Shared Decisionmaking Tools Plus Peer Support Lead to More Efficient and Effective Mental Health Consultations and High Satisfaction

Service Delivery Innovation Profile

Shared Decisionmaking Tools Plus Peer Support Lead to More Efficient and Effective Mental Health Consultations and High Satisfaction

Snapshot

Summary

A program known as CommonGround uses paper-based and computerized decision support tools and peer specialists to help mental health clients identify treatment preferences and effectively communicate them to clinicians. Before meeting with a clinician, clients spend roughly 30 minutes working through a decision support tool that generates a consultation report and self-management suggestions for reference during the subsequent 15-minute consultation. The clinician and the client review the report and access additional decision aids to address specific concerns. Peer specialists are available to assist with completion of the initial tool and to help the client access additional information or complete other decision aids after the visit. The program has proven easy for people diagnosed with mental illness to use; has led to frequent use of shared decisionmaking between clinician and patients; and has increased the effectiveness and efficiency of consultations, leading to high levels of satisfaction among clients. Ongoing studies are evaluating the program's impact on clinical outcomes.

Evidence Rating

Suggestive: The evidence consists of post-implementation analysis of use of the program and the shared decisionmaking approach (including analysis of 98 audiotaped transcripts from clinic visits), feedback from clinician and client focus groups on the efficiency and effectiveness of consultations, and the results from client surveys exploring various aspects of their satisfaction with the program.

Developing Organizations

Pat Deegan, PhD & Associates

Pat Deegan, PhD & Associates is located in Byfield, MA.

Date First Implemented

2006

September

Problem Addressed

Shared decisionmaking—the collaboration between patients and caregivers in reaching an agreement about a health care decision—can be useful when medical evidence does not suggest a clearly optimal treatment option, as frequently occurs with patients suffering from mental illness. Yet few mental health practices offer shared decisionmaking to patients.

  • Potential benefits of shared decision making in mental health: In shared decisionmaking, the caregiver provides information about the possible outcomes of various treatment options, encourages the patient to consider aspects of each option that are personally important, and encourages the patient to fully participate in decisions about medical care. Shared decisionmaking processes often make sense with patients suffering from mental health issues, because a medication's effectiveness for a given individual is often uncertain, and risk profiles of equally efficacious medications can vary widely. Shared decisionmaking allows the clinician and the mental health client to identify both nonpharmacological strategies and medical therapies to improve wellness.
  • Failure to offer shared decisionmaking in mental health care: Conventional models of mental health care often do not focus on shared decisionmaking. Rather, most mental health care focuses on encouraging client compliance with a physician-determined medication regimen. One barrier to shared decisionmaking may be the brevity of visits, which typically last 15 minutes; the clinician may find it difficult to answer all client questions or embark upon a nuanced exploration of treatment risks and benefits during such a short visit. A second barrier may relate to a clinician not viewing the patient as being capable of participating in decision making. However, research clearly shows that even individuals with major mental disorders are fully competent to participate in shared decisionmaking and to provide informed consent. 
  • Unrealized benefits of decision support tools: Decision support tools can facilitate shared decisionmaking by increasing patients’ knowledge about their conditions and treatment options, reducing decisional conflict, improving visit efficiency, and prompting better adherence to treatment regimens that reflect patient preferences.  Yet few mental health providers currently offer such tools to patients.

Description of the Innovative Activity

Paper-based and computerized decision support tools and peer specialists help mental health clients identify treatment preferences and effectively communicate them to clinicians. Before meeting with a clinician, clients spend roughly 30 minutes working through a decision support tool that generates a consultation report and self-management suggestions for reference during the subsequent 15-minute consultation. The clinician and the client review the report and access additional decision aids to address specific concerns. Peer specialists are available to assist with completion of the initial tool and to help the client access additional information or complete other decision aids after the visit. Key elements of the approach include the following:

