Telepsychiatry in Rural Youth
| Status: | Completed |
|---|---|
| Conditions: | Neurology, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 6 - 17 |
| Updated: | 4/2/2016 |
| Start Date: | April 2010 |
| End Date: | September 2011 |
| Contact: | Eric D Colling, BSN |
| Email: | collinge@ohsu.edu |
| Phone: | 5034941491 |
A Randomized Exploratory Study of Telepsychiatry Outcomes in Rural Youth
1. It is difficult to offer kids who live in rural areas good psychiatric care. There are
only about 7000 psychiatrists for kids (pediatric psychiatrists) in the entire country.
When adding nurse practitioners who specialize in mental health care for children,
there still are not enough for everyone who needs care. This means either delays in
treatment or no treatment at all by these important specialists. The purpose of this
study is to explore how the investigators might offer psychiatric care to kids who live
in rural areas through the use of telepsychiatry (TP), specifically those with
attention deficit/hyperactivity disorder (ADHD).
TP is a way for a physician to talk to someone in a remote area using a computer. The
investigators will split the subjects into two study groups. As subjects are
identified, they will be assigned a screening number according to a randomization
table. The investigators will use TP for one group and face-to-face (F2F) care for the
other group. The computer will allow the physician to look at and talk with the child
and their parent(s). The investigators would like to know if TP is as good as, or
nearly as good as F2F care, so the only difference in treatment approach between the
two groups will be whether the subject is receiving treatment through TP or F2F care.
Treatment is standardized using a flow chart called the Children's Medication Algorithm
Project (CMAP) algorithm. The CMAP algorithm is a guideline established by a large
number of experts who have agreed on the best approach to treatment based on scientific
evidence. If TP proves as good as F2F care, it would help many parents and their
children who do not live in or near a large city.
2. The investigators will find study subjects when parents seek care at clinics in rural
Oregon. The physicians in those locations will be aware of the study and will tell us
when they think someone needs specialized mental health professional (either a
pediatric psychiatrist or nurse practitioner with extensive experience in pediatric
mental health). The investigators will make sure that ADHD is the right diagnosis using
special exams that have been well-tested to show that they are reliable.
3. The first visit—the intake visit—will probably take about an hour. At that visit,
mental health professional will determine whether or not the patient is a candidate for
the study. If the patient agrees, they will be asked to sign consent and child assent.
The parent and child will then be given an exam that will confirm the diagnosis of
ADHD. If confirmed, subjects will then learn if they have been assigned to the TP group
or the F2F group and will be assigned to the treating mental health professional. In
addition to the DISC, after consent the parent will be given several study instruments
to take home with them. They will take about an hour altogether to complete.
The first visit with the treating mental health professional will take about one hour
and the three following visits will take about 30 minutes each. These visits will be
about six weeks apart. At the third follow-up visit—the final visit—the parents will be
again asked to complete the instruments they completed after consent and will be asked
to complete a brief questionnaire that will give them the opportunity to describe their
satisfaction or dissatisfaction with the treatment and care they received.
Teachers will be asked to complete the Conner's 10-Item Global Index for the subject
twice over the course of the study. The parent of the subject will present the scale to
the teacher and retrieve the scale in a sealed envelope to return to the clinic.
4. The diagnosis for ADHD will be made using an exam called the Diagnostic Interview
Schedule for Children Version IV (DISC IV). This is a 90-minute exam that is done with
a computer that helps you know what questions to ask and helps record the responses.
The parents will also be asked to complete a few instruments and surveys that help us
understand how well treatment is working. The investigators expect these exams to take
about half an hour to complete. They contain questions about the subject's behavior and
are completed by parents, except one brief instrument that the investigators will ask
and teachers to complete before each follow-up visit. These instruments take about 10
minutes each to complete.
5. This is an initial "pilot" study, so the information collected will mainly offer a
better understanding of whether or not a larger study is possible. The investigators
will look at how many subjects stayed in the study or dropped out and when they dropped
out. The investigators will also look at the exams, scoring them to help us understand
if those who were part of the TP group did as well, or nearly as well, as those in the
F2F group.
only about 7000 psychiatrists for kids (pediatric psychiatrists) in the entire country.
When adding nurse practitioners who specialize in mental health care for children,
there still are not enough for everyone who needs care. This means either delays in
treatment or no treatment at all by these important specialists. The purpose of this
study is to explore how the investigators might offer psychiatric care to kids who live
in rural areas through the use of telepsychiatry (TP), specifically those with
attention deficit/hyperactivity disorder (ADHD).
