Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application

Abstract

Background Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Our institution developed an email-based software to collect ADHD information from parents and teachers, which delivered data directly to the clinician within the electronic health record (EHR). Objective We sought to adapt our institution's existing EHR-linked system for ADHD symptom monitoring to support communication between parents and teachers and then to assess child characteristics associated with sharing of ADHD information. Methods We updated our software to support automated sharing of ADHD information between parents and teachers. Sharing was optional for parents but obligatory for teachers. We conducted a retrospective cohort study involving 590 patients at 31 primary care sites to evaluate a system for sharing of ADHD-specific health information between parents and teachers. We used multivariable logistic regression to estimate associations between child characteristics and parental sharing. We further investigated the association between child characteristics and viewing of survey results delivered through the electronic communication system. Results Most parents (64%) elected to share survey results with teachers at the first opportunity and the vast majority (80%) elected to share all possible information. Parents who elected to share usually continue sharing at subsequent opportunities (89%). Younger child age and performance impairments were associated with increased likelihood of sharing. However, parents viewed only 16% of teacher submitted surveys and teachers only viewed 30% of surveys shared by parents. Conclusion This study demonstrates that electronic systems to capture ADHD information from parents and teachers can be adapted to support communication between them, and that parents are amenable to sharing ADHD information with teachers. However, strategies are needed to encourage viewing of shared information.

ADHD Diagnosis and Treatment Guidelines: A Historical Perspective

“…53 Investigators at Children's Hospital of Philadelphia developed the ADHD Care Assistant, a system that sends electronic ADHD rating scales to parents and teachers, presents results seamlessly in the EHR and allows parents to elect automated sharing of ADHD information between themselves and teachers, thereby facilitating communication. 55 Michel et al 56 found that most parents are amenable to sharing ADHD rating scale information collected in the system with teachers, but parents viewed only 16% of teachersubmitted ADHD surveys, and teachers viewed 30% of parent surveys. The investigators concluded that in future efforts, researchers should target the development of strategies to encourage viewing of shared information.…”

A Team-Based Collaborative Care Model for Youth With Attention-Deficit Hyperactivity Disorder in Education and Health Care Settings

“…This allows family members to become team members in the management of a child’s ADHD. To improve communication and collaboration between professionals in health care and education and facilitate the use of evidence-based assessment and intervention across home and school contexts, Power and colleagues developed and refined the ADHD Care Assistant (Michel et al, 2018; Power et al, 2016). Other electronic systems exist, but they are not directly linked to the health care electronic system (Epstein et al, 2013).…”

“…The ADHD Care Assistant has four distinct features: (a) an electronic survey designed to collect data from parents and teachers, (b) a module visible to providers and integrated into the electronic health record (EHR) system, (c) a web service design to facilitate communication between the shared data and the EHR, and (d) an e-mail-based platform for sharing data between parents and teachers (Michel et al, 2018; Power et al, 2016). One of the particular benefits of the ADHD Care Assistant is the opportunity it affords parents to select preferred treatments for the child, including medication and/or behavior therapy, and to share data among members of the health care team and with the child’s teachers.…”

“…However, they also found that parents and teachers in urban communities were significantly less likely to use the tool than were parents and teachers in suburban communities (Power et al, 2016). To further improve and test the effectiveness of the ADHD Care Assistant, Michel and colleagues (2018) obtained feedback from stakeholders (parents, teachers, and pediatricians) about which data they preferred to share (i.e., goals for their children, as well as children’s symptoms, educational performance, and medication side effects) and updated the tool accordingly. Michel and colleagues (2018) then studied the effectiveness of the ADHD Care Assistant as a communication tool, finding that among parents who used it, the majority (64%) agreed to share information with teachers; and in 80% of those cases, parents agreed to share all of the child’s data.…”

“…Although professionals from both health care and education are central to the treatment of children and youth with ADHD, there has been surprisingly limited communication and collaboration between professionals in the two systems (Guevara et al, 2005; Power et al, 2013). This pattern persists despite the finding that health care providers, parents, and teachers willingly share information about a given child’s care when they have a method for doing so (Michel et al, 2018). In fact, there remain persistent barriers to effective collaboration among professionals from the education and health care systems, including (a) administrative and fiscal barriers, including time for collaboration, (b) conceptual and linguistic differences between professionals’ training and practice, (c) differences in expectations for collaboration held by health care providers and educators, (d) limitations to collaboration associated with one’s role in a given system, (e) absence of specific processes to coordinate care, (f) barriers associated with privacy laws in health care (Health Information Portability and Accountability Act, HIPAA) and education (Family Educational Rights and Privacy Act, FERPA), (g) lack of continuity in care for youth from year to year, and (h) lack of resources in some low-income communities and schools (Power et al, 2013).…”