Examining the Potential of Shared Decision Making to Improve the Effectiveness of Youth Mental Health Treatment in Community Mental Health Centers

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PROJECT SUMMARY Up to one third of American youth struggle with a mental health (MH) disorder, which are associated with negative short- and long-term outcomes. Fortunately, evidence-based programs (EBPs) have demonstrated positive effects for youth MH disorders in clinical trials. However, the effectiveness of these EBPs in community MH centers (CMHCs), where most youth receive MH services, has been disappointing. Thus, improving the effectiveness of EBPs for youth in CMHCs is critical to health outcomes for these youth. One method by which clinicians can potentially achieve this goal is by implementing shared decision making (SDM) practices in conjunction with EBPs. SDM is a process by which clinicians and clients collaboratively make treatment decisions. Evidence from the medical and adult MH treatment fields suggests that SDM can improve the patient-provider relationship as well as improve clinical outcomes. By implementing SDM practices (e.g., discussing treatment options with youth and caregivers), clinicians may be better suited to adapt EBPs to fit client preferences, ideals, and cultural values. However, SDM in youth MH treatment is understudied, and thus clinicians may not know the ideal methods for implementing SDM practices with their youth clients. A critical gap this field is the paucity of measures designed to assess SDM practices in youth MH treatment. This project fills this gap with a reliable and valid observer-rated measure of SDM practices designed for youth MH treatment (i.e., the Shared Decision Making in Youth Mental Health Treatment Scale or SDM-YMH) and thus addresses NIMH’s research Objective 4.1 by contributing to research aimed at improving the effectiveness of EBPs in CMHCs. This project’s overarching goal will be addressed via two specific aims: 1) develop and evaluate the initial reliability and validity of SDM-YMH item and subscale scores, and 2) examine the predictive validity of SDM-YMH subscale scores. These aims will be realized by the secondary analysis of therapy tapes recorded as part of an effectiveness trial as well as accompanying treatment integrity and alliance data. The 38 youth participants (52.6% male, 60.5% White) in these therapy sessions ranged in age from 8 to 13 years old (M = 9.84, SD = 1.65). The SDM-YMH will be developed and evaluated via an iterative process: 1) SDM literature review, 2) generation of items, with the incorporation of expert consensus, 3) pilot coding and generation of an accompanying SDM-YMH coding manual, 4) training of coders, 5) coding of treatment sessions, and 6) examination of interrater reliability, construct validity, and predictive validity. This project will result in a new observer-rated measure of SDM practices specific to youth MH treatment, thereby filling a critical gap in the literature. It is expected that study findings will help inform future research regarding the development and evaluation of clinician practices that can increase the effectiveness of EBPs in CMHCs with youth clients.