@article{foy_process_2005,
	title = {A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder},
	volume = {115},
	issn = {0031-4005},
	url = {http://dx.doi.org/10.1542/peds.2004-0953},
	doi = {10.1542/peds.2004-0953},
	abstract = {There remain large discrepancies between pediatricians' practice patterns
and the American Academy of Pediatrics (AAP) guidelines for the assessment
and treatment of children with attention-deficit/hyperactivity disorder
(ADHD). Several studies raise additional concerns about access to ADHD
treatment for girls, blacks, and poorer individuals. Barriers may occur at
multiple levels, including identification and referral by school
personnel, parents' help-seeking behavior, diagnosis by the medical
provider, treatment decisions, and acceptance of treatment. Such findings
confirm the importance of establishing appropriate mechanisms to ensure
that children of both genders and all socioeconomic, racial, and ethnic
groups receive appropriate assessment and treatment. Publication of the
AAP ADHD toolkit provides resources to assist with implementing the ADHD
guidelines in clinical practice. These resources address a number of the
barriers to office implementation, including unfamiliarity with Diagnostic
and Statistical Manual of Mental Disorders criteria, difficulty
identifying comorbidities, and inadequate knowledge of effective coding
practices. Also crucial to the success of improved processes within
clinical practice is community collaboration in care, particularly
collaboration with the educational system. Such collaboration addresses
other barriers to good care, such as pressures from parents and schools to
prescribe stimulants, cultural biases that may prevent schools from
assessing children for ADHD or may prevent families from seeking health
care, and inconsistencies in recognition and referral among schools in the
same system. Collaboration may also create efficiencies in collection of
data and school-physician communications, thereby decreasing physicians'
non-face-to-face (and thus nonreimbursable) elements of care. This article
describes a process used in Guilford County, North Carolina, to develop a
consensus among health care providers, educators, and child advocates
regarding the assessment and treatment of children with symptoms of ADHD.
The outcome, ie, a community protocol followed by school personnel and
community physicians for {\textgreater}10 years, ensures communication and
collaboration between educators and physicians in the assessment and
treatment of children with symptoms of ADHD. This protocol has the
potential to increase practice efficiency, improve practice standards for
children with ADHD, and enhance identification of children in schools.
Perhaps most importantly, the community process through which the protocol
was developed and implemented has an educational component that increases
the knowledge of school personnel about ADHD and its treatment, increasing
the likelihood that referrals will be appropriate and increasing the
likelihood that children will benefit from coordination of interventions
among school personnel, physicians, and parents. The protocol reflects a
consensus of school personnel and community health care providers
regarding the following: (1) ideal ADHD assessment and management
principles; (2) a common entry point (a team) at schools for children
needing assessment because of inattention and classroom behavior problems,
whether the problems present first to a medical provider, the behavioral
health system, or the school; (3) a protocol followed by the school
system, recognizing the schools' resource limitations but meeting the
needs of community health care providers for classroom observations,
psychoeducational testing, parent and teacher behavior rating scales, and
functional assessment; (4) a packet of information about each child who is
determined to need medical assessment; (5) a contact person or team at
each physician's office to receive the packet from the school and direct
it to the appropriate clinician; (6) an assessment process that
investigates comorbidities and applies appropriate diagnostic criteria;
(7) evidence-based interventions; (8) processes for follow-up monitoring
of children after establishment of a treatment plan; (9) roles for central
participants (school personnel, physicians, school nurses, and mental
health professionals) in assessment, management, and follow-up monitoring
of children with attention problems; (10) forms for collecting and
exchanging information at every step; (11) processes and key contacts for
flow of communication at every step; and (12) a plan for educating school
and health care professionals about the new processes. A replication of
the community process, initiated in Forsyth County, North Carolina, in
2001, offers insights into the role of the AAP ADHD guidelines in
facilitating development of a community consensus protocol. This
replication also draws attention to identification and referral barriers
at the school level. The following recommendations, drawn from the 2
community processes, describe a role for physicians in the collaborative
community care of children with symptoms of ADHD. (1) Achieve consensus
with the school system regarding the role of school personnel in
collecting data for children with learning and behavior problems;
components to consider include (a) vision and hearing screening, (b)
school/academic histories, (c) classroom observation by a counselor, (d)
parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or
Achenbach scales), (e) consideration of speech/language evaluation, (f)
screening intelligence testing, (g) screening achievement testing, (h)
full intelligence and achievement testing if discrepancies are apparent in
abbreviated tests, and (i) trials of classroom interventions. (2) Use
pediatric office visits to identify children with academic or behavior
problems and symptoms of inattention (history or questionnaire). (3) Refer
identified children to the contact person at each child's school,
requesting information in accordance with community consensus. (4)
Designate a contact person to receive school materials for the practice.
