Many pediatric practices use paper-based questionnaires to screen patients for developmental issues such as autism, attention deficit hyperactivity disorder (ADHD), depression and anxiety, and high-risk behaviors, as recommended by the American Academy of Pediatrics.
What follows are some accessible portals for computers and tablets that will facilitate the evaluation in the office, speeding up your visits and providing actionable information.
The CHADIS online portal
In 2001, 2 developmental pediatricians, Barbara Howard, MD, and Raymond Sturner, MD, developed the Child Health and Development Interactive System (CHADIS), a comprehensive web-based system for screening children for behavioral problems. and development. The CHADIS online portal has received more than $24 million in federal and foundation research and development grants. To date, more than 5,000 providers around the world are using the CHADIS system, and it continues to grow in functionality and popularity.
The CHADIS Screening Tool allows pediatricians to invite parents to complete age-appropriate screening tools online prior to well-child visits. The CHADIS system evaluates the forms parents complete, scores when indicated, and alerts pediatricians to issues that need to be discussed with parents during well-child or behavior-related visits. Many pediatricians speak favorably of the CHADIS system because it allows them to identify parental concerns and behavior problems that might not have been identified in the past. A CHADIS subscription costs approximately $1,500 per provider per year, with discounts available for volume licenses.
CHADIS incorporates hundreds of screening tools commonly used by pediatricians, such as the Revised Checklist for Autism in Young Children, Follow-Up Revised; Age and Stage Questionnaires; Vanderbilt Rating Scales; Patient Health Questionnaire for Adolescents; and Generalized Anxiety Disorder 7-item forms. It also provides a comprehensive library of resources to aid in management once a condition is diagnosed.
Mesalud for ADHD
A clinical study showing that an Internet portal could improve ADHD care was published by researchers affiliated with Cincinnati Children’s Hospital Medical Center in Ohio in 2011.1 The study demonstrated significantly higher rates of complete ADHD assessments when the portal was used to expedite diagnosis.
The portal was later marketed as mehealth for ADHD. Parents seeking an evaluation sign up for the portal online at the time of visit or by phone, and then receive an email with an activation code from the practice that provides access to the portal.
Parents complete an initial medical history form as well as Vanderbilt assessment forms. Parents then invite their child’s teachers to the portal to complete the Vanderbilt forms. Once completed, all forms are scored and made available in the patient’s mehealth for ADHD record, and an email is sent to the physician alerting them that a complete record is available for review. A report with a detailed interpretation is generated. This facilitates discussion of the diagnosis with the parents at the follow-up visit. If a child receives medication, questionnaires are automatically sent to parents and teachers at preselected intervals (eg, typically every 1 to 3 months) to help monitor response to treatment and alert providers to any symptoms that suggest side effects. medication adverse effects. Best of all, mehealth for ADHD it is a free servicesponsored by a grant from the National Institutes of Health.
The Best Kept Secret in Mental Health Assessment: Results References
David Kraus, PhD, has been working diligently for the past 30 years to develop a universal screening tool for children, adolescents, and adults. Your Treatment Outcomes Packet (TOP) consists of 58 questions for adults and adolescents and 48 questions for children, and takes less than 10 minutes to complete. TOP can be administered online or via paper form, and results are available immediately when submitted electronically and within 15 minutes when submitted by fax.
The TOP screens teens and children for suicidal ideation, violent behavior, psychosis, depression, ADHD, conduct problems, school and work problems, substance abuse, and others. In children, it also detects eating disorders and anxiety. It is available through WellnessCheck.net, which facilitates the registration process for patients and parents, accelerating the completion of the questionnaires. Questionnaires can be completed via tablet at patient encounter or via email or short message service text message, which can be sent to the patient or parent to complete on their own smart device. An alert is issued to the provider when a questionnaire is completed and regular messages are sent if a requested questionnaire is not completed. The service uses a prescription model and is available for less than $100 per provider per month.
The TOP has been validated in many clinical studies, showing that it is as effective, if not more so, than standard screening tools.23 Repeated testing during counseling shows how well the patient has responded to therapy and identifies areas that need more work. It is now used by over 30,000 therapists and over 1 million screens have been made to date.
Kraus has used TOP to develop a system that has identified therapists who are particularly good at certain problems (i.e., excellent at treating anxiety but poor at treating substance abuse) in order to find the best therapist for a particular patient. . Kraus’ study published in 2021 indicates that better results can be achieved in a shorter period when patients are matched with the most suitable therapists.4 In fact, top performing therapists are being compensated at higher rates by some insurance companies because the system provides an objective measure of results.
Accelerated diagnosis of autism
Canvas Dx, an AI-based system created by Cognoa that streamlines autism diagnosis in children ages 18 months to 6 years, is now FDA-approved (full disclosure: I’m consulting with Cognoa to help improve their system).
Parents and providers complete short questionnaires, and parents upload various videos of children to the Canvas Dx website for analysis. Canvas Dx then presents 1 of 3 results: screen positive for autism, screen negative for autism, or screen inconclusive. A positive screen allows a child to receive the necessary advanced behavioral analysis therapy. There is usually a waiting list of many months before a developmental pediatrician or other expert can see a child and make a diagnosis. By contrast, Canvas Dx can be completed in a matter of weeks.
Obstacles and conclusions
To use any of the portals described in this article, vendors and staff must be trained on the system, and a workflow must be developed and tested to ensure things run smoothly. Successful use of these portals also requires physicians to be consistent in encouraging patients to complete forms prior to visits whenever possible.
In the years to come, more and more services are likely to become available through specialized portals like the ones described in this article.
References:
1. Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011;128(5):e1201-1208. doi:10.1542/peds.2011-0872
2. Baxter EE, Alexander PC, Kraus DR, Bentley JH, Boswell JF, Castonguay LG. Concurrent validation of the Treatment Outcomes Package (TOP) for children and adolescents. J Child Family Stud. 2016;25:2415-2422. doi:10.1007/s10826-016-0419-4
3. Youn SJ, Kraus DR, Castonguay LG. The treatment outcomes package: facilitating practice and clinically relevant research. Psychotherapy (Chic). 2012;49(2):115-122. doi:10.1037/a0027932
4. Constantine MJ, Boswell JF, Coyne AE, Swales TP, Kraus DR. Effect of matching therapists with patients versus usual assignment on psychotherapy outcomes in adults: a randomized clinical trial. JAMA Psychiatry. 2021;78(9):960-969. doi:10.1001/jamapsychiatry.2021.1221
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