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Shared Decision Making for Youth Treated with Psychotropic Medications

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).

Activity Details
Start Date:  June 15, 2021
End Date:  June 15, 2024
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
Registration and Credit Claim

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording. View the entire presentation.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

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

Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete  the activity attestation and evaluation. (you must register to access).
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
Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:
Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center
clpd.support@hitchcock.org


Type:     Internet Activity (Enduring Material)
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