Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis

Abstract Background Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration ClinicalTrials.gov Identifier: NCT04324944

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“I Would Like Someone to Hear Me”: Understanding Stakeholder Perceptions in Pursuit of Improving Collaborative Decision-Making among People with Serious Mental Illness

10.31234/osf.io/gmkrc ◽

2020 ◽

Author(s):

Emily Treichler

Keyword(s):

Decision Making ◽

Mental Illness ◽

Serious Mental Illness ◽

Mental Health Treatment ◽

Skills Training ◽

Mental Illnesses ◽

Training Manual ◽

Collaborative Decision Making ◽

Self Advocacy ◽

Collaborative Decision

Objective: Collaborative decision-making is valued by people with serious mental illnesses and associated with important outcomes like treatment engagement and satisfaction, but levels of collaboration remain low. We developed a skills training manual to increase consumer ability to initiate and engage in collaborative decision-making in the hopes of facilitating higher levels of collaboration. Our study included two aims: 1) to understand stakeholder perception of collaborative decision-making, and 2) to gain feedback from stakeholders regarding the skills training manual to inform manual revisions.Methods: Eleven consumers with serious mental illness and eleven providers of mental health treatment were recruited. Each participant received a copy of the skills training manual and engaged in one of two mixed participatory dialogues with eleven participants each.Results: Stakeholders reported having a positive perception of collaborative decision-making, but also reported concern about a number of barriers that may inhibit collaborative interactions. Participants believed that increases in collaboration would have to come from consumer self-advocacy despite provider resistance. Stakeholders responded positively overall to the skills training manual, but made a number of suggestions to improve it, leading to 10 revisions.Conclusions and Implications for Practice: Stakeholders’ response emphasizes the desirability and importance of improving CDM, and suggests that a consumer-led intervention is a promising method to do so. Participatory dialogues were not only an effective method to gather data for this study, but also provided a structured and supportive space for consumers to speak to and with providers, including responding directly to stigma among providers.

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SA134. Applying Skills Training to Improve Shared Decision-Making in Serious Mental Illness

Schizophrenia Bulletin ◽

10.1093/schbul/sbx023.130 ◽

2017 ◽

Vol 43 (suppl_1) ◽

pp. S160-S160

Author(s):

Emily Treichler ◽

Eric Evans ◽

Will Spaulding

Keyword(s):

Decision Making ◽

Mental Illness ◽

Shared Decision Making ◽

Serious Mental Illness ◽

Skills Training ◽

Shared Decision

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Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry

Community Mental Health Journal ◽

10.1007/s10597-021-00856-z ◽

2021 ◽

Author(s):

Natalie J. Maples ◽

Dawn I. Velligan ◽

Eric C. Jones ◽

Erin M. Espinosa ◽

Robert O. Morgan ◽

...

Keyword(s):

Decision Making ◽

Mental Illness ◽

Shared Decision Making ◽

Serious Mental Illness ◽

Transitional Care ◽

Psychiatric Hospitalization ◽

Qualitative Interviews ◽

Shared Decision ◽

Care Clinic ◽

External Forces

AbstractThere is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.

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