title: Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  To identify systematic problems in coordinating care for inner-city minority youths with attention-deficit/hyperactivity disorder.
  
  
  METHODS
  We recruited participants from inner-city minority communities in a single metropolitan area for a focus group study. We held separate meetings for pediatricians, mental health therapists, school staff, and parents (both black and Latino). We audiotaped and transcribed the meetings. We identified themes by consensus and used root cause analysis as a conceptual framework to guide our analysis.
  
  
  RESULTS
  We held 13 focus group meetings. Participants uniformly perceived insufficient communication and coordination of care. Five themes representing system and human factors that contributed to this fragmentation in care emerged: (1) a lack of consensus about who should oversee care; (2) changes in health care providers or teachers; (3) uncertainty in the diagnosis, insufficient training, and few resources; (4) distrust and blame that emerged when relationships among people who care for the child were absent or otherwise inadequate; and (5) lack of support from employers, friends, and family to engage in collaborative care.
  
  
  CONCLUSIONS
  Using a root cause analysis framework, we identified system- and human-level factors that were perceived to impede communication and coordination of care for this population of children with attention-deficit/hyperactivity disorder. These results suggest that better organizational policies that define provider responsibilities and accountability, support the coordination of care, bridge relationships between agencies, and provide additional education and resources may improve collaboration. Additional study is needed to assess the generalizability of these finding to other settings.
authors.affiliation: Pediatric Generalist Research Group, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. guevara@email.chop.edu
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Daniel
authors.initials: D
authors.lastname: Romer
authors.forename: Thomas
authors.initials: T
authors.lastname: Power
authors.forename: Ricardo
authors.initials: R
authors.lastname: Eiraldi
authors.forename: Snejana
authors.initials: S
authors.lastname: Nihtianova
authors.forename: Aracely
authors.initials: A
authors.lastname: Rosales
authors.forename: Janet
authors.initials: J
authors.lastname: Ohene-Frempong
authors.forename: Donald F
authors.initials: DF
authors.lastname: Schwarz
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000208:ethnology* / Q000628:therapy*; D001290:Attitude; D044383:Black People; D002648:Child; D002662:Child Health Services; D003156:Community Mental Health Services; D003266:Continuity of Patient Care; D006630:Hispanic or Latino; D006801:Humans; D010290:Parents / Q000523:psychology; D010372:Pediatrics; D011203:Poverty; D012574:Schools; D019037:Urban Health Services