Journal of Abnormal Child Psychology

, Volume 45, Issue 1, pp 27–43 | Cite as

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

  • Ann Vander Stoep
  • Carolyn A. McCarty
  • Chuan Zhou
  • Carol M. Rockhill
  • Erin N. Schoenfelder
  • Kathleen Myers
Article
First Online:

Abstract

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 − 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95 % CI = [−2.74, −0.08], p < .05), PSI (β = −4.59, 95 % CI = [−7.87, − 1.31], p < .001), CSQ (β = −5.41, 95 % CI = [− 8.58, −2.24], p < .001) and FES (β = 6.69, 95 % CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.

Keywords

Telehealth Telepsychiatry Telemental health ADHD Service delivery model Randomized controlled trial Caregiver training E-health Primary outcome of reduction in caregiver distress Mediation by improvement in child ADHD symptoms 
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Notes

Compliance with Ethical Standards

Funding

The design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript was supported by funding from the U.S. National Institute of Mental Health [1R01MH081997 and R01MH081997-04S1]. Funding for pilot data collection was provided by the University of Washington Institute of Translational Health Sciences, Small Pilot Project Grant program [566821]; the University of Washington Royalty Research Fund program [65–4020]; and the American Academy of Child and Adolescent Psychiatry Abramson Fund [506200020101]. The CATTS trial is registered with Clinical Trials: http://clinicaltrials.gov/show/NCT00830700.

Presentations

Earlier versions of this paper were presented at the 16th Biennial Scientific Meeting of the International Society for Research in Child and Adolescent Psychopathology in Leuven, Belgium, June 13–16, 2013 and at the 60th Annual Meeting of the American Academy of Child and Adolescent Psychiatry in Orlando, FL, October 22–27, 2013.

Contributors

We would like to thank: Research Coordinators – Heather Violette, PhD and Kelly Thompson, MSW; CATTS Therapists – Joan Arrasmith, MEd, Laura Aviles, MSW, Aloma Burrows, MEd, Corrie Piper MSFT, Sarah Rundell, MA, Heather Violette, PhD, Lila Waldron, MS; Telepsychiatrists –Lynda Lee Carlisle, MD, Kelley Fellman, MD, Daniel Ferber, MD, William French, MD, Michael Kisicki, MD, Ian Kodish, MD, PhD, Carol Rockhill, MD, PhD, MPH; Research Staff – Sarah Grover, Gina Kim, John Geyer, Caitlin Lobdell, Jane Koltracht, Yuet Juhn Tse; Community Champions- Lynn O’Leary MD & Blaine Tolby MD, PhD; and the Families and Primary Care Providers of Washington and Oregon who participated in the CATTS Trial.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the Institutional Review Board of Seattle Children’s Research Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ann Vander Stoep
    • 1
    • 2
    • 3
  • Carolyn A. McCarty
    • 1
    • 4
  • Chuan Zhou
    • 1
    • 4
    • 5
  • Carol M. Rockhill
    • 2
  • Erin N. Schoenfelder
    • 2
  • Kathleen Myers
    • 1
    • 2
  1. 1.Center for Child Health, Behavior, and DevelopmentSeattle Childrens’ Research InstituteSeattleUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA
  3. 3.Department of EpidemiologyUniversity of Washington School of Public HealthSeattleUSA
  4. 4.Department of PediatricsUniversity of Washington School of MedicineSeattleUSA
  5. 5.Department of Health ServicesUniversity of Washington School of Public HealthSeattleUSA

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