The Dartmouth Institute for Health Policy & Clinical Practice and the Department of Psychiatry at the Geisel School of Medicine at Dartmouth, aims to leverage the power of partnerships between patients, families, communities, health professionals, and health systems to co-create and test innovative approaches to improving health and health care.
One of our projects, the AWARE study, is testing an intervention that combines shared decision making with structured guidance on reducing mental health medications. Youths prescribed off-label antipsychotic medications or polypharmacy (3 or more mental health medications) engage in shared decision making with their caregivers and clinicians to better understand their medications and, if appropriate, choose to reduce or stop a medication (called “deprescribing”). Clinicians then follow the structured deprescribing protocol to slowly and safely taper the medication.
The AWARE study has partnered with Fora Health to support this process; caregivers and youth use a smartphone-based chatbot app to access information about mental health treatment options and monitor the intervention and their health and mental health. The app uses a previously developed comparison table to help youth and caregivers quickly compare different types of medications and treatments. Within the app, they also indicate their medication preferences, evaluate whether they shared in the decisions with their clinician, and provide weekly updates about the youth’s functioning in 6 key areas. Clinicians have access to a web portal where they can see families’ activity using the Fora Health app and review youth functioning ratings prior to clinic visits.
Funded by The Charles H. Hood Foundation through their Major Grant Initiative to Advance Child Health, the AWARE study has recruited 32 families from two community mental health centers in the Northeastern US. We are pleased with the level of engagement we have already seen:
- 82% of the families we approached agreed to join the study
- More than half of participating families chose to try to reduce a medication
- 68% of participants have activated their Fora Health app
- Of those, about 66% regularly interact with the app
Glyn Elwyn, one of the lead researchers on the AWARE Study, commented, “We are delighted to see that adolescents and their parents are very willing to join our study and try to reduce their off-label use of mental health medications in a safe and guided way. This combination of clinical shared decision making and technological support empowers them in their treatment decisions and contributes to better health outcomes.”
The early success of the AWARE Study is a testament to the power of collaboration and innovation in improving child health. We are excited to continue this work and look forward to sharing further results as the study progresses.