Poster #91 - Talking and Listening Together: Understanding Shared Decision Making for Child Welfare & Mental Health Care Teams

• In Event: 2-002 - Special Poster Session 05 with Continental Breakfast Reception
  In Poster Session: PS 05 - Interdisciplinary Section

Integrative Statement

Background: Youth in foster care are prescribed psychotropic/antipsychotic medications at higher rates than those insured by Medicaid. In 2012, federal mandates required state child welfare agencies to develop plans for oversight regarding the use of psychotropic medications for foster youth. Additionally, recent federal child welfare policies have promoted case practice measures that are informed by a shared decision-making philosophy. Critical components include youth engagement and youth clients’ rights to self-determination. The shared decision-making philosophy, is quite complex to implement in clinical practice settings. In this study, we explored how former foster youth were engaged in the informed consent (to medication) process and how they view the necessary elements of this process. Moreover, it also captures how the youth view themselves as active agents in the clinical encounter with prescribing physicians and psychiatrists.
Method: Focus groups were completed with recent former foster youth who had lived experience in being prescribed psychotropic and antipsychotic medication while in the child welfare system. This presentation presents qualitative findings from an analysis of 10 focus groups. Participants (18-26 years) were recruited through snowball sampling methods through national advocacy organizations. Trained investigators collected data using a Deliberative Discussion focus group format.
Four trained analysts conducted the qualitative analysis using Dedoose software. Emergent and a priori coding structure was employed. The initial round of coding was conducted to identify broad themes and sensitizing concepts pertaining to the participants’ perceptions of Informed Consent to medication and the process of engaging youth in clinical interactions. The second phase of the analysis was completed to determine thematic patterns for relevant codes. Thematic findings will be presented with illustrative quotes. Interrater reliability among the analysts was .74 for the coding phase of the analysis.
Results: Results thus far have yielded multiple themes among foster care alumni when discussing the vital tenants of the clinical interaction and informed consent process from their perspective. Overall, alumni seemed to understand the concept of informed consent but differed on how it should be applied. Alumni generally felt that it was a positive process that was largely in place to protect them, however they noted that involving many people in the process had both trust and time pitfalls. Among participants, there was no consensus about whom should have the final authoritative say in the informed consent decision. Alumni raised concerns about barriers to implementing informed consent: treatment plan comprehension, including information about the complexity of medications being prescribed, especially side effects. Additional themes discussed: youth control over decision-making, youth voice, maturity level, and the need for a supportive and trusting relationship with the prescribing physician and other allies. Another barrier referred to time delays in accessing appropriate treatment in emergency situations when medication is needed immediately so that further behavioral consequences are not suffered by youth.
Results convey the necessity of involving foster youth as consenters of their own mental health treatment. Integrating these issues into practice may produce a greater level of engagement and accountability for all child welfare stakeholders involved in psychotropic and antipsychotic prescription.

Authors

• Cassandra Simmel, Rutgers University
  Presenting Author

• Cadence Bowden, Rutgers University
  Non-Presenting Author

• Sheree Neese Todd, Rutgers University
  Non-Presenting Author

• Stephen Crystal, Rutgers University
  Non-Presenting Author