Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions

Correlates of perceived shared decision making with parents of children with special healthcare needs: Findings from the PART-CHILD study

OBJECTIVE

To assess the extent of perceived shared decision making (SDM) with parents of pediatric patients and to examine its association with characteristics of patients, professionals, and healthcare facilities.

METHODS

Parents of pediatric patients (n = 4383) were recruited in 15 social pediatric centers in Germany and provided information on perceived SDM (binary CollaboRATEpediatric score: optimal versus suboptimal extent of SDM), child age and sex, type of impairment, appointment, and healthcare professional present at the appointment. Organizational characteristics were assessed in a cross-sectional survey of staff at the study sites.

RESULTS

Overall, 58.4% of parents reported an optimal extent of SDM. The optimal extent of SDM was more likely reported by parents of girls (OR=1.27, p < 0.001) and children with physical (as opposed to cognitive and combined) impairments (OR=1.30, p = 0.006), and after appointments attended by allied health professionals (OR=1.28, p = 0.004). In addition, parents in facilities receiving financing in addition to compensation by statutory health insurance funds were less likely to report an optimal extent of perceived SDM.

CONCLUSION

While SDM with parents was mostly related to individual characteristics of children and professionals at appointments, organizational characteristics seemed less relevant in our study.

PRACTICE IMPLICATIONS

Staff should be made aware of lower SDM with parents of boys, older children, and those with cognitive impairments, and trained to improve the SDM in these groups.

Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care

Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.

COVID-19 Modifications in Public Home- and Community-Based Services for Children with Mental Health Needs

Eleven states offer 1915(c) Home and Community Based Services (HCBS) Medicaid waivers to organize and fund programs that provide in-home and community support services to address the unique needs of children and youth with complex mental health concerns and their families. However, as the COVID-19 pandemic-imposed restrictions on community movement and school engagement were enacted, these children and youth lost in-person access to needed supports through school-based programs and professional community providers. The well documented mental health impacts of the pandemic on children and youth necessitates understanding how behavioral health programs and policies were adapted to the constraints of pandemic life for this uniquely at-risk population. This study examines and characterizes trends in modifications made to these programs. Appendix K applications amending HCBS waiver programs targeting children with serious emotional disturbances (SED) were collected from the Center for Medicaid & Medicare Services (CMS) website. In total, 33 applications from 10 states were included in the study. Utilizing a policy mapping approach, applications were coded by hand comparing text from elements in the applications across all 10 states. A summary of program changes reported in applications was created and changes were tracked over the course of the federal public health emergency. States modified programs by adding services for waiver participants, changing the service settings allowed, removing service limit restrictions, and offering electronic/remote service delivery. All states also issued measures to either expand or retain their provider workforce, adding family members as providers, modifying experience requirements, and offering financial incentives via increased payment rates or retainer payments. Modifications to mental health assessment processes ranged from changing the evaluation tools or documentation requirements, extending deadlines, and allowing for remote evaluations. Service plan development processes were adapted by allowing virtual service plan development meetings, allowing participants or representatives to electronically sign plans of care, and permitting verbal consent to begin receiving services. Documenting programmatic adjustments provides a context for further research to understand the experiences of youth, families, and providers in navigating these changes and the relative success or failures of these policies.

Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services

OBJECTIVES

This observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. Study aims were to (1) Characterize therapist use of SDM strategies and (2) Describe the types of treatment decisions that were the focus of therapist use of SDM.

METHODS

The OPTION instrument was used to measure SDM in 210 audio-recorded therapy sessions with 62 community therapists and 109 Latinx caregivers; frequency and mean ratings of OPTION items were examined. Qualitative analysis on the descriptions of treatment decisions being deliberated was also conducted.

RESULTS

Results revealed that therapists used at least one SDM step in most sessions (N = 192; 91.43%) with a mean composite score of 32.78 (SD=17.79; range: 6.25-81.25). Four superordinate categories of decisions were: (1) Treatment planning, (2) Evidence-based Parenting Strategies, (3) Addressing Youth Functioning, and (4) Addressing Family Psychosocial Needs.

CONCLUSIONS

Findings suggest that community therapists serving Latinx families are naturalistically engaging in SDM steps about a variety of decisions during most EBP sessions, but only at modest levels.