TP is a way for a physician to talk to someone in a remote area using a computer. The
investigators will split the subjects into two study groups. As subjects are
identified, they will be assigned a screening number according to a randomization
table. The investigators will use TP for one group and face-to-face (F2F) care for the
other group. The computer will allow the physician to look at and talk with the child
and their parent(s). The investigators would like to know if TP is as good as, or
nearly as good as F2F care, so the only difference in treatment approach between the
two groups will be whether the subject is receiving treatment through TP or F2F care.
Treatment is standardized using a flow chart called the Children's Medication Algorithm
Project (CMAP) algorithm. The CMAP algorithm is a guideline established by a large
number of experts who have agreed on the best approach to treatment based on scientific
evidence. If TP proves as good as F2F care, it would help many parents and their
children who do not live in or near a large city.
2. The investigators will find study subjects when parents seek care at clinics in rural
Oregon. The physicians in those locations will be aware of the study and will tell us
when they think someone needs specialized mental health professional (either a
pediatric psychiatrist or nurse practitioner with extensive experience in pediatric
mental health). The investigators will make sure that ADHD is the right diagnosis using
special exams that have been well-tested to show that they are reliable.
3. The first visit—the intake visit—will probably take about an hour. At that visit,
mental health professional will determine whether or not the patient is a candidate for
the study. If the patient agrees, they will be asked to sign consent and child assent.
The parent and child will then be given an exam that will confirm the diagnosis of
ADHD. If confirmed, subjects will then learn if they have been assigned to the TP group
or the F2F group and will be assigned to the treating mental health professional. In
addition to the DISC, after consent the parent will be given several study instruments
to take home with them. They will take about an hour altogether to complete.
The first visit with the treating mental health professional will take about one hour
and the three following visits will take about 30 minutes each. These visits will be
about six weeks apart. At the third follow-up visit—the final visit—the parents will be
again asked to complete the instruments they completed after consent and will be asked
to complete a brief questionnaire that will give them the opportunity to describe their
satisfaction or dissatisfaction with the treatment and care they received.
Teachers will be asked to complete the Conner's 10-Item Global Index for the subject
twice over the course of the study. The parent of the subject will present the scale to
the teacher and retrieve the scale in a sealed envelope to return to the clinic.
4. The diagnosis for ADHD will be made using an exam called the Diagnostic Interview
Schedule for Children Version IV (DISC IV). This is a 90-minute exam that is done with
a computer that helps you know what questions to ask and helps record the responses.
The parents will also be asked to complete a few instruments and surveys that help us
understand how well treatment is working. The investigators expect these exams to take
about half an hour to complete. They contain questions about the subject's behavior and
are completed by parents, except one brief instrument that the investigators will ask
and teachers to complete before each follow-up visit. These instruments take about 10
minutes each to complete.
5. This is an initial "pilot" study, so the information collected will mainly offer a
better understanding of whether or not a larger study is possible. The investigators
will look at how many subjects stayed in the study or dropped out and when they dropped
out. The investigators will also look at the exams, scoring them to help us understand
if those who were part of the TP group did as well, or nearly as well, as those in the
F2F group.
Inclusion Criteria:
Inclusions:
The study will include children with co-occurring psychiatric conditions because of high
comorbidity rates in ADHD. Comorbidity is present in as many as two-thirds of children
with ADHD, including up to 50% for other disruptive disorders, 15%-20% for mood disorders,
20% to 25% for anxiety disorders, and 15-20% for learning disorders (Dulcan et al., 1997).
Thus, with inclusion of children with comorbidity, the findings will have greater
generalizability. Additionally, the comorbid children and adolescents are often too
complex for primary care treatment and need child psychiatric services. The study will
include:
1. Learning disorders, such as Mathematics Disorder, Reading Disorder, and Disorders of
Written Expression.
2. Other disruptive disorders, such as (oppositional Oppositional defiant Defiant
disorder Disorder and conduct Conduct disorder.)
3. Unipolar mood disorders, including Major Depressive Disorder and Dysthymic Disorder
4. Anxiety disorders hat coexist with ADHD, anxiety, and
5. Post traumatic stress disorder (PTSD).
6. Non-rapid cycling bipolar disorder stable on medications
Exclusions:
As in Pliszka et al.'s (2003) study of the CMAP ADHD treatment algorithm, only conditions
that would prevent treatment for the primary disorder from being effective will be
excluded. The study will not include subjects with:
Exclusion Criteria:
1. Rapid cycling bipolar disorder
2. A history of psychosis of any etiology. (Exceptions may include temporary medically
or pharmacologically induced delirium.)
3. Medically impairing eating disorders,
4. Substance abuse within the past year or "active substance use"
5. Mental retardation (IQ < 70)
6. Autism spectrum disorders.
Children and families who are not English speaking will not be included in the study.
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