Feasibility of Conducting a Randomized Controlled Trial of Telemental Health with Children Diagnosed with Attention-Deficit/Hyperactivity Disorder in Underserved Communities

Abstract

Objective: Telemental health (TMH), the use of videoteleconferencing to provide care that is usually delivered in person, is increasingly used to rectify disparities in access to care. Few studies, however, have been conducted to demonstrate the effectiveness of TMH as a service delivery model. The Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) is a randomized clinical trial (RCT) of TMH conducted in multiple underserved communities. This article reports on the feasibility of conducting an effectiveness trial of TMH with children. Methods: The CATTS trial used videoteleconferencing to provide guideline-based care and secure web sites to coordinate key aspects of trial implementation, such as participant recruitment and retention, intervention fidelity, and completion of assessments. Results: The CATTS trial engaged seven communities and 150 primary care providers as partners in the study, and enrolled 223 children 5.5-12.9 years old. The intervention group completed an average of 5.3 of 6.0 planned sessions and 96% of controls completed a TMH consultation. Both groups completed an average of 4.8 of the 5.0 assessments. Clinicians demonstrated high fidelity to their treatment protocols. Minor technical difficulties did not interfere with providing care. Conclusions:The CATTS trial demonstrated the feasibility of conducting an RCT of TMH with children living in multiple underserved communities. Telecommunications technologies can facilitate the coordination of research activities across sites and clinicians. Future trials should work closely with study partners to ensure referral of a representative study sample. Further trials are needed to help establish the effectiveness of TMH as a service delivery model. Trial Registration: http://clinicaltrials.gov/show/NCT00830700.

Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

“…The RCT was approved by the institutional review board of Seattle Children’s Research Institute and monitored by a data safety and monitoring board. The methodology for the trial has been described in detail elsewhere 34–35 and is summarized below.…”

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

“…All sessions were recorded, and sessions were randomly selected to rate clinician adherence to their intervention protocols using checklists that outlined the essential treatment components. Telepsychiatrists and therapists showed high fidelity to their protocols (Myers, Vander Stoep, & Lobdell, 2013; Vander Stoep & Myers, 2013). …”

Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

“…Children and caregivers described in the current study consisted of 37 of the 223 participants in the Children's ADHD Telemental Health Treatment Study (CATTS). The methodology [22][23][24] and outcomes 25 for the CATTS trial have been described elsewhere and are briefly summarized.…”