A Phenomenological Exploration of Families' Experiences of the Mental Health System of Care in the Monadnock Region

Accessing mental health treatment in rural locations is a unique challenge for families with youth experiencing adverse mental health conditions. Families often experience a variety of difficulties accessing and negotiating changes within the system of care. This study aimed to understand the experiences of families and their youth in navigating the mental health system in a rural community. Interpretative phenomenological analysis was used to examine how participants interpret their experiences within the local system of care. Qualitative interviews were conducted with eight families. Results included five main themes: youth experience, family experience, access to a system of care, relationships between stakeholders, and larger societal beliefs. Families highlighted their experiences accessing the local care system and their hope for strengthening community access and partnerships. Findings indicate that prioritizing family voices should be encouraged by local systems.

Organization of rehabilitation services for youth with physical disabilities and mental health problems: A scoping review

Introduction

Youth with childhood-onset physical disabilities receiving rehabilitation services often present with many complex needs. Emerging evidence confirms co-occurrence of mental health problems in this population is common, and mental health is often overlooked during rehabilitation for chronic physical conditions. For example, symptoms of depression and anxiety are frequently present in adolescents with physical disability such as spina bifida or Duchenne muscular dystrophy, and access to mental health services is often limited. Addressing mental health concerns for this age group is particularly critical as it encompasses a challenging transition to adulthood.

Objectives

Building upon findings from a recent scoping review on the co-occurrence of physical disabilities and mental health problems, this paper synthesizes scientific literature related to the organization and delivery of services for youth with co-occurring childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida) and mental health problems (e.g., depression, anxiety).

Methods

A scoping review protocol stemming from Arksey & O'Malley's framework and updated guidelines from the Joanna Briggs Institute was developed. Four databases (Medline, PsycINFO, CINAHL, Embase) were searched. The search was limited to French or English peer-reviewed articles published between 2000 and 2021. Articles included were primary papers addressing: 1) youth aged 15 to 24 with a childhood-onset physical disability, 2) mental health problems, and 3) healthcare service organization or delivery. They were screened by two reviewers and discussed with a third to establish consensus on the inclusion criteria and resolve disagreements.

Results

Sixteen articles were retained from the 1,010 screened. Many (9/16) were from the United States. Two models were found: the Biopsychosocial, Collaborative, Agency-Based Service Integration Approach (including psychiatry in a pediatric rehabilitation hospital) and the Client Network Consultation (an interagency collaboration in mental health care for children with complex healthcare needs). Twelve key principles for service organization and delivery were identified and categorized into: collaboration and coordination, training and support, and delivery of care.

Conclusion

Identified principles can guide improved service delivery for this population. Highlighted research gaps include the need for developing models of collaborative healthcare delivery and subsequently evaluating their effectiveness.

An app to classify a 5-year survival in patients with breast cancer using the convolutional neural networks (CNN) in Microsoft Excel: Development and usability study

BACKGROUND

Breast cancer (BC) is the most common malignant cancer in women. A predictive model is required to predict the 5-year survival in patients with BC (5YSPBC) and improve the treatment quality by increasing their survival rate. However, no reports in literature about apps developed and designed in medical practice to classify the 5YSPBC. This study aimed to build a model to develop an app for an automatically accurate classification of the 5YSPBC.

METHODS

A total of 1810 patients with BC were recruited in a hospital in Taiwan from the secondary data with codes on 53 characteristic variables that were endorsed by professional staff clerks as of December 31, 2019. Five models (i.e., revolution neural network [CNN], artificial neural network, Naïve Bayes, K-nearest Neighbors Algorithm, and Logistic regression) and 3 tasks (i.e., extraction of feature variables, model comparison in accuracy [ACC] and stability, and app development) were performed to achieve the goal of developing an app to predict the 5YSPBC. The sensitivity, specificity, and receiver operating characteristic curve (area under ROC curve) on models across 2 scenarios of training (70%) and testing (30%) sets were compared. An app predicting the 5YSPBC was developed involving the model estimated parameters for a website assessment.

