Symposia
Treatment - Other
Alicia R. Fenley, M.A.
Boston University
Brookline, Massachusetts
Bruce F. Chorpita, Ph.D.
Professor
University of California Los Angeles
Los Angeles, California
David Langer, Ph.D.
Assistant Professor
Suffolk University
Boston, Massachusetts
Objective: Recent research shows benefits to collaborating with youth and caregivers to personalize psychosocial treatments according to patient preferences, values, and goals through a process known as shared decision-making. This literature has focused on implementing SDM within a clinical research setting. However, little is known about the degree to which community clinicians plan treatments collaboratively with youth and caregivers using an SDM approach. It is imperative to understand how clinicians approach treatment planning within community settings to identify barriers to SDM and refine dissemination and implementation efforts to plan personalized, evidence-based treatments.
Methods: This study utilized a novel observational coding system to examine treatment planning discussions within a sample of community treatment sessions from a randomized controlled trial (Chorpita et al., 2017). Participants were community clinicians (N=21) and youth (N=60, Mage = 9.30, SD = 2.82, 55.1% male) with anxiety, depression, conduct problems, or traumatic stress. Early session recordings (N=80) were transcribed and coded to rate clinician SDM behaviors (0-4 Likert scale) during treatment planning discussions focused on the following topics: goals, modality, tasks, outcome measurement, participants, parameters, and outside services.
Results: Descriptive statistics yielded a mean SDM score of 1.61 (SD = 0.85) across sessions and treatment topics. SDM scores within treatment topics ranged from 0.67 (SD=1.03) for discussions about treatment modality to 1.93 (SD = 1.31) for discussions about treatment goals. Significant differences in SDM scores were found between sessions in which a caregiver and child participated and caregiver-only sessions (Wald = 4.35, B = -.878, p = .04), with lower scores in the latter. Clinicians engaged in more extensive SDM with patients assigned to the anxiety protocol compared to the depression protocol (Anxiety Protocol: N=10, Wald = 5.45, B = -.654, p = .02).
Conclusion: Despite a growing emphasis on clinician-patient collaboration, results show that community clinicians naturally engage in lower levels of SDM during treatment planning discussions. Given recent findings on the benefits of SDM during psychosocial treatment planning, further research is needed on the dissemination and implementation of SDM in real-world clinical contexts to plan treatments that are responsive to families’ goals and values.