RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Development of a Systematic Approach to Mental Health Evaluations at Treasure Valley Pediatric Clinic in Ontario, OR Project Date: 9/11/2006 Treasure Valley Pediatric Clinic (TVPC) in Ontario, Oregon has a significant number of patients that are seen for mental health care with ADHD accounting for the majority of these cases. The clinic has a total patient population of approximately 5600 patients and 204 (3.6%) patients have a diagnosis of ADHD. Other common mental health issues seen at the clinic include depression (129 patients), anxiety (51 patients), and autism (25 patients). With a staff that includes one pediatrician, two physician’s assistants, two counselors, and a registered nurse that acts as a care coordinator, TVPC is well-equipped to meet the mental health needs of its patients, but it lacks a unified approach to the initial evaluation of these patients. The goal of this project was to learn more about how initial mental health evaluations are performed at the TVPC and to work with the various healthcare providers at the clinic to develop a unified approach to these evaluations. The final product of this project was the development of a protocol for initial evaluation of patients with possible ADHD and other mental health concerns. ADHD vs. Bipolar Affective Disorder: a Comparison of the Two Mental Health Problems in the Pediatric Population of Klamath Falls. Project Date: 5/10/2004 Mental illness is an important medical problem in the pediatric population that affects communities ranging from large metropolitan areas like Portland to small towns such as Klamath Falls. Although the prevalence of attention deficit hyperactivity disorder (ADHD) and bipolar affective disorder (BAD) are significantly different in the pediatric population, they are often confused with one another due to the overlap of common symptoms. Therefore it is important to identify children with these disorders and make an accurate diagnosis to ensure that they receive the proper medical and psychological treatment. Analysis of ICD9 codes from 2003 demonstrated almost 1,000 visits for ADHD and BAD at The Klamath Pediatric Clinic. These numbers were confirmed by my own record keeping during a three week period which showed 16% of all visits were for mental health issues. Given the number of patients with ADHD and BAD, a screening tool was utilized to try to find differences in the presentation of these two illnesses at the time of diagnosis. Results from questionnaires handed out in the clinic showed higher scores by patients with BAD (24 versus 15; p 0.011). In addition, three specific categories including irritability, thought content, and disruptive behavior were significantly higher in children with BAD. The results of this project suggest that mental illnesses, specifically ADHD and BAD are an important healthcare issue at The Klamath Pediatric Clinic and that there may be ways to better screen for and treat these patients. How ADHD Children are Diagnosed and How they are Cared for in the Community of Ontario, Oregon. Project Date: 7/7/2003 Attention-Deficit Disorder (ADHD) is now one of most common chronic childhood disorders. My goal for my project was to learn more about ADHD and how it affects a private office. Also, I wanted to know what resources the office brought to bear to handle this disease. The design was mostly observational. I did do a few interviews of office staff and patients. Since, there is not a physical test that can be run, like a CBC or MRI, to diagnose ADHD I also wanted to learn how to make a diagnosis. Then, after getting a diagnosis I wanted to know how kids in this community were being helped. Some comparisons were made between national guidelines and how children in the Ontario area were being cared for. In my project work I found out that this clinic does have a way to diagnose ADHD and a variety of ways that they use to help these patients. Conversations and Perspectives on Attention Deficit Disorders in Grant County, Oregon. Project Date: 8/12/2002 The goal of this community project was to examine the perceptions, detection and diagnosis, and tratment and managment of attention deficit disorders, with (ADHD) or without hyperactivity (ADD), in a small rural community such as John Day, Oregon, and within the surrounding country. Conversations with three professionals intimately involved with the diagnosis and/or management of AD(H)D and a member of a family dealing with ADHD were held and recorded on mircocassette, and the contents were then transcribed. From these conversations, it appears that the unique blue-collar, small-town environment of John Day serves to discourage the rampant use of medication in the treatment of AD(H)D, despite universal agreement among the four interviewees concerning its effectiveness. However, nearly all endorse an increasing prevalence of acceptance of attention deficit disorders as legitimate and treatable illness amongst the local