RESULTS

We observed that the 15-variable CNN model yields higher ACC rates (0.87 and 0.86) with area under ROC curves of 0.80 and 0.78 (95% confidence interval 0.78-82 and 0.74-81) based on 1357 training and 540 testing cases an available app for patients predicting the 5YSPBC was successfully developed and demonstrated in this study.

CONCLUSION

The 15-variable CNN model with 38 parameters estimated using CNN for improving the ACC of the 5YSPBC has been particularly demonstrated in Microsoft Excel. An app developed for helping clinicians assess the 5YSPBC in clinical settings is required for application in the future.

The Effect of Medical Home on Shared Decision-Making for Caregivers of Children with Emotional, Developmental, or Behavioral Health Conditions

INTRODUCTION

Known as the "pinnacle of patient-centered care," shared decision-making (SDM) is the process that enables and encourages the health care provider, the patient, and/or their caregiver (parent or guardian) to participate collaboratively in medical decisions. Prior research indicates that children with emotional, developmental, or behavioral health conditions (EDB) are less likely to attain SDM than children with other special health care needs (SHCNs). This study investigates whether the presence of a medical home reduces disparities in SDM among children with EDB when compared to children with other SHCNs and the general pediatric population.

METHODS

Using the 2016 National Survey of Children's Health, we conducted weighted descriptive statistics to investigate the prevalence of medical home and SDM for children with (1) EDB, (2) other SHCNs, and (3) no SHCNs. We then employed a nested multivariate logistic regression model to examine whether the presence of a medical home reduced the disparity between children with EDB and their counterparts.

RESULTS

Nationally, 21% of children with EDB (n = 647,274), 14.0% of children with other SHCNs (n = 1,086,068), and 13% of children with no SHCNs (n = 883,969) did not attain caregiver-reported SDM in medical care. In each of the health condition groups, the presence of a medical home significantly improved the odds of SDM (p < 0.001). Presence of a medical home also reduced the disparities observed in caregiver-reported SDM among children with EDB as compared to those with other SHCNs and no SHCNs.

DISCUSSION

Ongoing investment in medical homes may reduce disparities in SDM experienced by children with EDB.

Parent/Carer-Reported Experience of Shared Decision Making at Child and Adolescent Mental Health Services: A Multilevel Modelling Approach

Background and Objective: Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties. Methods: Secondary analysis was conducted on administrative data collected from CAMHS between 2011 and 2015. The sample was composed of 3,175 cases across 58 sites in England. Frequencies were recorded and associations were explored between clinician-reported measures and parent/carer-reported experiences of SDM using a two-level mixed-effect logistic regression analytic approach. Results: Almost 70% of parents/carers reported experiencing higher levels of SDM. Individual-level variables in model one revealed statistically significant (p <0.05) associations suggesting Asian parents/carers (OR = 1.95, 95% CI [1.4, 2.73]) and parents/carers having children with learning difficulties (OR = 1.45, 95% CI [1.06, 1.97]) were more likely to report higher levels of SDM. However, having two parents/carers involved in the child's care and treatment decisions (OR = 0.3, 95% CI [0.21, 0.44]) and being a parent/carer of a child or young person experiencing conduct problems (OR = 0.78, 95% CI [0.63, 0.98]) were associated with lower levels of SDM. When adjusting for service level data (model two) the presence of conduct problems was the only variable found to be significant and predicted lower levels of SDM (OR = 0.29, 95% CI [0.52, 0.58]). Conclusion: Multilevel modelling of CAMHS administrative data may help identify potential influencing factors to SDM. The current findings may inform useful models to better predict and support SDM.

Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature

The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.

Shared Decision Making and Treatment for Minority Children With ADHD

Shared decision making (SDM) involves the patient and family in medical decisions regarding treatment. The purpose of this article is to utilize the 2016 National Survey of Children’s Health to explore whether family engagement in SDM increases the odds of treatment for children with ADHD, and more specifically, if the presence of SDM is associated with the reduction of racial and ethnic disparities in treatment. Multivariate logistic regression was used to model the odds of treatment for each racial/ethnic group controlling for sociodemographic and health-related variables. Results indicated that White and Multiracial families engaged in SDM were twice as likely to report treatment for ADHD. Black and Latinx families, however, showed no difference in treatment for ADHD when SDM was present. Based on these findings, we conclude that SDM may be less important for Black and Latinx families when making treatment decisions for children with ADHD.

