(PS5-10) Clinician Attitudes Toward Collaborative Decision-making and Recovery-oriented Practices in Mental Health Care

Abstract Text: Collaborative decision-making (CDM) is a cornerstone of recovery-oriented mental health care, aiming to empower clients to actively participate in decisions about their treatment. This is especially critical for individuals with serious mental illness (SMI), who often face stigma, coercion, and paternalistic treatment approaches that may limit their role in decision-making. While recovery-oriented care (ROC) attitudes reflect clinicians’ beliefs about the potential for individuals with SMI to recover (e.g., ability to live independently), CDM attitudes focus on beliefs about client ability to participate in their treatment decisions. Prior research suggests that clinicians endorse ROC attitudes but misunderstand the principles of ROC, reducing ability to meaningfully implement ROC or CDM. Furthermore, minority clients face additional obstacles with engagement but often receive less information about treatment decisions from their providers. It is imperative to understand this potential misalignment between endorsement and implementation to effectively advance the promise of ROC.

In this study, our aims were to: 1) examine the relationship between clinicians’ ROC and CDM attitudes and reported CDM practices; 2) investigate racial differences in clinicians’ caseload for providers who reported high ( >50% of the time) versus low (≤50% of the time) CDM practices. This secondary data analysis examined survey responses from 96 clinicians from 34 U.S. states, all working in public mental health programs.
To examine the first aim, bivariate correlations assessed the extent to which clinician reported CDM practices were associated with CDM and ROC attitudes. Findings indicated no significant correlations for either CDM attitudes (r(67)= .154, p= .208) or ROC attitudes (r(94)= -.004, p= .972)
To examine the second aim, we initially planned to conduct an independent t-test to compare the racial/ethnic composition of clinician caseloads between high and low CDM groups. Descriptive statistics indicated that 7.3% (N=7) of clinicians reported low CDM practices and 92.7% (N=89) of clinicians reported high CDM practices. Due to the small sample size in the low CDM group, statistical comparisons were not appropriate. Descriptive analyses showed that Black clients, in the high CDM group reported a lower proportion (M=26.82%, SD= 21.95) than the low CDM group (M=41.00%, SD=26.72). Effect size calculations indicated large differences in Black (Cohen’s d=.636) and small differences in White (Cohen’s d= .080) client proportions between high and low CDM groups.  

Clinicians nearly uniformly reported high use of CDM. However, there was no relationship between reported use of clinician attitudes, suggesting a potential misalignment akin to past work in ROC. A follow-up analysis prior to the November convention will examine why most clinicians reported high CDM. Further research is needed to identify determinants of equitable CDM implementation. Bridging this gap in CDM implementation is essential to inform broader ROC practice by facilitating patient empowerment, particularly among communities who have historically been excluded from meaningful treatment decisions.