Clinic Overview and Trainee Perceptions of Implementing National ADHD Guidelines in TeleKidcare Clinics

1. Clinic Overview and Trainee Perceptions of Implementing National ADHD Guidelines in TeleKidcare Clinics Eve-Lynn Nelson, PhD Georgina Peacock, MD, MPH Jane Sosland, PhD Norbert Belz, RHIA

2. 1998�first school based telemedicine program, Drs. Shaw & Goodwin; 3000 consults over time; 358 in 2004-20051998�first school based telemedicine program, Drs. Shaw & Goodwin; 3000 consults over time; 358 in 2004-2005

3. Add #s from 2005-2006; have gone from mental health �as needed� to 31 hours/week in TKC alone now (9 eln, 3 gp, 3 ss, 6 pk, 6 ks, 2 js, 2 mr and other) as well as as neededAdd #s from 2005-2006; have gone from mental health �as needed� to 31 hours/week in TKC alone now (9 eln, 3 gp, 3 ss, 6 pk, 6 ks, 2 js, 2 mr and other) as well as as needed

4. Specific Project Aims Aim 1: To describe characteristics of an ADHD telemedicine clinic and children presenting for evaluation. Aim 2: To evaluate the feasibility of implementing AAP clinical practice guidelines for the evaluation of ADHD in the telemedicine context and to identify barriers and/or facilitators in guideline adherence, including referral back to a medical home. Aim 3: To assess pediatric residents� and other trainees� perceptions of the ADHD telemedicine clinic.

5. Background ADHD�core symptoms Inattention, High Energy, and Impulsivity AAP guidelines A recent Michigan-based survey of primary care providers (n=1,374) reported high pediatrician awareness of the AAP guidelines (91.5%), but at the same time only one-quarter reported routinely using all AAP components (Rushton, Fant, & Clark, 2004) Feasibility of adopting the AAP guidelines primary care setting (Foy & Earls, 2005) San Diego across community practices (Leslie et al., 2004) an academic medical setting (Olson et al., 2005) rural Nebraska (Polaha et al., 2005) NO RCT WITH AND WITHOUT TOOLKIT

8. Adherence to AAP guidelines. Yes. and No. Yes�multiple informants; R/O alternative diagnoses, fax info to families No�forms, difficult get back and not on web, Describe with each of the criteriaYes�multiple informants; R/O alternative diagnoses, fax info to families No�forms, difficult get back and not on web, Describe with each of the criteria

11. Process measures Difficulty getting all paperwork Difficulty with no shows/last minute cancellations Reimbursement

12. Trainee perceptions

13. Implications Trainees benefit Meet training/curriculum needs for community consultation Pipeline concerns�encouraging long-term practice with underserved communities Training�desire to have more 1:1 feedback; videotaping possibilities and use bug-in-ear technologies via telemed Curriculum suggestions Consider training both in technology use and specific to the underserved population More training in behavioral peds and developmental peds Train both about populations and technologies; also training presenters re: technology and psychiatry topics; build trust by being availableTrain both about populations and technologies; also training presenters re: technology and psychiatry topics; build trust by being available

14. Clinic Future