(5) Review the packet from the school and incorporate school data into the
clinical assessment. (6) Reinforce with the parents and the school the
need for multimodal intervention, including academic and study strategies
for the classroom and home, in-depth psychologic testing of children whose
discrepancies between cognitive level and achievement suggest learning or
language disabilities and the need for an individualized educational plan
(special education), consideration of the "other health impaired"
designation as an alternate route to an individualized educational plan or
504 plan (classroom accommodations), behavior-modification techniques for
targeted behavior problems, and medication trials, as indicated. (7) Refer
the patient to a mental health professional if the assessment suggests
coexisting conditions. (8) Use communication forms to share diagnostic and
medication information, recommended interventions, and follow-up plans
with the school and the family. (9) Receive requested teacher and parent
follow-up reports and make adjustments in therapy as indicated by the
child's functioning in targeted areas. (10) Maintain communication with
the school and the parents, especially at times of transition (eg,
beginning and end of the school year, change of schools, times of family
stress, times of change in management, adolescence, and entry into college
or the workforce).},
	number = {1},
	journal = {Pediatrics},
	author = {Foy, Jane Meschan and Earls, Marian F},
	month = jan,
	year = {2005},
	note = {00096},
	keywords = {Mental Health Diversity},
	pages = {e97--104}
}

{"_id":"mX6MTPACQ4Bygbi9d","bibbaseid":"foy-earls-aprocessfordevelopingcommunityconsensusregardingthediagnosisandmanagementofattentiondeficithyperactivitydisorder-2005","downloads":0,"creationDate":"2018-04-27T04:04:44.064Z","title":"A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder","author_short":["Foy, J. M.","Earls, M. F"],"year":2005,"bibtype":"article","biburl":"https://bibbase.org/zotero/davidlloyd33","bibdata":{"bibtype":"article","type":"article","title":"A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder","volume":"115","issn":"0031-4005","url":"http://dx.doi.org/10.1542/peds.2004-0953","doi":"10.1542/peds.2004-0953","abstract":"There remain large discrepancies between pediatricians' practice patterns and the American Academy of Pediatrics (AAP) guidelines for the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment. Publication of the AAP ADHD toolkit provides resources to assist with implementing the ADHD guidelines in clinical practice. These resources address a number of the barriers to office implementation, including unfamiliarity with Diagnostic and Statistical Manual of Mental Disorders criteria, difficulty identifying comorbidities, and inadequate knowledge of effective coding practices. Also crucial to the success of improved processes within clinical practice is community collaboration in care, particularly collaboration with the educational system. Such collaboration addresses other barriers to good care, such as pressures from parents and schools to prescribe stimulants, cultural biases that may prevent schools from assessing children for ADHD or may prevent families from seeking health care, and inconsistencies in recognition and referral among schools in the same system. Collaboration may also create efficiencies in collection of data and school-physician communications, thereby decreasing physicians' non-face-to-face (and thus nonreimbursable) elements of care. This article describes a process used in Guilford County, North Carolina, to develop a consensus among health care providers, educators, and child advocates regarding the assessment and treatment of children with symptoms of ADHD. The outcome, ie, a community protocol followed by school personnel and community physicians for \\textgreater10 years, ensures communication and collaboration between educators and physicians in the assessment and treatment of children with symptoms of ADHD. This protocol has the potential to increase practice efficiency, improve practice standards for children with ADHD, and enhance identification of children in schools. Perhaps most importantly, the community process through which the protocol was developed and implemented has an educational component that increases the knowledge of school personnel about ADHD and its treatment, increasing the likelihood that referrals will be appropriate and increasing the likelihood that children will benefit from coordination of interventions among school personnel, physicians, and parents. The protocol reflects a consensus of school personnel and community health care providers regarding the following: (1) ideal ADHD assessment and management principles; (2) a common entry point (a team) at schools for children needing assessment because of inattention and classroom behavior problems, whether the problems present first to a medical provider, the behavioral health system, or the school; (3) a protocol followed by the school system, recognizing the schools' resource limitations but meeting the needs of community health care providers for classroom observations, psychoeducational testing, parent and teacher behavior rating scales, and functional assessment; (4) a packet of information about each child who is determined to need medical assessment; (5) a contact person or team at each physician's office to receive the packet from the school and direct it to the appropriate clinician; (6) an assessment process that investigates comorbidities and applies appropriate diagnostic criteria; (7) evidence-based interventions; (8) processes for follow-up monitoring of children after establishment of a treatment plan; (9) roles for central participants (school personnel, physicians, school