Youth depression and anxiety represent a serious public health concern, with affected youth often experiencing social, familial, and academic impairment. Research evidence supports a growing array of effective treatments for youth depression and anxiety, yet as the collection of evidence-based treatments (EBTs) expands, so do the challenges of utilizing the evidence: clinicians must be able to (1) access, integrate, and apply the available evidence, and (2) engage in a collaborative process with each family to develop a plan that is responsive to each family's unique characteristics, preferences, and goals. Such collaboration, frequently referred to as shared decision-making (SDM), is a hallmark of evidence-based practice and a key feature of federal guidelines for health care delivery and the NIMH Strategic Aims. However, despite growing rhetorical support for SDM, empirical support is lacking, particularly in the area of youth mental health treatment. The absence of such research is unfortunate, given the potential for SDM to facilitate the dissemination and implementation of EBTs and to personalize the use of established treatments to increase acceptability, retention, satisfaction, and overall effectiveness. The proposed Mentored Patient-Oriented Research Career Development Award (K23) is a 5-year plan for the candidate to (a) acquire the skills and knowledge necessary to develop and evaluate SDM and other treatment personalization approaches for youth psychotherapy, extending the reach and relevance of EBTs, and (b) conduct a 3-phase study that will serve as the foundation for pursuing this line of research as an independent investigator. Phase I will focus on SDM protocol development using mixed methodology and consultation with experts in EBTs, SDM, and family/youth advocacy. Phase II will consist of a case series to further refine the protocol prior to pilot testing. PhaseIII will test the feasibility and acceptability of SDM through a pilot RCT of 40 youths (ages 7-15) meeting diagnostic criteria for an anxiety or depressive disorder. The RCT will compare an EBT that is planned collaboratively with youths and caregivers using the SDM protocol, to an EBT that is planned by the clinician and supervisor using pretreatment assessment data. One product of this project will be a structured guide for conducting SDM with youths and caregivers. The results of the pilot RCT will support the development of an R01 grant application for a larger RCT evaluating the efficacy of the SDM protocol and identifying mechanisms of action leading to clinical change. Longer term research goals include expanding the testing of SDM and other treatment personalization approaches to diverse settings (e.g., community clinics) and broader populations (e.g., other types of psychopathology).The training plan closely matches the proposed research and long-term goals with an emphasis on training activities that will facilitate the candidate's development as an independent investigator. Specifically, the training aims are to: (1) Enhance training in treatment development and efficacy testing, with a focus on personalizing EBTs and modular treatment design; (2) Develop advanced understanding of mixed-methods strategies to facilitate the incorporation of consumer perspectives into the treatment design process; (3) Acquire advanced training in the application of shared decision-making principles to youth mental health treatment; and (4) Further develop biostatistics skills to analyze data from clinical trials with repeated measurements.
Engaging caregivers and youths as active collaborators in the treatment planning process is a patient-centered approach with the potential to improve the process and outcome of youth mental health care by facilitating the personalization of established evidence-based treatment approaches; structured shared decision-making protocols may provide the tools needed to foster this collaboration. This project seeks to enhance the potential public health impact of established evidence-based treatments by developing and refining a shared decision- making protocol for youth psychotherapy based on caregiver and youth qualitative feedback, and input from experts specializing in evidence-based treatments and shared decision-making. Once the protocol has been developed and refined, a pilot randomized controlled trial will assess the feasibility of a larger trial evaluating the potetial clinical benefits of incorporating shared decision-making practices in youth mental health care.
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