As many as 87% of children discontinue ADHD medication, which can lead to clinically significant academic, cognitive, and social impairment. ADHD costs billions of dollars to the healthcare and educational systems, and previous attempts to stem these costs and increase ADHD medication adherence have been unsuccessful. The purpose of this study was to determine if patient-centered medical homes (PCMH), which have been shown to improve patient health outcomes, impact parental beliefs (benefits vs. risks) about ADHD medication and adherence to ADHD medication. The theory of planned behavior was the theoretical framework for this study. There were 294 parents of children between the ages of 5 and 12 who had been prescribed ADHD medication who participated in a quantitative self-administered survey. Parental beliefs were assessed using the Beliefs About Medicines Questionnaire-Specific, and medication adherence was assessed using the Morisky Medication Adherence Scale-8. The 2007 National Survey of Children's Health was used to determine group assignment. A MANCOVA was used to analyze the data and found parents in the PCMH group scored significantly higher in their beliefs that the benefits outweighed the risks of ADHD medication. However, no significant differences were found between groups related to parental adherence to ADHD medication. More research is recommended to learn how PCMHs can change positive ADHD medication beliefs into better ADHD medication adherence. This study has social change implications as it increases what is known about PCMHs and how they impact health outcomes. It also supports previous literature in the need to deliver all PCMH services, which is required to realize the full benefit of PCMHs.

The Affordable Care Act of 2010 proposed a new integrated care model for individuals with chronic mental illness and multiple medical comorbidities by using Behavioral Health Homes (BHH). The purpose of this doctoral project was to evaluate the effectiveness of the BHH in reducing emergency department (ED) use in the community mental health outpatient setting. Guided by the American Association for Critical Care Nurses synergy model for patient care a cross-sectional, post-test only with comparison group quasi-experimental research design was used. A de-identified data set of 68 patient records in the BHH group and 73 patient records in non-BHH as a control group were analyzed using logistic regression. The analysis revealed that participants in the BHH were statistically less likely to visit the ED. Sensitivity was 16.2%, specificity was 95.2%, positive predictive value was 54.5%, and negative predictive value was 76.2%. The Homer-Lemeshow and omnibus test of model coefficients showed the model was a good fit (p=.726, p=.007). Participants in BHH were .225 less likely to visit the ED. For every year of reduction in age, the odds of visiting the ED increased by a factor of 1.0. Females had a 1.8 higher odds of visiting the ED than males. This study provides evidence for the effectiveness of the BHH in reducing visits to the ED. Standard measures to track ED use in BHH are essential to understanding reasons for ED use and reducing nonurgent use. The BHH has the potential to transform health care delivery toward an all-inclusive model of care. Providers can utilize the findings of this project to promote social change by targeting patients with serious mental illness and reducing health disparities by emphasizing preventive care and eliminating barriers to care.