nurses, and mental health professionals) in assessment, management, and follow-up monitoring of children with attention problems; (10) forms for collecting and exchanging information at every step; (11) processes and key contacts for flow of communication at every step; and (12) a plan for educating school and health care professionals about the new processes. A replication of the community process, initiated in Forsyth County, North Carolina, in 2001, offers insights into the role of the AAP ADHD guidelines in facilitating development of a community consensus protocol. This replication also draws attention to identification and referral barriers at the school level. The following recommendations, drawn from the 2 community processes, describe a role for physicians in the collaborative community care of children with symptoms of ADHD. (1) Achieve consensus with the school system regarding the role of school personnel in collecting data for children with learning and behavior problems; components to consider include (a) vision and hearing screening, (b) school/academic histories, (c) classroom observation by a counselor, (d) parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or Achenbach scales), (e) consideration of speech/language evaluation, (f) screening intelligence testing, (g) screening achievement testing, (h) full intelligence and achievement testing if discrepancies are apparent in abbreviated tests, and (i) trials of classroom interventions. (2) Use pediatric office visits to identify children with academic or behavior problems and symptoms of inattention (history or questionnaire). (3) Refer identified children to the contact person at each child's school, requesting information in accordance with community consensus. (4) Designate a contact person to receive school materials for the practice. (5) Review the packet from the school and incorporate school data into the clinical assessment. (6) Reinforce with the parents and the school the need for multimodal intervention, including academic and study strategies for the classroom and home, in-depth psychologic testing of children whose discrepancies between cognitive level and achievement suggest learning or language disabilities and the need for an individualized educational plan (special education), consideration of the \"other health impaired\" designation as an alternate route to an individualized educational plan or 504 plan (classroom accommodations), behavior-modification techniques for targeted behavior problems, and medication trials, as indicated. (7) Refer the patient to a mental health professional if the assessment suggests coexisting conditions. (8) Use communication forms to share diagnostic and medication information, recommended interventions, and follow-up plans with the school and the family. (9) Receive requested teacher and parent follow-up reports and make adjustments in therapy as indicated by the child's functioning in targeted areas. (10) Maintain communication with the school and the parents, especially at times of transition (eg, beginning and end of the school year, change of schools, times of family stress, times of change in management, adolescence, and entry into college or the workforce).","number":"1","journal":"Pediatrics","author":[{"propositions":[],"lastnames":["Foy"],"firstnames":["Jane","Meschan"],"suffixes":[]},{"propositions":[],"lastnames":["Earls"],"firstnames":["Marian","F"],"suffixes":[]}],"month":"January","year":"2005","note":"00096","keywords":"Mental Health Diversity","pages":"e97--104","bibtex":"@article{foy_process_2005,\n\ttitle = {A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder},\n\tvolume = {115},\n\tissn = {0031-4005},\n\turl = {http://dx.doi.org/10.1542/peds.2004-0953},\n\tdoi = {10.1542/peds.2004-0953},\n\tabstract = {There remain large discrepancies between pediatricians' practice patterns\nand the American Academy of Pediatrics (AAP) guidelines for the assessment\nand treatment of children with attention-deficit/hyperactivity disorder\n(ADHD). Several studies raise additional concerns about access to ADHD\ntreatment for girls, blacks, and poorer individuals. Barriers may occur at\nmultiple levels, including identification and referral by school\npersonnel, parents' help-seeking behavior, diagnosis by the medical\nprovider, treatment decisions, and acceptance of treatment. Such findings\nconfirm the importance of establishing appropriate mechanisms to ensure\nthat children of both genders and all socioeconomic, racial, and ethnic\ngroups receive appropriate assessment and treatment. Publication of the\nAAP ADHD toolkit provides resources to assist with implementing the ADHD\nguidelines in clinical practice. These resources address a number of the\nbarriers to office implementation, including unfamiliarity with Diagnostic\nand Statistical Manual of Mental Disorders criteria, difficulty\nidentifying comorbidities, and inadequate knowledge of effective coding\npractices. Also crucial to the success of improved processes within\nclinical practice is community collaboration in care, particularly\ncollaboration with the educational system. Such collaboration addresses\nother barriers to good care, such as pressures from parents and schools to\nprescribe stimulants, cultural biases that may prevent schools from\nassessing children for ADHD or may prevent families from seeking health\ncare, and inconsistencies in recognition and referral among schools in the\nsame system. Collaboration may also create efficiencies in collection of\ndata and school-physician communications, thereby decreasing physicians'\nnon-face-to-face (and thus nonreimbursable) elements of care. This article\ndescribes a process used in Guilford County, North Carolina, to develop a\nconsensus among health care providers, educators, and child advocates\nregarding the assessment and treatment of children with symptoms of ADHD.