Original Title: Avis sur une trajectoire optimale de services pour les enfants, adolescents et jeunes adultes ayant un trouble de déficit de l’attention avec ou sans hyperactivité (TDAH) ou des difficultés apparentées

Authors' objectives: INESSS produced three states of practice in 2017 to address the Minister of Health and Social Services’ concerns regarding the widespread use of psychostimulants in the treatment of ADHD in Québec. Its work led to the identification of certain deficiencies in the patient service trajectory in Québec, with regard both to pharmacological and psychosocial interventions. This report on the optimal service trajectory for children, adolescents and young adults with attention deficit disorder with or without hyperactivity (ADHD) or related problems proposes guiding principles and recommendations developed in light of the observations stemming from these states of practice. Although the primary objective of the proposed trajectory is the management of ADHD, the trajectory also takes into consideration ADHD-related problems in young persons in the perspective of a service continuum in the health and social services system and in close collaboration with the school and community networks. Furthermore, INESSS’s work led it and its partners to consider the application of the guiding principles and several of the recommendations concerning the proposed service trajectory for ADHD to other mental health problems, mental disorders or problems encountered in young persons.

Authors' results and conclusions: RESULTS: Triangulation of the scientific, experiential and contextual data led INESSS to set out four guiding principles and 18 recommendations, which were endorsed by the members of the working committee. The guiding principles are cross-disciplinary. They apply to the entire trajectory and involve objectives regarding access to services, shared responsibility between the systems and networks concerned (health and social services system, school network and partners) and optimal communication between the players. These principles make addressing the young person’s and their family’s needs the focus of the intervention. As for the report’s recommendations, they pertain to the different stages of the trajectory, which are detection, evaluation, intervention and follow-up. They cover aspects aimed at improving practices for young persons and their families, identify the key players to involve, determine the inputs or actions that should be carried out and how to accomplish this, and recommend psychosocial interventions at the different stages of the trajectory. Lastly, two recommendations concern pharmacological interventions: 1) the integration of ADHD-specific pharmacological therapy into a personalized approach in connection with the targets in the individualized treatment plan, and 2) the conditions for accessing ADHD-specific drugs. Thus, the trajectory is characterized by the following, in particular: • It is focused on the patient’s needs more than on the importance of concluding on the presence of a mental disorder. • It calls for psychosocial interventions at each of its stages to meet the person’s needs and take action on any problems identified. • It provides for a liaison function with an administrative component and a clinical component to ensure coordination of the necessary linkages, specifically, between the health and social services system and the school network. • It involves a framework and parameters that can be applied to other common mental health issues or mental disorders in young persons served by different service providers in the public system. CONCLUSION: ADHD has been the subject of numerous scientific studies that provide information on effective interventions, both pharmacological and psychosocial, for treating affected individuals. Also, there is considerable discussion in the literature of the optimal conditions for organizing services to ensure these individuals’ evaluation and treatment, although the discussion does not address the different stages of a service trajectory. This report proposes an optimal service trajectory for children, adolescents and young adults with ADHD or related problems. The trajectory is based on the gathered data regarding ADHD and on the contextual and experiential data collected as part of INESSS’s work. It proposes targets for improving practices and fosters the active involvement of the different players in the public system and of its partners. It should be borne in mind that the guiding principles and several of the recommendations regarding the implementation of this service trajectory can be applied to other mental health issues or mental disorders affecting the lives of young persons and their families.

Authors' methods: Scientific, contextual and experiential data were collected for triangulation and to answer the following four assessment questions: • What is the optimal service trajectory within the health and social services system and the school and community networks for detecting and evaluating ADHD and for the referral, intervention and follow-up of children, adolescents and young adults diagnosed with ADHD or related problems? • What are the winning conditions for and the organizational obstacles to creating an integrated service continuum for children, adolescents and young adults diagnosed with ADHD or related problems? • What are the most effective psychosocial practices and interventions for reducing the symptoms of ADHD and ADHD-related problems in children, adolescents and young adults diagnosed with ADHD or related problems? • What are the issues regarding the conditions for accessing ADHD-specific drugs? Two committees supported INESSS in its work: • A follow-up committee consisting of CISSS/CIUSSS administrators working in youth directorates and mental health and dependency directorates; physicians; researchers; persons representing patients, the school sector and professional orders; and representatives from the MSSS and the MEES; • A committee of institutional experts from six regions represented by middle management personnel and a CISSS/CIUSSS professional who had successfully experimented with putting ADHD-related trajectories and mechanisms in place. Partners from the school and community networks participated in the committee’s meetings. As well, the professional orders closely associated with the offer of services for young persons with ADHD in the public system were consulted at different stages to ensure compliance with Québec’s professional system. In addition, we performed searches in the grey and scientific literature and a rigorous assessment of the evidence used to evaluate the efficacy of psychosocial interventions. Pooling the data from the different consultations and literature sources enabled us to answer the four assessment questions above in order to enlighten the Ministère de la Santé et des Services sociaux with regard to the task given to INESSS.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/trajectoire-optimale-de-services-pour-les-enfants-adolescents-et-jeunes-adultes-ayant-un-trouble-de-deficit-de-lattention-avec-ou-sans-hyperactivite-tdah-ou-des-difficultes-apparentees.html

Year Published: 2018

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/trajectoire-optimale-de-services-pour-les-enfants-adolescents-et-jeunes-adultes-ayant-un-trouble-de-deficit-de-lattention-avec-ou-sans-hyperactivite-tdah-ou-des-difficultes-apparentees.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec