A qualitative analysis of implementing shared decision making in Child and Adolescent Mental Health Services in the United Kingdom: Stages and facilitators.

OBJECTIVES: To explore the implementation of shared decision making (SDM) in Child and Adolescent Mental Health Services (CAMHS), and identify clinician-determined facilitators to SDM. METHODS: Professionals from four UK CAMHS tried a range of tools to support SDM. They reflected on their experiences using plan-do-study-act log books. A total of 23 professionals completed 307 logs, which were transcribed and analysed using Framework Analysis in Atlas.Ti. RESULTS: Three states of implementation (apprehension, feeling clunky, and integration) and three aspects of clinician behavior or approach (effort, trust, and flexibility) were identified. CONCLUSIONS: Implementation of SDM in CAMHS requires key positive clinician behaviors, including preparedness to put in effort, trust in young people, and use of the approach flexibly. PRACTICE IMPLICATIONS: Implementation of SDM in CAMHS is effortful, and while tools may help support SDM, clinicians need to be allowed to use the tools flexibly to allow them to move from a state of apprehension through a sense of feeling "clunky" to integration in practice.

An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: Parents' and young people's views.

The Kidstime programme is an innovative attempt to address the particular needs of children and young people who have parents with mental illnesses. It comprises a monthly psycho-educational workshop involving discussions about the meaning of mental health, dramatizations of stories constructed by the children (often filmed), and concurrent parents' groups, as well as joint seminars and review sessions. This paper presents a qualitative analysis of interviews with young people (n=6) and parents (n=5) attending the groups and interviews with former service users (n=9). Five themes emerged from the thematic analysis: initial engagement, sharing with others, learning about mental health, opportunity for fun and impact on family relationships. Areas for further development were identified including the formation of a distinct adolescent Kidstime workshop to better meet their age-specific needs, and adjustments to the system for introducing new families to established workshop groups. Given the positive experience of the groups by those attending, a rigorous evaluation of the approach is suggested.