\nThe outcome, ie, a community protocol followed by school personnel and\ncommunity physicians for {\\textgreater}10 years, ensures communication and\ncollaboration between educators and physicians in the assessment and\ntreatment of children with symptoms of ADHD. This protocol has the\npotential to increase practice efficiency, improve practice standards for\nchildren with ADHD, and enhance identification of children in schools.\nPerhaps most importantly, the community process through which the protocol\nwas developed and implemented has an educational component that increases\nthe knowledge of school personnel about ADHD and its treatment, increasing\nthe likelihood that referrals will be appropriate and increasing the\nlikelihood that children will benefit from coordination of interventions\namong school personnel, physicians, and parents. The protocol reflects a\nconsensus of school personnel and community health care providers\nregarding the following: (1) ideal ADHD assessment and management\nprinciples; (2) a common entry point (a team) at schools for children\nneeding assessment because of inattention and classroom behavior problems,\nwhether the problems present first to a medical provider, the behavioral\nhealth system, or the school; (3) a protocol followed by the school\nsystem, recognizing the schools' resource limitations but meeting the\nneeds of community health care providers for classroom observations,\npsychoeducational testing, parent and teacher behavior rating scales, and\nfunctional assessment; (4) a packet of information about each child who is\ndetermined to need medical assessment; (5) a contact person or team at\neach physician's office to receive the packet from the school and direct\nit to the appropriate clinician; (6) an assessment process that\ninvestigates comorbidities and applies appropriate diagnostic criteria;\n(7) evidence-based interventions; (8) processes for follow-up monitoring\nof children after establishment of a treatment plan; (9) roles for central\nparticipants (school personnel, physicians, school nurses, and mental\nhealth professionals) in assessment, management, and follow-up monitoring\nof children with attention problems; (10) forms for collecting and\nexchanging information at every step; (11) processes and key contacts for\nflow of communication at every step; and (12) a plan for educating school\nand health care professionals about the new processes. A replication of\nthe community process, initiated in Forsyth County, North Carolina, in\n2001, offers insights into the role of the AAP ADHD guidelines in\nfacilitating development of a community consensus protocol. This\nreplication also draws attention to identification and referral barriers\nat the school level. The following recommendations, drawn from the 2\ncommunity processes, describe a role for physicians in the collaborative\ncommunity care of children with symptoms of ADHD. (1) Achieve consensus\nwith the school system regarding the role of school personnel in\ncollecting data for children with learning and behavior problems;\ncomponents to consider include (a) vision and hearing screening, (b)\nschool/academic histories, (c) classroom observation by a counselor, (d)\nparent and teacher behavior rating scales (eg, Vanderbilt, Conner, or\nAchenbach scales), (e) consideration of speech/language evaluation, (f)\nscreening intelligence testing, (g) screening achievement testing, (h)\nfull intelligence and achievement testing if discrepancies are apparent in\nabbreviated tests, and (i) trials of classroom interventions. (2) Use\npediatric office visits to identify children with academic or behavior\nproblems and symptoms of inattention (history or questionnaire). (3) Refer\nidentified children to the contact person at each child's school,\nrequesting information in accordance with community consensus. (4)\nDesignate a contact person to receive school materials for the practice.\n(5) Review the packet from the school and incorporate school data into the\nclinical assessment. (6) Reinforce with the parents and the school the\nneed for multimodal intervention, including academic and study strategies\nfor the classroom and home, in-depth psychologic testing of children whose\ndiscrepancies between cognitive level and achievement suggest learning or\nlanguage disabilities and the need for an individualized educational plan\n(special education), consideration of the \"other health impaired\"\ndesignation as an alternate route to an individualized educational plan or\n504 plan (classroom accommodations), behavior-modification techniques for\ntargeted behavior problems, and medication trials, as indicated. (7) Refer\nthe patient to a mental health professional if the assessment suggests\ncoexisting conditions. (8) Use communication forms to share diagnostic and\nmedication information, recommended interventions, and follow-up plans\nwith the school and the family. (9) Receive requested teacher and parent\nfollow-up reports and make adjustments in therapy as indicated by the\nchild's functioning in targeted areas. (10) Maintain communication with\nthe school and the parents, especially at times of transition (eg,\nbeginning and end of the school year, change of schools, times of family\nstress, times of change in management, adolescence, and entry into college\nor the workforce).},\n\tnumber = {1},\n\tjournal = {Pediatrics},\n\tauthor = {Foy, Jane Meschan and Earls, Marian F},\n\tmonth = jan,\n\tyear = {2005},\n\tnote = {00096},\n\tkeywords = {Mental Health Diversity},\n\tpages = {e97--104}\n}\n\n","author_short":["Foy, J. M.","Earls, M. 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