title: Methodology for conducting the children's attention-deficit hyperactivity disorder telemental health treatment study in multiple underserved communities.
abstract: BACKGROUND
  Children living in nonmetropolitan communities are underserved by evidence-based mental health care and are underrepresented in clinical trials.
  
  
  OBJECTIVE
  In this article, we describe lessons learned in conducting the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health (TMH) Treatment Study (CATTS), a randomized controlled trial testing the effectiveness of TMH in improving outcomes of children with ADHD living in underserved communities.
  
  
  METHODS
  Children were referred by primary care providers (PCPs). The test intervention group received six telepsychiatry sessions with each session followed by an caregiver behavior training session delivered in-person by a local therapist. A secure website was used to support decision making by the telepsychiatrists and to facilitate real-time collaboration between the telepsychiatrists and community therapists. The control group received a single telepsychiatry consultation. Questionnaires tapping ADHD symptoms and other outcomes were administered to parents and teachers online through a secure portal from personal computers.
  
  
  RESULTS
  total of 88 PCPs in seven communities referred the 223 children who participated in the trial. Attrition in treatment sessions and research assessments was very low. Lessons learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and training to local therapists. Recruitment was enhanced by offering the control group a telepsychiatry consultation. Site-specific strategies were needed to meet recruitment targets.
  
  
  CONCLUSIONS
  The CATTS trial used methods designed to optimize inclusion of children living in multiple dispersed and underserved areas. The study will serve as a model for other research projects aiming at reducing geographic disparities in access to quality mental health care.
authors.affiliation: aDepartment of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Vander Stoep
authors.forename: Kathleen
authors.initials: K
authors.lastname: Myers
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008605:Mental Health Services; D015337:Multicenter Studies as Topic / Q000379:methods; D011570:Psychiatry / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012017:Referral and Consultation; D017216:Telemedicine / Q000379:methods*
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