Abstract
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.
Highlights
Shared decision making (SDM) is defined as the involvement of service users in the decision-making process where there are important competing care and treatment options [1, 2]
The sample included in the analysis was composed of N = 3,175 cases of children and young people (CYP) accessing care from 58 child and adolescent mental health services (CAMHS) offered by the National Health Services in England
Model 1: Factors Associated With Parent/Carer Experience of SDM (Unadjusted)
Summary
Shared decision making (SDM) is defined as the involvement of service users in the decision-making process where there are important competing care and treatment options [1, 2]. This approach to health decisions has been widely advocated across various health settings and patient populations [3, 4]. In child and adolescent mental health services (CAMHS), the SDM process is unique as it involves a sometimes-complex triad relationship between clinicians, parents/carers and children or young people [5, 6]. 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
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