Shared Decision-Making with Latinx Caregivers During Community Implemented Evidence-Based Practices: Determinants and Associations with Alliance

ABSTRACT

Objective

The current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers.

Method

The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions.

Results

Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = −8.79, 95% CI[−14.09, −3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance.

Conclusions

SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Previous Data Usage

Data were used in a dissertation by the first author and a previous publication (Wright et al., 2023).

Additional information

Funding

This work was supported by the National Institute of Mental Health [under grants R01MH100134 and R01MH112536]. The first author was supported by the Robert Wood Johnson Foundation [under Award ID 74805], National Institute of Mental Health [under grant F31MH121000], and Agency of Healthcare Research and Quality [under grant T32HS000046].