Grant: Team Grant: GACD Mental Health - Canada-China

In the context of modern China, children experience a tremendous pressure to perform at high levels. This stressful environment is associated with depressive symptoms, suicidal ideation and attempts in adolescence. Children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) are highly inattentive, restless, impulsive, and therefore at high risk, despite a normal intellectual potential. ADHD is easy to diagnose and treat, but difficult to diagnose and treat well. The treatment effects are dependent on the quality of care and on the coordination of different interventions, planned according to individual needs. The first main barrier to treatment is the shortage of qualified clinicians. In response, our main strategy will be to implement a shared care between general practitioners (GPs) and specialists. The second barrier is the lack of training in GPs. We will implement a focused ADHD training targeted to the needs of GPs. A third barrier is the lack referral process. We will implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome. We will adapt the Canadian shared care model for ADHD to the Chinese context. To test its flexibility, it will be implemented within the pediatric care system in two districts of Shanghai and within the mental health care system in one district of Beijing. We will first assess how ADHD guidelines are used, and the existing collaboration between GPs and specialists. After a Consensus Conference, we will implement a shared care pathway and we will produce actionable findings in a formative evaluation to improve implementation. At the end of the setup phase, we will assess the use of guidelines, the deviation from the intended protocol, how its members evaluate the care process, examine the effectiveness with regard to ADHD outcome, and functioning of the pathway, in terms of patient flow and timing. Once the shared care model is functionally implemented, we will scale up the care system horizontally by linking it progressively with schools selected randomly in the target districts. Using already established collaborations with the educational psychologists, we will first survey the knowledge and perceived needs of teacher, then implement a screening strategy for ADHD problems in the schools, as well as web-based effective strategies to educate parents and teachers about ADHD and mitigate its impact. We will assess the effectiveness of the intervention, and how it changes the perception of ADHD and the help-seeking process, as well as the rate of referrals into the shared care system. These two steps will allow defining the scalable unit that could be used in further implementation of the model. A costeffectiveness analysis is integrated in the project in order to support its scalability. Beyond ADHD, this shared care model will be able to respond to various mental health treatment challenges, both in children and adults.