Abstract 77 Poster Session III, Monday, 5/3 (poster 365)

In today's managed care environment, pediatricians increasingly evaluate and treat children with ADHD and other school problems, often without input from subspecialists. We developed a pilot, primary-care based "School Problems Clinic" staffed by one psychologist and several trainees to (1) demonstrate that assessing learning and behavioral problems can happen cost-effectively in a primary care setting; and (2) reduce barriers to treatment for this primarily (98%) African American, poor population.

Over 33 sessions, staff saw 31 children (84% male, 16% female) ages 4-15 (M = 7.9). All families completed behavior rating scales and received diagnostic interviews. One-third received psychoeducational testing on-site and several families received behavior management training. Children beginning stimulant medication trials (5) worked closely with their pediatrician and psychologist to monitor the medication's effectiveness and side effects.

Fifty-two percent of the children were diagnosed with ADHD and 44% had multiple diagnoses. We frequently identified children with significant academic problems, including 22% with MR/BIQ and another 26% with specific learning disorders. Staff referred children with severe psychopathology to community clinics, consulted with schools and made referrals for medical, speech/language and neurological evaluations.

The relatively modest costs of this pilot program ($1500 per annum) were covered by a Pediatrics Department grant. More than 80% of the families kept their appointments, comparing favorably with the attendance rate at a hospital-based, outpatient psychiatry clinic (30-50%) or missed appointment rates cited in previous literature (Swenson & Pekarik, 1988). In addition, both patients and collaborating pediatricians expressed high satisfaction with the Clinic. In a telephone survey, 50% of the families rated their overall satisfaction as "very high" and another 25% rated it "satisfactory."

This promising pilot program has met all of its objectives to date, including reducing some barriers to treatment and demonstrating that these services can be provided cost effectively in a primary care setting. Compared to a mental health "carve out", the model has reduced fragmentation of care and yielded high consumer and pediatrician satisfaction. We are now expanding our services to include a second pediatric practice and will use this model in a larger, urban HMO pediatric practice.