Dartmouth Health Continuing Education for Professionals Home, Shared Decision Making for Youth Treated with Psychotropic Medications, 6/15/2021 8:00:00 AM - 6/15/2024 8:00:00 AM, Many psychotropic medication prescriptions for youth are prescribed off-label (McLaren et al., 2018). Given the lack of research, off-label medications are sometimes needed and justified, especially during acute crises. However, many youth remain on these medications following the crisis, and youth, families, and providers are hesitant to taper or remove the medications. Certain medications have significant side effects, and little is known about the long-term effects of the medications. In addition, research has found that youth and parents are often uninformed about the risks associated with these medications (Barnett et al., 2019). Youth and parents are also seldom engaged in the discussions about the harms and benefits of psychotropic medications and other treatment options (Barnett et al., 2019; Brinkman et al., 2013), despite risks being reported as the most important factor when making decisions about medications (Coyne, 2006; O'Brien et al., 2013). Two major explanations for the lack of information and engagement by youth and parents include the necessarily brief psychiatric encounters and a lack of tools and decision aids to help youth and parents understand the issues and make informed, shared decisions. Decision aids can help providers structure the discussion and provide easily digestible information about risks and benefits. They can also provide a tangible resource for youth and parents to access after the session to aid in their knowledge and decision-making. Government bodies, health organizations, and clinical practice guidelines all recommended efforts to improve shared decision-making in this population to improve the patient experience and reduce high-risk medications and adverse effects (Findling, 2011; Keeshin at al. 2020; Kutz, 2011).
Presenters
Erin Barnett, PhD
Assistant Professor, licensed child psychologist, clinician at West-Central Behavioral Health
Jennifer McLaren, MD
Associate Professor, board-certified child and adolescent psychiatrist, attending psychiatrist at DHMC, Medical Director of the NH Bureau of Developmental Services
Learning Outcome(s)
At the conclusion of this learning activity, participants will be able to apply the principles of shared decision making when managing the care of youth who are candidates for treatment with psychotropics.
Accreditation
Speaker Disclosure
In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.
The activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported NO financial interest or relationship* which could be perceived as a real or apparent conflict of interest. There were no individuals in a position to control the content that refused to disclose.
*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.
Bibliography
• Aubree Shay, L., & Lafata, J. E. (2015). Where is the evidence? a systematic review of shared decision making and patient outcomes. In Medical Decision Making (Vol. 35, Issue 1, pp. 114–131). SAGE Publications Inc. Link to Article
• Barnett, E. R., Boucher, E. A., Daviss, W. B., & Elwyn, G. (2018). Supporting Shared Decision-making for Children’s Complex Behavioral Problems: Development and User Testing of an Option GridTM Decision Aid. Community Mental Health Journal, 54(1), 7–16. Link to Article
• Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., Elwyn, G., & Légaré, F. (2015). Assessments of the extent to which health-care providers involve patients in decision making: A systematic review of studies using the OPTION instrument. Health Expectations, 18(4), 542–561. Link to Article
• Crickard, E. L., O’Brien, M. S., Rapp, C. A., & Holmes, C. L. (2010). Developing a framework to support shared decision making for youth mental health medication treatment. Community Mental Health Journal, 46(5), 474–481. Link to Article
• Elwyn, G., Lloyd, A., Joseph-Williams, N., Cording, E., Thomson, R., Durand, M. A., & Edwards, A. (2013). Option Grids: Shared decision making made easier. Patient Education and Counseling, 90(2), 207–212. Link to Article
• Fiks, A. G., Mayne, S., Localio, A. R., Feudtner, C., Alessandrini, E. A., & Guevara, J. P. (2012). Shared decision making and behavioral impairment: a national study among children with special health care needs. BMC Pediatrics, 12. Link to Article
