Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making. The framework includes three functional areas (1) setting the stage for youth shared decision making, (2) facilitating youth shared decision making, and (3) supporting youth shared decision making. While still in the formative stages, the value of a specific framework for a youth model in support of moving from a client-practitioner value system to a systematic, intentional process is evident.

the primary aims of this article are to describe the current context for youth shared decision making (sDm) within the U.s. children's mental health system and to identify important considerations for the development of this approach as a research and service domain. the notion is substantiated in the literature that participation in treatment decisions can prepare youth for making their own decisions as adults, can be therapeutic, and can have positive effects on their self-confidence and self-esteem. still, the complex youth-family-provider dynamic raises important issues that need to be addressed before sDm can be successfully implemented.imPliCations FoR PRaCtiCe •Developing a youth sDm model will involve practitioner training, training for youth and parents, defining roles for youth and parents, consent, confidentiality, service delivery factors, and identifying outcomes.

Few studies have directly examined the interrelationship of teen and parent attitudes toward psychiatric medication and how this relates to medication adherence. In the current study, survey data from 19 parent-child dyads were analyzed to investigate the relationship of parent and teen attitudes toward medication, decision self-efficacy, and current involvement in decisions about psychiatric medication with self-reported adherence. Structural equation modeling techniques were used to fit actor-partner interdependence models to examine bidirectional effects of the dyadic relationships. Teens and parents had similarly positive attitudes toward medication, high levels of self-efficacy and self-reported adherence. Current involvement in decisions about medications was significantly lower for teens compared to their parents. The actor-partner interdependence models revealed that parent levels of decision self-efficacy were related to youth self-reported adherence (partner effect). Youth attitudes toward medications were related to youth self-reported adherence (actor effect). Parent and teen actor effects of decisional self-efficacy were significantly associated with current involvement. Providers need to be aware of the importance of engaging both teens and parents in decisions about psychiatric medication and recognize the need to explicitly elicit questions and concerns from young patients.

Background: Encouragement of youth participation in mental health treatment is relatively new and there have been few specific interventions to improve engagement, particularly as it relates to medication management. This article describes the development of a tool to support engagement during medication appointments by identifying areas of agreement/disagreement between parents and teens. Method: Data were analyzed from 240 parent/teen dyads visiting an outpatient community mental health center for medication management. Frequencies and percentages were calculated for all items. Kappa scores were used to assess agreement between parent and teen dyads. Results: The level of agreement between parents and teens was low. Overall, teens expressed preference for discussion of 'positive' aspects of treatment such as what is going well, whereas parents preferred to focus on 'negative' aspects of treatment such as problematic symptoms. The lowest level of agreement was found for the item: 'My teen seems to be having problems with energy levels' (Kappa = .19; 95% CI = .05-.34). The strongest level of agreement was for the question 'How has your teen been using the medication since the last appointment?' (Kappa = .56; 95% CI = .44-.69). Conclusions: The findings support the utility of the tool for illustrating the variation in needs of teens and parents during medication appointments. Knowledge of these differences can be used by providers to encourage teen participation and may enhance overall communication. Key Practitioner Message• Parents and teens often have different agendas for medical appointments and value hands-on tools to assist with communication during psychiatric medication appointments.• The Preparing for the Appointment worksheet represents one hands-on option clinicians can use to reveal divergent parent/teen perspectives.• Clinicians can use the worksheet to facilitate communication, to amplify teen voice and to empower both parents and teens to communicate with one another and with providers.

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