Peer Review for Solution #2, Nicole Cooke: Improve Assessment of ADHD for Children & Youth in Fraser Health Primary Care Clinics

I asked the presenter how the proposed one-hour assessment model would impact access and workflow in primary care clinics, particularly in overburdened or rural clinics where appointment availability is already limited and wait times to see primary care providers are already long.

The presenter acknowledged that this concern represents a significant limitation of the proposed model and reflects broader system-level challenges within the healthcare system. While they did not have a direct or definitive answer, they thoughtfully explained that having primary care providers conduct initial ADHD assessments could reduce other types of healthcare visits, such as unnecessary emergency department presentations, thereby indirectly supporting the system. They also recognized that this reflects a structural gap in the current healthcare environment. The honesty and transparency of the response were appreciated, as was the acknowledgement that although difficult to implement, the model has the potential to benefit clients meaningfully.

The presentation demonstrated strong organization and clarity, with visuals that were both engaging and supportive of key concepts. The content was streamlined, easy to follow, and effectively addressed the major components outlined in the rubric in my opinion. The idea of piloting this model in a larger clinic with multiple providers was practical and well justified, especially given the opportunity to evaluate its effectiveness before wider implementation. The inclusion of a pre-evaluation component to enhance the efficiency of in-clinic assessments was also a smart addition. The presenter communicated clearly, and the technical aspects of the presentation ran smoothly without any issues.

There were several areas where the presentation could have offered greater depth. The presentation would have benefited from a clearer explanation of how the proposed solution directly addresses the specific challenges identified, such as long wait times, clinic pressure, and limited provider capacity. Strengthening these connections would have reinforced the rationale behind the intervention.

Additionally, the discussion of the fee-for-service (FFS) model compared with the longitudinal family practice model (LFPM) was addressed quickly, leaving uncertainty about how different funding structures would affect the feasibility of a one-hour assessment model and how these different models function overall. Because provider compensation and workflow are heavily influenced by these models, a deeper exploration of their implications would have provided important context.

Further elaboration on how the proposed model integrates with broader operational factors, such as staffing, workflow patterns, and external system pressures, would also have strengthened the feasibility discussion. Addressing these components more directly would have helped illustrate how the solution could function in the practice setting.

To enhance the clarity and depth of the presentation, several refinements could be considered. First, a more detailed comparison of the FFS and LFPM funding models would strengthen the feasibility analysis by highlighting how each structure influences provider scheduling, reimbursement, and willingness to incorporate longer appointments.

Second, expanding on how the proposed model could be adapted across different primary care environments, such as rural clinics, high-volume urban practices, or interdisciplinary teams, would offer a clearer view of real-world implementation. This addition would have been particularly helpful in addressing my question about feasibility within the current healthcare landscape, given the limited availability of primary care providers and the strict constraints surrounding appointment length and scheduling capacity.

Finally, outlining potential enabling factors that could support successful implementation, such as additional administrative resources, adjustments to clinic workflow or scheduling models, or targeted funding supports, would add depth to the feasibility discussion. Identifying these supports would help clarify the practical steps required for broader adoption of the proposed approach.