Development of the ADHD Task Force  

Following Senate Concurrent Resolution No. 39, LDH Secretary Kathy Kliebert mustered resources in the Department of Health to convene a departmental task force to study the proper utilization of ADHD medication in Louisiana. This Task Force was composed of staff from the Office of the Secretary, the Office of Behavioral Health, the Office for Citizens with Developmental Disabilities, the Bureau of Health Services Financing (Medicaid), and the Office of Public Health including pediatricians, psychiatrists, psychologists, experts in maternal and child health, GIS experts, and policy experts. The Task Force also received expertise in pediatrics/psychiatry from Tulane University and technical assistance from the Centers for Disease Control and Prevention.

As the resolution requested the Department study the most effective means to ensure proper utilization of ADHD medications in Louisiana and report findings, members of the Task Force made the initial decision to focus efforts on ADHD medication use in Louisiana’s children, as the rates for children were particularly high and the group believed more effective results could be achieved if efforts were focused on ages 0-18. The Task Force examined the data and research on ADHD and ADHD medication in general and then, utilizing data and GIS expertise, looked into the hard data in Louisiana in order to provide for the Task Force a clearer picture of the trends in the state. The Task Force reviewed data from three sources— Medicaid (which covers 62% of Louisiana’s children); Express Scripts (which includes information from the privately insured); and the Centers for Disease Control and Prevention (CDC) (which covers Louisiana and National trends). From this information, the Task Force created the most comprehensive picture of what was happening in the state regarding medication trends in children and as it compares with the rest of the country. 

With these figures in mind, the Task Force began holding meetings and discussing what the data meant and what it might inform in terms of solutions, keeping in mind best practices in this field and recommendations based on other states’ approaches. Starting in August of 2014, the Task Force held a total of eight meetings, along with additional conference calls with Express Scripts, legislators, and the CDC. The Task Force reached out to Susanna Visser, DrPH, head of the CDC’s program on ADHD, to provide further data and technical assistance on this issue, as well as insight into what was working and not working in other states regarding responses to proper utilization of ADHD medication. 

The ADHD Symposium 

The ADHD Task Force, on behalf of Secretary Kliebert and the Department of Health and Hospitals, held an ADHD Symposium on December 9, 2014, as part of an outreach strategy to involve and educate the community, as well as draw on their varying areas of expertise and gather potential solutions. Specifically, the Department invited and welcomed experts, leaders, and interested parties from medicine, behavioral health, health plan management, education, family members, advocates, and government to share the data collected on ADHD medication rates for youth in Louisiana and the U.S., best practices surrounding proper utilization of ADHD medications, and begin the larger discussion of solutions on how to best serve Louisiana’s youth. The goals of the Symposium were twofold: to raise awareness and education about this issue, and to bring partners together to develop solutions and discuss potential barriers and levers for change. The event was highly successful, with larger than expected attendance. The Task Force also received tremendous feedback from attendees.

ADHD Task Force Report

Following the Louisiana ADHD Symposium, the ADHD Task Force completed and submitted a report on its findings to the Louisiana State Legislature in February of 2015.

Current Work of the ADHD Task Force

The Task Force completed its report to the legislature in February and is now working toward the implementation of the recommendations from the report. Efforts have included:

  • adding members to the Task Force to represent consumers and families, the Louisiana Department of Education (LDOE), the Louisiana Department of Child and Family Services (DCFS), the Louisiana Office of Juvenile Justice (OJJ) and LSU Health in addition to existing members from the Louisiana Department of Health and Hospitals' (LDH) Office of Behavioral Health (OBH), LDH's Office of Public Health (OPH), LDH's Office of Citizens with Developmental Disabilities, Louisiana Medicaid and Tulane University;
  • planning meetings of the expanded Task Force to determine what specialized workgroups are needed for specific topics; and
  • activating the ADHD workgroup for pharmacy and primary care.
    • This more specialized workgroup includes a subset of Task Force members and additional key staff from Medicaid, OBH, OPH, and the University of Louisiana Monroe, and it is assisted through consultation by Tulane and the CDC. It has been working through proposals for and refinements of a performance improvement project (PIP), ADHD among children and adolescents: Improving the Quality of Diagnosis, Management and Care Coordination, for the Bayou Health plans. The proposed PIP includes performance measures and strategies for the Bayou Health Plans to:
      • increase the accuracy of ADHD assessment, reducing both over-diagnosis and misdiagnosis;
      • decrease the overutilization of medications while increasing the best-practice use of behavioral therapy, particularly for children under age 6; and
      • increase the use of best-practice pharmacological treatments (e.g. increasing the monitoring of medications and follow-up, aligning dosage and the types of medication prescribed with best practices, etc.).

Integration of Physical and Behavioral Health: Opportunities for ADHD Care

The Task Force's report and recommendations have also informed the planning process for OBH and Medicaid as those offices prepare for the integration of specialized behavioral healthcare with physical healthcare. Based on the Task Force's recommendations, consideration is being given to ensuring that the Bayou Health plans:

  • are working to increase the alignment of ADHD treatment with best practices;
  • develop pharmacy management plans that specifically target best practices for children with ADHD under the age of 6;
  • continue to contract with the providers of evidence-based behavioral therapies for children under the age of 6 developed by Magellan, as these are the appropriate first-line treatment providers for preschoolers with ADHD;
  • are working to increase the use of evidence-based assessments and screenings for behavioral health concerns within primary care settings so that children with ADHD are diagnosed accurately and children who might otherwise be misdiagnosed with ADHD will have their true treatment needs (e.g., anxiety, autism, exposure to trauma or other adverse events, etc.) identified early and treated appropriately.

Collaboration with the Louisiana Department of Education (LDOE)

LDOE is an active partner in these efforts to address ADHD in Louisiana. Among other efforts, LDOE and LDH recently announced a collaboration with Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), a national organization providing education, advocacy and support for individuals with ADHD. The partnership will train more Louisiana teachers to recognize classroom behaviors caused by ADHD and to use appropriate and effective techniques to address them. To learn more about this partnership, you can read its announcement by clicking here.