DiGirolamo, Ann

Martinez, Amanda

Smith, Colleen

Snyder, Angie

English

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Materials Georgia Health Policy Center 1-3-2018 Benefits and Barriers to Evidence-Based Behavioral Health Services for Children with ADHD: National Survey Data, Parent & Provider Perspectives, and Promising Practices Angie Snyder Ann DiGirolamo Amanda Martinez Colleen Smith Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials Recommended Citation Snyder, Angie; DiGirolamo, Ann; Martinez, Amanda; and Smith, Colleen, "Benefits and Barriers to Evidence-Based Behavioral Health Services for Children with ADHD: National Survey Data, Parent & Provider Perspectives, and Promising Practices" (2018). GHPC Materials. 120. https://scholarworks.gsu.edu/ghpc_materials/120 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. ANDREW  YOUNG SCHOOL O F  P O L I C Y  S T U D I E SBenefits and Barriers to Evidence-Based Behavioral  Health Services for Children with ADHD:National Survey Data, Parent & Provider Perspectives, and Promising PracticesAngie Snyder, Ann DiGirolamo, Amanda Martinez, Colleen SmithCenter of Excellence for Children’s Behavioral Health, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GAMedication and Behavior Therapy for ADHD,  2009-2010Visser, Bitsko, Danielson et al. (2015). J Pediatrics 166(6):1423-30.Data source: National Survey of Children with Special Health Care NeedsRESEARCH OBJECTIVE The American Academy of Pediatrics (AAP) recommends behavioral therapy as first-line treatment for young children with attention-deficit/hyperactivity disorder (ADHD), but findings from national surveys suggest a misalignment  between current practice and best practice for ADHD treatment. This study characterizes perceived benefits and  barriers to receiving behavioral treatment among parents of young children and their health care providers and  discusses lessons learned from implementing model programs across the country.STUDY DESIGN The study team utilized national survey data and claims data to produce prevalence estimates of ADHD, ADHD  medication usage, and receipt of behavioral treatment. These quantitative data are complemented with in-depth  qualitative data (interviews and focus groups) on parental and provider perceptions of barriers and benefits to  behavioral treatment for young children with ADHD and information on model programs. All qualitative data were  transcribed and analyzed for common themes.POPULATION STUDIED Data were collected via a series of structured focus groups with parents of young and recently diagnosed children and a series of structured interviews with primary care and behavioral health providers treating these children. Structured interviews were also performed with representatives from model programs across the country implementing innovative approaches to expand the reach of three evidenced-based practices (Incredible Years, Triple P, and Parent-Child  Interaction Therapy).PRINCIPAL FINDINGS Parents noted exploring a variety of interventions to address their children’s ADHD behavior, including behavioral  therapy; medication treatment; and alternative therapies such as diet/nutrition, physical activity, and increased sleep.  A key challenge noted by parents in obtaining services was the lack of a comprehensive view of the child by most  health care professionals. Additional barriers to behavioral treatment included cost, time lost at work, stigma, varied  quality of therapists, and difficulty obtaining behavioral treatment through schools.Similar themes emerged from primary care and behavioral health  provider interviews including stigma, lack of knowledge/awareness of  services, parent preferences for medication/dedication to behavioral therapy, lack of insurance coverage/  low reimbursement rates, differing  levels of parent engagement with  school systems, and integrative care  between health care providers.Several promising practices were identified through analysis of the model program interviews. Funding from federal and/or state agencies was a key feature in leveraging  buy-in and statewide implementation of evidence-based behavioral therapy and  parenting programs. Integrating with existing programs that had mutual interest and  served young children and their families was integral to successful implementation.CONCLUSION Despite clear evidence and recommendations by AAP to use behavioral therapy as first-line treatment for ADHD,  parents are still experiencing difficulties obtaining behavioral services when needed and providers continue to  experience barriers to providing and linking parents to appropriate services. Of key concern is a lack of coordinated  care for children with health care professionals often working in silos, and factors such as cost for families and  reimbursement for providers as well as the availability of providers trained in evidence-based behavioral therapy.IMPLICATIONS FOR  POLICY OR PRACTICE Several programs are creatively leveraging resources and partnerships to increase access to behavioral therapy for  young children. These strategies can serve as examples for other states who seek to build their capacity to scale up  and deliver evidence-based parenting programs.For more information, please contact the Georgia Health Policy Center  at 404.413.0314 or visit us online at www.gsu.edu/ghpc.

Benefits and Barriers to Evidence-Based Behavioral  Health Services for Children with ADHD: National Survey Data, Parent & Provider Perspectives, and Promising Practices

Georgia State University

Georgia State University 
ScholarWorks @ Georgia State University 
GHPC Materials Georgia Health Policy Center 
1-3-2018 
Benefits and Barriers to Evidence-Based Behavioral Health 
Services for Children with ADHD: National Survey Data, Parent & 
Provider Perspectives, and Promising Practices 
Angie Snyder 
Ann DiGirolamo 
Amanda Martinez 
Colleen Smith 
Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials 
Recommended Citation 
Snyder, Angie; DiGirolamo, Ann; Martinez, Amanda; and Smith, Colleen, "Benefits and Barriers to Evidence-
Based Behavioral Health Services for Children with ADHD: National Survey Data, Parent & Provider 
Perspectives, and Promising Practices" (2018). GHPC Materials. 120. 
https://scholarworks.gsu.edu/ghpc_materials/120 
This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ 
Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of 
ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. 
ANDREW  YOUNG SCHOOL
 O F  P O L I C Y  S T U D I E S
Benefits and Barriers to Evidence-Based Behavioral  
Health Services for Children with ADHD:
National Survey Data, Parent & Provider Perspectives, and Promising Practices
Angie Snyder, Ann DiGirolamo, Amanda Martinez, Colleen Smith
Center of Excellence for Children’s Behavioral Health, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA
Medication and Behavior Therapy for ADHD,  
2009-2010
Visser, Bitsko, Danielson et al. (2015). J Pediatrics 166(6):1423-30.
Data source: National Survey of Children with Special Health Care Needs
RESEARCH OBJECTIVE 
The American Academy of Pediatrics (AAP) recommends behavioral therapy as first-line treatment for young children 
with attention-deficit/hyperactivity disorder (ADHD), but findings from national surveys suggest a misalignment  between 
current practice and best practice for ADHD treatment. This study characterizes perceived benefits and  barriers to 
receiving behavioral treatment among parents of young children and their health care providers and  discusses lessons 
learned from implementing model programs across the country.
STUDY DESIGN 
The study team utilized national survey data and claims data to produce prevalence estimates of ADHD, ADHD  medication 
usage, and receipt of behavioral treatment. These quantitative data are complemented with in-depth  qualitative data 
(interviews and focus groups) on parental and provider perceptions of barriers and benefits to  behavioral treatment for 
young children with ADHD and information on model programs. All qualitative data were  transcribed and analyzed for 
common themes.
POPULATION STUDIED 
Data were collected via a series of structured focus groups with parents of young and recently diagnosed children and 
a series of structured interviews with primary care and behavioral health providers treating these children. Structured 
interviews were also performed with representatives from model programs across the country implementing innovative 
approaches to expand the reach of three evidenced-based practices (Incredible Years, Triple P, and Parent-Child  Interaction 
Therapy).
PRINCIPAL FINDINGS 
Parents noted exploring a variety of interventions to address their children’s ADHD behavior, including behavioral  therapy; 
medication treatment; and alternative therapies such as diet/nutrition, physical activity, and increased sleep.  A key 
challenge noted by parents in obtaining services was the lack of a comprehensive view of the child by most  health care 
professionals. Additional barriers to behavioral treatment included cost, time lost at work, stigma, varied  quality of 
therapists, and difficulty obtaining behavioral treatment through schools.
Similar themes emerged from primary care and behavioral 
health  provider interviews including stigma, lack of knowledge/
awareness of  services, parent preferences for medication/
dedication to behavioral 
therapy, lack of 
insurance coverage/  low 
reimbursement rates, 
differing  levels of parent 
engagement with  school 
systems, and integrative 
care  between health care 
providers.
Several promising practices were identified through analysis of the model program 
interviews. Funding from federal and/or state agencies was a key feature in 
leveraging  buy-in and statewide implementation of evidence-based behavioral 
therapy and  parenting programs. Integrating with existing programs that had mutual interest and  served young children 
and their families was integral to successful implementation.
CONCLUSION 
Despite clear evidence and recommendations by AAP to use behavioral therapy as first-line treatment for ADHD,  parents 
are still experiencing difficulties obtaining behavioral services when needed and providers continue to  experience barriers 
to providing and linking parents to appropriate services. Of key concern is a lack of coordinated  care for children with 
health care professionals often working in silos, and factors such as cost for families and  reimbursement for providers as 
well as the availability of providers trained in evidence-based behavioral therapy.
IMPLICATIONS FOR  POLICY OR PRACTICE 
Several programs are creatively leveraging resources and partnerships to increase access to behavioral therapy for  young 
children. These strategies can serve as examples for other states who seek to build their capacity to scale up  and deliver 
evidence-based parenting programs.
For more information, please contact the Georgia Health Policy Center  at 
404.413.0314 or visit us online at www.gsu.edu/ghpc.


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Benefits and Barriers to Evidence-Based Behavioral Health Services for Children with ADHD: National Survey Data, Parent & Provider Perspectives, and Promising Practices

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