CONGRUENCE OF PARENT AND TEEN AGENDAS FOR PSYCHOTROPIC MEDICATION APPOINTMENTS

Purpose:

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. The Preparing for the Appointment (PFTA) worksheet was developed as part of a shared decision making model for youth and parents during psychiatric medication appointments (Crickard, O’Brien et al. 2010; O’Brien, Crickard et al. 2011). Here we describe the application of the PFTA worksheet to support engagement during medication appointments by identifying areas of agreement/disagreement between parents and teens.

Method:

The PFTA pre-appointment worksheet inquires about preferences for discussion in a variety of areas ranging from medication adherence and side effects, to changes at home or school. Data were analyzed from 240 parent/teen dyads visiting an outpatient community mental health center for medication management. Frequencies were calculated for all items. Kappa scores and effect size conventions for kappa were calculated to assess agreement between parent and teen dyads.

Result:

Between dyads, compared to parents, teens preferred to discuss “positive” issues such as what has been going well since the last appointment. Within dyads, the level of agreement between parents and teens was low. The lowest levels of agreement were 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). Satisfaction with the worksheet was moderate to high, indicating potential as an acceptable tool to promote parent and teen engagement in psychiatric medication appointments.

Conclusion:

Findings from this study add to current knowledge about divergence commonly found when using multiple informants, by pinpointing areas of disagreement specific to medication appointments. The most commonly chosen area of priority for the appointment for the teen was “share what is going well,” which illustrates a need for teens to be able to discuss topics related to more positive internal aspects during the appointment. The findings support the utility of the tool for illustrating gaps in communication between parents and teens. Knowledge of these gaps can be used by providers to encourage teen participation and may enhance overall communication.