) but similarly used the portal (mean 2.3 vs 2.2) as parents in the portal alone arm. In multivariate models, VPRS scores decreased over time (Adjusted β = -.015; 95% confidence interval -0.023 to -0.07) in both groups, but there were no intervention-by-time effects (Adjusted β = .000; 95% confidence interval -0.011 to 0.012) between groups. Children who received ≥2 care management sessions had greater reductions in VPRS scores than those with fewer sessions.</p>

<p><strong>CONCLUSIONS: </strong>Results did not provide evidence that care management combined with a patient portal was different from portal use alone among children with ADHD. Both groups demonstrated similar reductions in ADHD symptoms. Those families with greater care management engagement demonstrated greater reductions than those with less engagement.</p>

10.1542/peds.2020-031518

Pediatrics

34281997

Improving child behaviors and parental stress: A randomized trial of Child Adult Relationship Enhancement in Primary Care.

2020

2020 Aug 10

1876-2867

<p><strong>BACKGROUND: </strong>Prior single site evaluations of PriCARE, a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes.</p>

<p><strong>OBJECTIVE: </strong>To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study.</p>

<p><strong>METHODS: </strong>Caregivers of children 2- to 6-years-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n=119) or waitlist control (n=55). 79% of caregivers identified as Black and 59% had annual household incomes under $22,000. Child behavior, parenting stress, and parenting attitudes were measured at baseline and 2-3 months after intervention using the Eyberg Child Behavior Inventory (ECBI), Parenting Stress Index (PSI), and Adult-Adolescent Parenting Inventory-2 (AAPI-2). Marginal standardization implemented in a linear regression compared mean change scores from baseline to follow-up by treatment arm while accounting for clustering by site.</p>

<p><strong>RESULTS: </strong>Mean change scores from baseline to follow-up demonstrated greater improvements (decreases) in ECBI problem scores but not intensity scores in the PriCARE arm compared to control, [problem: -4.4 (-7.5, -1.2) versus -1.8 (-4.1, 0.4), p=0.004; intensity: -17.6 (-28.3, -6.9) versus -10.4 (-18.1, -2.6), p=0.255]. Decreases in parenting stress were greater in the PriCARE arm compared to control [-3.3 (-4.3, -2.3,) versus 0 (-2.5, 2.5), p=0.025]. Parenting attitudes showed no significant changes (all p&gt;0.10).</p>

<p><strong>CONCLUSIONS: </strong>PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.</p>

10.1016/j.acap.2020.08.002

Acad Pediatr

32791318

Child Adult Relationship Enhancement in Primary Care: A randomized trial of a parent training for child behavior problems.

2016

2016 Jun 25

1876-2867

<p><strong>OBJECTIVE: </strong>Child Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group parent training designed to teach positive parenting skills. Our objective was to measure PriCARE's impact on child behavior and parenting attitudes.</p>

<p><strong>METHODS: </strong>Parents of children 2 to 6 years old with behavior concerns were randomized to PriCARE (n=80) or control (n=40). Child behavior and parenting attitudes were measured at baseline (0 weeks), program completion (9 weeks), and 7 weeks following program completion (16 weeks) using the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory-2 (AAPI2). Linear regression models compared mean ECBI and AAPI2 change scores from 0 to 16 weeks in the PriCARE and control groups, adjusted for baseline scores.</p>

<p><strong>RESULTS: </strong>Of those randomized to PriCARE, 43% attended 3 or more sessions. Decreases in mean ECBI intensity and problem scores between 0 and 16 weeks were greater in the PriCARE group, reflecting a larger improvement in behavior problems [intensity: -22 (-16, -29) vs -7 (2, -17), p=0.012; problem: -5 (-4, -7) vs -2 (0, -4), p=0.014]. Scores on 3 of the 5 AAPI2 sub-scales reflected greater improvements in parenting attitudes in the PriCARE group compared to control in the following areas: empathy towards children's needs [0.82 (1.14, 0.51) vs 0.25 (0.70, -0.19), p=0.04], corporal punishment [0.22 (0.45, 0.00) vs -0.30 (0.02, -0.61), p=0.009], and power and independence [0.37 (0.76, -0.02) vs -0.64 (-0.09, -1.19), p=0.003].</p>

<p><strong>CONCLUSIONS: </strong>PriCARE shows promise in improving parent-reported child-behavior problems in preschool-aged children and increasing positive parenting attitudes.</p>

10.1016/j.acap.2016.06.009

Acad Pediatr

27353449