populace. Although resources are limited in such a sparsely populated region, community networks involving local physicians, the Mental Health Service, and the local school districts offer ample aid for those dealing with AD(H)D. While gaps still exist in terms of coverage and communication among the players and with those affected by AD(H)D, it appears that there is adequate coordination and comprehensiveness to successfully manage the great majority of young persons suffering from disorders of attention. Breast Feeding As A Possible Protective Factor In Children Diagnosed With ADHD. Project Date: 1/2/2002 This study sought to look at a possible connection between the lack of breastfeeding and the diagnosis of ADHD, in the Treasure Valley Pediatric Clinic in Ontario, Oregon. The design is retrospective case control study involving all patients being seen for ADHD in the clinic. When charts were reviewed in the ADHD population, 39% of that population received a diet containing breast milk within the first six months of life, as compared to 67% in the control population. This report discusses the protective effects of breastfeeding versus non-breastfeeding and how this might affect the diagnosis of ADHD. A Survey Of Teacher Satisfaction With The Woodburn Pediatric Clinic's Monitoring Practices Of Students Diagnosed With Attention Deficit-Hyperactivity Disorder. Project Date: 11/5/2001 Attention-deficit/hyperactivity disorder is the most common school-aged behavioral problem with a prevalence of 3-5%. The Woodburn Pediatric Clinic has a large subset of these patients on its census. Management and monitoring included a questionnaire sent to the teachers and counselors of these patients concerning AD/HD-specific behaviors. This study investigated the efficacy of this questionnaire by employing a teacher survey. Generally, feedback concerning the questionnaire was positive. Suggestions for improvement centered on changing the format from fax to e-mail and giving respondents more lead time in completing the questionnaire. Use of Anthropometry in an Outpatient Office Setting: Screening for Fetal Alcohol Syndrome and Fetal Alcohol Effects. Project Date: 5/6/2002 Fetal alcohol syndrome (FAS) is a pattern of physical, behavioral, and cognitive defects seen in individuals exposed to alcohol in utero. Fetal alcohol effects (FAE) consists of more subtle symptoms sometimes presenting as poor academic achievement and behavioral problems. The FAS and especially the FAE phenotype is highly variable and may be difficult to distinguish from other conditions such as attention-deficit hyperactivity disorder (ADHD). ADHD is a common childhood psychiatric disorder consisting of behaviors that include one of the following hallmarks of hyperactivity, inattention and/or impulsivity. Anthropometry is a technique that objectifies craniofacial features for use in plastic surgery, dysmorphology and medical genetics. Recently, Moore et. al. 2001 described a method utilizing anthropometry that was 96% accurate for differentiating between individuals with or without exposure to alcohol in utero. Using this same tool we screened 21 children and were able to correctly identify two children with known FAS, and by using less stringent criteria were able to identify 6 more children with suspected alcohol exposure in utero. Interestingly, 4 out of these 6 children had known diagnoses of ADHD. Diagnosis And Management Of Attention Deficit Hyperactivity Disorder Among Children And Adolescents Below The Age Of 14 In A Rural Community Primary Practice. Project Date: 9/24/2001 Attention Deficit Hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. It is also among the most prevalent chronic health conditions affecting school-age children. ADHD occurs in 3 to 5% of school-aged children, accounts for as many as 30% to 50% of children referrals to mental health services, and results in substantial impairment in peer, family, and academic functioning. Given the paucity of child mental health providers both in urban and rural settings, primary care providers - family medicine physicians and pediatricians - play an important role in the initial diagnosis as well as subsequent management of children and adolescents with ADHD. They recognize behavior problems that may impact academic achievement in 18% of school-age children seen in their offices and clinics. Hyperactivity or inattention is diagnosed in approximately 9% of the latter. In this light, the projects focuses on: Current practice guidelines on the diagnosis and management of ADHD among school-age children and adolescents below the age of 14; Chart review of a sample of fourteen patients followed by three family practitioners in Lebanon, Oregon for baseline data of time of diagnosis, treatment regimen and frequency of follow; Availability of school-based resources, and a number of proposed future steps towards improvement of the latter services and resources in primary care settings. Back to subject search page or search by preceptor site