Shared Decision-Making as a Tool for Navigating Multi-Stakeholder Discrepancies in Youth Psychotherapy

ABSTRACT

Objective

Discrepancies among the key stakeholders in youth psychotherapy (e.g., caregivers, youths) commonly present an obstacle to treatment planning, forcing clinicians to align with one perspective over another and increasing the likelihood of a treatment plan that is not fully responsive to divergent opinions. At the same time, multi-stakeholder discrepancies can also offer opportunities to build an inclusive, effective treatment plan, guided by the integration of numerous sources of domain-specific knowledge related to the concerns for which families seek clinical care.

Method

We aim to: 1) investigate the degree to which multi-stakeholder discrepancies are observed when youths and caregivers are invited to report their treatment priorities, rather than the presence and severity of youth symptoms, 2) describe the rationale for, as well as the promise and challenges of, shared decision-making (SDM)—an approach designed to facilitate multi-stakeholder collaboration during treatment planning, 3) provide a case example illustrating how a clinician, youth, and caregiver could use SDM to navigate discrepancies and identify therapy targets, and 4) propose future directions for exploring the potential value of SDM in youth psychotherapy.

Results

Different levels of multi-stakeholder agreement were observed when caregivers and youths were asked to identify their treatment priorities, compared to youth symptom presence and severity, revealing nuances in multi-stakeholder agreement in youth psychotherapy.

Conclusions

Multi-stakeholder discrepancies can inform treatment planning processes, and SDM may be an effective approach for navigating them and building a treatment plan that integrates the perspective of all stakeholders in youth psychotherapy.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

¹ More information about this RCT can be found in Weisz et al. (2021). It compared the effectiveness of MATCH, delivered in outpatient settings when clinicians received varying levels of training support, among 200 families (youths aged 7–15 years old; 54% male; 33% White, 28% Black, 24% Latinx/Hispanic, 14% multi-racial, 2% other; 75% accessing Medicaid).

² This case example is fictional and is not based on a specific client.

Additional information

Funding

OMF receives research funding from the National Institute of Mental Health [NIMH; F31MH127862], the Harvard University Dean’s Competitive Fund for Promising Scholarship, School Mental Health Ontario (SMHO). JRW receives funding from the NIMH [1R01 MH124965-01], the Institute of Education Sciences [R305A140253-17], the John Templeton Foundation, the Manton Foundation, SMHO, and the Marriott Foundation. DL receives funding from the NIMH [R34-MH123601].