Medication management for people with severe mental illness (SMI) is a complex process that involves a partnership between two experts: the consumer and the practitioner. Shared decision-making (SDM) is now widely recognized as an indicator of high quality healthcare but has not yet been broadly adopted in the mental health field. Most consumers of healthcare services, including those with SMI, desire a role in treatment decisions;and research shows that consumer involvement may result in better outcomes. However, several barriers have impeded widespread use of shared decision-making for adults with SMI, including prescriber time constraints, questions of feasibility for some consumers or clinical situations, confusion around roles and responsibilities, and consumer needs for assistance in identifying best management approaches and interacting with providers. Given these barriers to SDM, providers and consumers need decision support tools that will make clinical consultation more efficient while encouraging reciprocal exchange of information and preferences. A decisional support center (DSC) within a mental health clinic is a novel approach to SDM that incorporates computer technology, peer support, and the coaching of both providers and consumers. Computer kiosks using Common Ground software incorporate technologically-advanced, self-guided discovery and learning modules about recovery pathways, personal medicine, and monitoring of progress. Trained peers facilitate use of the DSC, and additional tools are available for providers and consumers to integrate learning and treatment. Mental health centers in several states have started implementing DSCs using Common Ground, but there has been little research. More work is needed to fully specify critical implementation elements, develop a training protocol, and refine and test measures of fidelity. We also need to examine the implementation and outcomes of the program in a more urban, culturally diverse setting outside of the clinical settings where Common Ground was first developed. This R34 application proposes to refine a training manual, implementation protocol, and fidelity measure for a shared decision-making program and use these materials to assess the implementation and outcomes of the DSC. Outcomes include degree of shared decision-making, improvements in the provider's level of patient- centered communication, and improvements in consumers'level of patient activation, medication adherence, as well as fewer missed appointments and fewer hospital and emergency services. This study will provide the developmental work necessary for rigorously testing the DSC as a tool to enhance shared decision-making in mental health services in accordance with recommendations of the Institute of Medicine and the strategic plan of NIMH. Following successful completion of the aims in this study, we will be well poised to pursue funding for a randomized, controlled trial of the intervention.
This R34 application proposes a study that will provide the developmental work necessary for rigorously testing a DSC as a tool to enhance shared decision-making in mental health services in accordance with recommendations of the Institute of Medicine and the strategic plan of NIMH.
