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

项目总结 多达三分之一的美国年轻人与精神健康(MH)障碍作斗争，这种障碍与 短期和长期的负面结果。幸运的是，循证计划(EBP)已经证明 临床试验对青少年MH障碍的积极作用。然而，这些EBPS在社区中的有效性 大多数年轻人接受MH服务的MH中心(CMHC)一直令人失望。因此，改善 儿童保健中心为青年提供的循证保健计划的有效性对这些青年的健康结果至关重要。一种方法，通过它 临床医生可以通过实施共享决策(SDM)实践来实现这一目标 与EBPS相结合。SDM是临床医生和客户协作进行治疗的过程 决定。来自医学和成人MH治疗领域的证据表明，SDM可以改善 患者与提供者之间的关系以及改善临床结果。通过实施SDM实践(例如， 与年轻人和照顾者讨论治疗方案)，临床医生可能更适合调整EBPS以适应 客户偏好、理想和文化价值观。然而，SDM在青少年MH治疗中的研究还不够深入，因此 临床医生可能不知道与他们的青年客户一起实施SDM实践的理想方法。一位批评者 GAP这一领域缺乏旨在评估青少年MH治疗中SDM做法的措施。这个项目 为青年MH设计的SDM实践的可靠和有效的观察者评级指标填补了这一空白 治疗(即青少年心理健康治疗量表或SDM-YMH中的共同决策)，因此 通过促进旨在提高NIMH的有效性的研究，满足NIMH的研究目标4.1 CMHC中的EBPS。该项目的总体目标将通过两个具体目标来实现：1)开发和 评估SDM-YMH条目和分量表分数的初步信度和效度；2)检验预测性 SDM-YMH分量表得分的效度。这些目标将通过对治疗磁带的二次分析来实现 作为有效性试验的一部分记录，以及伴随的治疗完整性和联盟数据。38岁的 参加这些治疗的青少年参与者(52.6%的男性，60.5%的白人)的年龄从8岁到13岁不等 (M=9.84，SD=1.65)。SDM-YMH将通过以下迭代过程进行开发和评估：1)SDM 文献审查，2)生成项目，纳入专家共识，3)试点编码和 生成随附的SDM-YMH编码手册，4)培训编码员，5)治疗编码 6)评价者间信度、结构效度和预测效度的检验。这个项目将 结果产生了针对青年MH治疗的SDM做法的新的观察员评级衡量标准，从而填补了 文学作品中的批判性空白。预计研究结果将有助于为未来关于 开发和评估临床医生实践，以提高循证医学计划在CMHC中的有效性 青年客户。

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.