Barriers and facilitators of pediatric shared decision-making: a systematic review

BACKGROUND

Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved).

METHODS

We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality.

RESULTS

Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings.

CONCLUSIONS

Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice.

TRIAL REGISTRATION

PROSPERO CRD42015020527.

Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework

Shared decision making (SDM) is increasingly being suggested as an integral part of mental health provision. Yet, there is little research on what clinicians believe the barriers and facilitators around practice to be. At the same time, there is also increasing recognition of a theory-practice gap within the field, with calls for more pragmatic uses of theory to inform and improve clinical practice. Using the Theoretical Domains Framework (TDF), a comprehensive, theoretical-led framework, underpinned by 33 behaviour change theories and 128 constructs, clinician perceived barriers and facilitators to SDM are investigated. The sample comprised of 15 clinicians across two sites in England, who took part in qualitative semi-structured interviews and focus groups. Transcripts were analysed using a deductive thematic analysis, and themes were coded under each theoretical domain. Overall, 21 barriers and facilitators for SDM in child and youth mental health were identified across ten domains of the TDF. Under capability, barriers and facilitators were found for knowledge, skills, memory/attention/decision making processes, and behavioural regulation. For opportunity, barriers and facilitators were found for social influences, as well as environmental context and resources. Finally, for motivation, domains covered included: beliefs about consequences, beliefs about capabilities, emotions, and professional role and identity. Findings suggest that a range of barriers and facilitators affect clinicians' abilities to engage in SDM with young people and parents. Interventions which target different domains related to capability, opportunity and motivation should be developed to better facilitate young people and their families in care and treatment decisions.

Shared decision-making and parental experiences with health services to meet their child's special health care needs: Racial and ethnic disparities

OBJECTIVES

Test the relationship between shared decision-making (SDM) and parental report of frustration with efforts to get services for their child and to address unmet health needs; assess SDM's influence on minority parents' service experiences.

METHODS

Performed secondary analysis using the 2009-2010 National Survey of Children with Special Health Care Needs (n = 40,242). Used multivariate logistic regressions to test the association between SDM and parent-reported service experiences, and whether SDM influenced the association between minorities and negative service experiences. Propensity scores accounted for observed selection bias.

RESULTS

Families engaged in SDM had lower odds of reporting service dissatisfaction. Fewer minority parents reported SDM engagement compared with Whites (between 62% and 66% versus 74%). Blacks engaged in SDM had higher odds of reporting negative service experiences compared with SDM-engaged Whites. This disparity was no longer significant after adjusting for covariates.

CONCLUSION

SDM is associated with lower reports of parental service dissatisfaction. Stratified analyses showed that SDM seems to be experienced differently across minority groups.

PRACTICE IMPLICATIONS

SDM may be a promising engagement strategy to improve parental service experiences. The role of SDM on increasing Black parents' reports of service dissatisfaction, perhaps due to increased awareness of service challenges, should be investigated.

Disparities in Self-reported Access to Patient-centered Medical Home Care for Children With Special Health Care Needs

BACKGROUND

Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs).

OBJECTIVE

The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics.

RESEARCH DESIGN

This was a cross-sectional pooled data analysis using the 2003-2012 Medical Expenditures Panel Survey data for CSHCNs, aged 5-17 years. Logistic regressions were implemented, accounting for child and parent sociodemographic, child's health insurance, and contextual characteristics. PCMH concordant care and each component were constructed as binary variables and child functional impairment was measured with the Columbia Impairment Scale.

RESULTS

Thirty-one percent of children reported medical home concordant care; comprehensive (83%) and compassionate (82%) care were most prevalent, and the least common were accessible care (59%) and patient-centered care (60%). PCMH concordant care significantly increased nationwide between 2003 and 2012, but disparities remained based on child needs and sociodemographic characteristics. Multivariate regressions showed variation across medical home components.

CONCLUSIONS

Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need CSHCNs. Future research may focus on better understanding how clinical settings tailor this care model, particularly on providing increased access and patient-centered care, to better serve children at the highest need.

Shared Decision Making among Children with Medical Complexity: Results from a Population-Based Survey

OBJECTIVE

To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN).