• Lafata, J. E., Shay, L. A., & Winship, J. M. (2017). Understanding the influences and impact of patient-clinician communication in cancer care. Health Expectations, 20(6), 1385–1392. Link to Article
• McEnany, F. B., Ojugbele, O., Doherty, J. R., McLaren, J. L., & Leyenaar, J. K. (2020). Pediatric mental health boarding. Pediatrics, 146(4). Link to Article
• McLaren, J. L., Barnett, E. R., Concepcion Zayas, M. T., Lichtenstein, J., Acquilano, S. C., Schwartz, L. M., Woloshin, S., & Drake, R. E. (2018). Psychotropic medications for highly vulnerable children. Expert Opinion on Pharmacotherapy, 19(6). Link to Article
• Wyatt, K. D., List, B., Brinkman, W. B., Prutsky Lopez, G., Asi, N., Erwin, P., Wang, Z., Domecq Garces, J. P., Montori, V. M., & LeBlanc, A. (2015). Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. In Academic Pediatrics (Vol. 15, Issue 6, pp. 573–583). Elsevier Inc. Link to Article
Presenters
Erin Barnett, PhD
Assistant Professor, licensed child psychologist, clinician at West-Central Behavioral Health
Jennifer McLaren, MD
Associate Professor, board-certified child and adolescent psychiatrist, attending psychiatrist at DHMC, Medical Director of the NH Bureau of Developmental Services
Learning Outcome(s)
At the conclusion of this learning activity, participants will be able to apply the principles of shared decision making when managing the care of youth who are candidates for treatment with psychotropics.
Accreditation
Speaker Disclosure
In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.
The activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have reported NO financial interest or relationship* which could be perceived as a real or apparent conflict of interest. There were no individuals in a position to control the content that refused to disclose.
*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.
Bibliography
• Aubree Shay, L., & Lafata, J. E. (2015). Where is the evidence? a systematic review of shared decision making and patient outcomes. In Medical Decision Making (Vol. 35, Issue 1, pp. 114–131). SAGE Publications Inc. Link to Article
• Barnett, E. R., Boucher, E. A., Daviss, W. B., & Elwyn, G. (2018). Supporting Shared Decision-making for Children’s Complex Behavioral Problems: Development and User Testing of an Option GridTM Decision Aid. Community Mental Health Journal, 54(1), 7–16. Link to Article
• Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., Elwyn, G., & Légaré, F. (2015). Assessments of the extent to which health-care providers involve patients in decision making: A systematic review of studies using the OPTION instrument. Health Expectations, 18(4), 542–561. Link to Article
• Crickard, E. L., O’Brien, M. S., Rapp, C. A., & Holmes, C. L. (2010). Developing a framework to support shared decision making for youth mental health medication treatment. Community Mental Health Journal, 46(5), 474–481. Link to Article
• Elwyn, G., Lloyd, A., Joseph-Williams, N., Cording, E., Thomson, R., Durand, M. A., & Edwards, A. (2013). Option Grids: Shared decision making made easier. Patient Education and Counseling, 90(2), 207–212. Link to Article
• Fiks, A. G., Mayne, S., Localio, A. R., Feudtner, C., Alessandrini, E. A., & Guevara, J. P. (2012). Shared decision making and behavioral impairment: a national study among children with special health care needs. BMC Pediatrics, 12. Link to Article
• Lafata, J. E., Shay, L. A., & Winship, J. M. (2017). Understanding the influences and impact of patient-clinician communication in cancer care. Health Expectations, 20(6), 1385–1392. Link to Article
• McEnany, F. B., Ojugbele, O., Doherty, J. R., McLaren, J. L., & Leyenaar, J. K. (2020). Pediatric mental health boarding. Pediatrics, 146(4). Link to Article
• McLaren, J. L., Barnett, E. R., Concepcion Zayas, M. T., Lichtenstein, J., Acquilano, S. C., Schwartz, L. M., Woloshin, S., & Drake, R. E. (2018). Psychotropic medications for highly vulnerable children. Expert Opinion on Pharmacotherapy, 19(6). Link to Article
• Wyatt, K. D., List, B., Brinkman, W. B., Prutsky Lopez, G., Asi, N., Erwin, P., Wang, Z., Domecq Garces, J. P., Montori, V. M., & LeBlanc, A. (2015). Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. In Academic Pediatrics (Vol. 15, Issue 6, pp. 573–583). Elsevier Inc. Link to Article
