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|a Chu, Joyce
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|a Does shared decision making improve care at community mental health clinics?
|h Elektronische Ressource
|c Joyce Chu, Alya Reeve, Nicole Milan, Zhen Zhao, Melissa Moore, Robert Wickham, Al Gilbert
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|a Washington, DC
|b Patient-Centered Outcomes Research Institute
|c [2019], 2019
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|a 1 PDF file (69 pages)
|b illustraions
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|a Includes bibliographical references
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|a Patient-Centered Outcomes Research Institute (U.S.)
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|a eng
|2 ISO 639-2
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|b NCBI
|a National Center for Biotechnology Information
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|a Final research report / Patient-Centered Outcomes Research Institute
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|u https://www.ncbi.nlm.nih.gov/books/NBK594604
|3 Volltext
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|a As secondary study aims, study exit interviews provided qualitative data to ascertain general impressions of mPOWR and perceived barriers and benefits of mPOWR. METHODS: In a quasi-experimental design, 240 existing clients (60 per clinical study site) who met study eligibility criteria (over 18 years; participating in CMH services for a serious mental health need in 4 target sites; able to provide informed consent; proficient in English, Spanish, or Chinese; and lacking a primary substance use disorder) were randomly selected for study inclusion. Clients in 1 pair of urban and rural intervention sites received mPOWR, and clients in the other pair of control urban and rural sites received CMH treatment as usual. Clients were followed every 6 months over 24 months.
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|a Primary outcomes were treatment engagement and SDM participation as measured by decision satisfaction and communication satisfaction, client understanding of treatment options, and perceived therapeutic support via a working alliance with providers. Secondary outcomes were treatment progress, global quality of life, and client functionality as measured by mental and physical health. Latent growth curve analyses compared study outcomes over time between intervention and control groups. RESULTS: mPOWR did not yield greater improvement in primary or secondary outcomes compared with treatment as usual. Instead, the most robust effect was driven by urban (in older adults) versus rural (all adults) location, with urban participants reporting lower baseline levels on treatment engagement and participation in SDM, perceived therapeutic support, treatment progress, general quality of life, client functionality, and treatment understanding (in the urban control site).
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|a Urban sites also reported greater declines in treatment engagement and SDM participation, working alliance, treatment understanding, and treatment progress and global quality of life in later study time points. Qualitative exit interview data suggested that external factors (institutional or client life events) and implementation challenges were the most salient barriers to mPOWR effectiveness, not the structure or content of mPOWR itself. Some clients reported positive experiences and perceived benefits from mPOWR. CONCLUSIONS: SDM interventions with clients with mental illness in CMH settings did not affect any study outcomes. Moe effectiveness and treatment adaptation research is needed to further investigate how to promote the successful use of interventions like mPOWR for behavioral health issues in CMH.
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|a BACKGROUND: Shared decision-making (SDM) is a collaborative client-provider interaction that aims to encourage clients' self-efficacy and voice in treatment decision-making. SDM needs to be extended from medical settings to diverse clientele with complex mental health and social needs in community mental health (CMH). The Moving Patient Outcomes toward Wellness and Recovery (mPOWR) system is a CMH-based SDM tool and training package that spans multiple life-functioning and community living skill domains. OBJECTIVES: This study investigated the effectiveness of mPOWR in diverse urban and rural CMH settings, with primary aims to (1) improve client and provider participation in SDM and engagement in mental health treatment; (2) increase client understanding of treatment and personal treatment progress; and (3) increase client functionality, personal quality of life, and perceived support for their therapeutic outcomes.
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