Barriers and facilitators to shared decision‐making in child and youth mental health: Exploring young person and parent perspectives using the Theoretical Domains Framework

Abstract

Objective: Young people and parents want to be more active in treatment decisions.Using the Theoretical Domains Framework (TDF), which segments behaviour change into barriers and facilitators across fourteen domains, the aim of this study is to explore the barriers and facilitators to shared decision-making (SDM) from young people and their parents' perspectives. Method:The sample comprised nine young people who presented with internalising difficulties and ten parents of young people with internalising difficulties across two sites in England. Interviews were conducted, and transcripts were analysed using a deductive thematic analysis. Results:Overall, 15 barriers to and facilitators for SDM in child and youth mental health were identified. Under capability, these included an awareness of SDM, forgetting discussions or not asking questions, clinician listening skills and communication skills. For opportunity, these included the availability of treatment options, availability of understandable resources, staff shortages, the environment being conducive to SDM, and if the school, or parents of young people, facilitated decisions. For motivation, these included whether SDM was thought to empower individuals, result in better treatment, or individuals making the 'wrong' decision, as well as whether individuals felt capable to be involved in treatment decision-making, whether young people lacked capacity, and whether they could make decisions due to enhanced emotional states. Conclusions:Barriers and facilitators across capability, opportunity and motivation were identified. Interventions which target these barriers and facilitators may facilitate young people and their parents' involvement in decision-making.

An Affective-Appraisal Approach for Parental Shared Decision Making in Children and Young People's Mental Health Settings: A Qualitative Study

“…This study also extends on what is already known about the “emotional roller coaster” that parents of children with mental health difficulties experience ( 30 , 31 ), suggesting implications for an effective SDM process. Although the current findings align with previous research identifying parents' emotions as a possible influencing factor to the SDM process ( 22 , 24 ); the current findings, build on this knowledge by identifying positive, negative and mixed emotions as barriers or facilitators. Further to this, the current findings suggest a two-way direction that emotions may be influencing parents' involvement in SDM and vice versa.…”

“…In addition, researchers suggest that emotions may impact service users' involvement in SDM ( 20 ) and threaten parents' assumed role in the decision making process ( 21 ). Interviews with clinicians, parents and young people corroborated those findings, highlighting that strong emotional states affected the SDM process ( 22 – 24 ). The extant literature also highlights the need to increase awareness of emotions as social information influencing SDM ( 25 ).…”

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

“…To be informed, trusted, and give someone the power to control decisions regarding their own health and life is a common definition of empowerment (30). Shared decision making has been linked to empowerment in previous studies (17,18).…”

“…There has been an ongoing shift in the direction of shared decision-making and person-centered treatment in adolescent mental healthcare ( 10 , 15 , 16 ). Shared decision-making is associated with patient engagement and perceived quality and satisfaction with the healthcare services ( 8 , 17 , 18 ). However, most research on shared decision-making have focused on implementation and experiences with decision aids, while little is known about mental health outcomes ( 18 ).…”

Exploring harm in psychotherapy: Perspectives of clinicians working with children and young people

“…Previous research around negative experiences has highlighted that clinicians should understand patients' psychosocial context to get the right fit (Hardy et al., 2019). Yet, children and young people frequently report being left out of conversations during appointments (Edbrooke‐Childs, Calderon, Wolpert, & Fonagy, 2015; Hayes, Edbrooke‐Childs, Town, Wolpert, & Midgley, 2019). This can result in an increased risk of drop out as the patient does not feel comfortable talking to the clinician, as well as not liking the structure and activity of the prescribed therapeutic modality (O’Keeffe, Martin, Target, & Midgley, 2019).…”