Development of an Integrated Electronic Platform for ADHD Medication Initiation in Child and Adolescent Mental Health Services – Central & North West London NHS Foundation Trust

Nominee Information

As background, I undertook a project in collaboration with the Brent CAMHS neurodevelopmental team. The purpose was streamline how children and young people (CYP) are initiated on medication for ADHD. Prior to our project starting, CYP with ADHD under Brent CAMHS experienced long waiting times for medication to be initiated (on average 3 months). This is often on top of an already very long waiting period for diagnosis, which can be up to 2 years in our service. It’s well documented that delays in initiating medication can lead to adverse outcomes.

The aims of the project were: firstly, to create an electronic platform (e-platform) to educate parents about medication for attention deficit hyperactive disorder (ADHD) and facilitate its initiation in Child and Adolescent Mental Health Services (CAMHS). The e-platform replaced the previous method of medication initiation which was typically delivered to a group over Zoom. Secondly, to reduce time-to-treatment initiation (TTI) by January 2024. Thirdly, to increase the proportion of patients with ADHD who were initiated on medication (when appropriate) by the same date.

The methodology was as follows: the content from three neurodevelopmental clinicians counselling parents about ADHD medication in Brent CAMHS was transcribed. Individual transcripts were collated into a master transcript to standardise the information delivered to parents. Medication initiation psychoeducation videos were created using the master transcript and a videographer and editor, in collaboration with the Trust’s Director of Communications and Web Development Team. The only expenses for the project were for the services of the videographer and editor (£600). The videos were integrated electronically with a question-and-answer section, a useful websites section and a medication decision section to construct an e-platform, which was embedded in the Brent CAMHS website.

Following the QI model-of-improvement, objective clinical measures included TTI, the proportion of CYP initiated on medication, and total clinical and administrative time saved. We involved service users throughout by measuring user-reported outcomes, harnessing pre- and post-intervention questionnaires combining Likert scale and free-response items.

The results showed that TTI reduced by 37% from 92 days (Zoom) to 58 days (e-platform). The proportion of CYP initiated on medication increased from 64% (Zoom) to 72% (e-platform). Over a 2-month period, 9 hours of clinician time was saved. Based on 20 respondents, overall user satisfaction increased from 4.13/5 (Zoom) to 4.71/5 (e-platform). Qualitative feedback revealed that users found the e-platform ‘easy to understand’, ‘easy to access, quick and useful’ and ‘provided clear explanations’.

In conclusion, the results indicate the positive impact of the e-platform initiative which can be derived from both clinical and user-reported outcomes. By integrating standardized educational content, user-friendly features and streamlined processes, the e-platform empowers parents/guardians with knowledge, enhances communication between families and the neurodevelopmental team, and ultimately expedites ADHD medication initiation and saves clinical time. We achieved this on a significantly low budget, at just £600. Regional spread has commenced, with Westminster CAMHS now adopting our approach. Other CAMHS have expressed strong interest, and we are in ongoing discussions to spread this initiative further.