STUDY DESIGN

We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home.

RESULTS

The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51).

CONCLUSIONS

SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.

Shared Decision-Making and Children With Disabilities: Pathways to Consensus

Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.

Shared Decision Making in the Care of Children with Developmental and Behavioral Disorders

OBJECTIVE

Shared decision making (SDM) is most needed when there are multiple treatment options and no "right" choice. As with quality and experience of care, frequency of SDM may vary by health condition. The objectives of this study were (1) to compare parent report of SDM between a physical and a behavioral health condition and; (2) to compare parent report of SDM between two different behavioral health conditions.

METHODS

Data on children age 3-17 years with asthma, attention deficit/hyperactivity disorder (ADHD), and/or autism spectrum disorder (ASD) were drawn from the 2009/10 National Survey of Children with Special Health Care Needs. Weighted logistic regression was used to compare a parent-reported, composite measure of SDM. Analyses controlled for sociodemographic factors that may influence experience of SDM.

RESULTS

Compared to parents of children with asthma, parents of children with ADHD were significantly less likely to report experiencing consistent SDM (AOR 0.73). Compared to parents of children with ADHD, those of children with ASD had significantly lower odds of experiencing consistent SDM (AOR 0.59). Those with both ADHD and ASD had the same odds as those with ASD alone of experiencing consistent SDM.

CONCLUSION

Use of SDM is particularly limited in developmental and behavioral conditions, such as ADHD and ASD. These data suggest that challenges to implementing SDM may include disease type, complexity, and use of specialty care. Research to identify specific barriers and facilitators of SDM is needed to inform interventions that will promote SDM in developmental and behavioral conditions.

Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care

Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions.

Clarifying the Predictive Value of Family-Centered Care and Shared Decision Making for Pediatric Healthcare Outcomes Using the Medical Expenditure Panel Survey

OBJECTIVES

To estimate (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children.

DATA SOURCE

The Medical Expenditure Panel Survey Household Component (MEPS-HC), a nationally representative survey of the noninstitutionalized, civilian population.

STUDY DESIGN

Secondary analyses of prospectively collected data on 15,764 U.S. children were conducted to examine FCC/SDM prevalence in year 1 and associations of FCC/SDM in year 1 with health services utilization, medical expenditures, and unmet health care needs in year 2.

DATA COLLECTION/EXTRACTION METHODS

We combined four MEPS-HC longitudinal files from 2007 to 2011.

PRINCIPAL FINDINGS

FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2. FCC/SDM, across all year 1 composites, was not associated with health services utilization or medical expenditures in year 2. FCC/SDM year 1 subcomponents describing consensus building and mutual agreement were consistently associated with unmet health care needs in year 2.

CONCLUSIONS

FCC/SDM composites with stringent scoring approaches measuring consensus building and mutual agreement may have the greatest utility for pediatric health care quality improvement efforts.

The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data

OBJECTIVE

Shared decision making (SDM) between service users and providers is increasingly being suggested as a key component of good healthcare. The aim of this research was to explore whether child- and parent-reported experience of SDM was associated with child- and parent-reported improvement in psychosocial difficulties and clinician-reported functioning at the end of treatment in child and adolescent mental health services (CAMHS).

METHOD

The sample comprised N = 177 children (62% female; 31% aged 6-12 and 69% aged 13-18) with a variety of mental health problems from 17 services where routinely collected data consisted of presenting problems at outset, child- and parent-reported change in symptoms between Time 1 and Time 2 (Strengths and Difficulties Questionnaire; SDQ), clinician-reported change in functioning between Time 1 and Time 2 (Children's Global Assessment Scale; CGAS), and experience of SDM at Time 2 (as measured by responses to the Experience of Service Questionnaire; ESQ).

RESULTS

Analysis revealed that both child- and parent-reported experience of SDM were associated with higher levels of child- and parent-reported improvement in psychosocial difficulties. However, child-reported experience of SDM was only associated with higher levels of child-reported improvement when their parents also reported higher levels of SDM.

CONCLUSION

In CAMHS, involving both children and parents in decision making may contribute to enhanced treatment outcomes.

Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders

OBJECTIVES

Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment.

METHODS

Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group.

RESULTS

SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group.

CONCLUSION

A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.