  • Program logistics: The clinic's waiting area is transformed into a peer-run decision support center, with semiprivate study carrels equipped with computers and headphones. Appointments are scheduled to accommodate 30 minutes of work in the center before meeting with the clinician.
  • Peer specialists to welcome and assist clients: Peer specialists (i.e., people on staff who are in recovery from a major mental disorder) welcome clients to the center, offer them a healthy snack and beverage, listen to their needs, provide emotional support if necessary, and help them access and use the decision support tool.
  • Computerized decision support tool/survey: Before each visit, clients typically use a touch-screen decision support tool to help them prepare for the consultation. (Clinics without computer access use a paper-based decision support tool.) The software presents information about mental illness recovery, plays video vignettes of people discussing how they achieved recovery, and emphasizes the importance of “personal medicines” (individualized nonpharmacological strategies that promote wellness). With assistance from the peer specialist if needed, clients also complete a survey about their symptoms and functioning, medication compliance, concerns related to psychiatric medicines (such as their impact on health), and goals related to medication use (known as the “power statement”). As of May 2014, more than 18,000 clients had used the software program. The output from this decision support system consists of two reports, outlined below:
    • Consultation report: Clients print a one-page summary report for reference during the consultation. The report helps clients organize their thoughts and concerns, thus allowing them to communicate more effectively with the clinician (who also receives an electronic version of the report). If desired, the client may choose to discuss the report's contents with the peer specialist before the clinician consultation.
    • Self-management suggestions: Based on the client’s responses, the computer software automatically generates self-management and recovery suggestions. For example, if a client indicates that he or she is struggling with sleep or hearing voices, the software will generate suggestions for self-care strategies. These strategies are printed on a personal medicine card for the client, and forwarded electronically to the clinician.
  • Joint client–clinician report review, including access to other support: During the 15-minute consultation, the client and the clinician review the report and the self-management suggestions, quickly honing in on specific concerns and overall progress. As part of this process, the clinician can access (via automatic prompts on his or her computer) other printable, topic-specific decision support tools and worksheets to help clients work through specific concerns. For example, tools may help clients list and rate the relative importance of the benefits and drawbacks of medical therapy and develop solutions to offset the drawbacks. Examples of available decision aids include the Ottawa Personal Decision Guide, the Agency for Healthcare Research and Quality (AHRQ) publication Antidepressant Medicines—A Guide for Adults With Depression, and tools developed by Pat Deegan, PhD & Associates. The system also provides links to nonindustry sponsored sources of information related to specific concerns the client may have.
  • Postappointment support from peer specialist: After the consultation, the client or clinician can request additional help from the peer specialist, typically with activities that could not be addressed during the visit due to time constraints. For example, the peer specialist can provide references or referrals to community resources, assist with completion of the additional decision support tools, help explore external Web sites, or create a medication reminder system.
  • Ongoing tracking of mental health status: Because surveys are completed at each visit, the software helps clients monitor their recovery. At subsequent visits, clients can use the software to track trends in symptoms, links between symptoms and medication use, and/or links between symptoms and substance use.

Context of the Innovation

Pat Deegan, PhD & Associates, a small company founded and operated by individuals in recovery from psychiatric disorders, develops innovative processes and technologies to support recovery from mental illness. Dr. Deegan believes that individuals with major mental illness have the right to receive person-centered care and, therefore, to receive unbiased information and participate in decisions regarding treatment. She developed CommonGround as a way to operationalize those values in everyday practice. Practice settings that have adopted CommonGround include public mental health clinics and State hospitals that serve patients with major mental disorders and co-occurring substance use disorders. These patients range in age from 18 to 65 years old, have typically been disabled for many years, and may have low literacy.

Results

The program has proven easy for people diagnosed with mental illness to use, has led to frequent use of shared decisionmaking between clinicians and patients, and has increased clinicians' ability to identify whole health concerns. The program has also increased the effectiveness of consultations, leading to high levels of satisfaction among clinicians and patients. Research has demonstrated that individuals report increased functioning and symptom improvement, as well as reduced concerns about prescribed medication. Ongoing studies, including a 2014–2015 person-centered comparative effectiveness study by the Patient Centered Outcomes Research Institute, are evaluating the program's impact on clinical outcomes.

  • Ease of use: Contrary to conventional wisdom that people with mental illness cannot use these types of shared decisionmaking tools, descriptive studies of CommonGround indicate that individuals with major mental illness do use the program, with one clinic finding that 90 percent of clients used the software. 
  • Frequent use of shared decisionmaking: Doctors who use CommonGround report entering into shared decisions with clients during 86.7 percent of consultations. 
  • Improved health functioning and symptoms over time: According to a 2013 study, clients who used CommonGround reported improvements in functioning and symptoms between T1 and T2 as measured by the How I Am Doing scale within CommonGround.
  • Use of self-management strategies and associated fewer concerns about medication: According to a 2013 study, clients using CommonGround indicated an increase in self-management strategies (Personal Medicine), and the increase in this use corresponded with a decrease in concerns about prescribed medications. Between T1 and T2, clients reported a 10-percent decrease in concerns about medication side effects, a 9-percent decrease in concerns about medications and their impact on physical health, and an 8-percent increase in the belief that prescribed medicine was helping.
  • Increased identification of whole health concerns: When the program was used to address health and lifestyle behaviors, the most frequently discussed behaviors were sleep (89 percent) and diet (61 percent). The clinician and patient came to a shared decision addressing their whole health concerns 44 percent of the time.
  • More effective communication and consultations, leading to high levels of satisfaction: Both clinicians and patients report that the program has enhanced the effectiveness of communication between them and of the overall consultation:
    • Positive feedback from clinicians: Clinicians believe the program has led to greater visit efficiency and effectiveness by facilitating client preparation and involvement in treatment discussions. Clinicians also report that the program helps improve their own shared decisionmaking skills, better understand their clients' lives, concerns and preferences, and focus more quickly on client concerns during the brief time available for the visit. In a number of cases, clinicians have found that clients are willing to disclose information via the computer that had not previously been discussed in face-to-face conversations.
    • Positive feedback from clients: Clients report that the program helps to ensure that they cover all of their concerns during the visit, and that completing the tool leads to a sense of accomplishment. Some—notably those with acute psychosis—report that the program enabled them to better organize their thoughts and concerns before the appointment In a survey asking clients to compare their office visits before and after program implementation, 77.6 percent reported an enhanced ability to discuss their concerns about medicines, 61.3 percent reported that the quality of their time with the doctor had improved, 59.8 percent reported being better able to identify “personal medicines,” and 90.5 percent reported being satisfied overall with CommonGround.

Evidence Rating

Suggestive: The evidence consists of post-implementation analysis of use of the program and the shared decisionmaking approach (including analysis of 98 audiotaped transcripts from clinic visits), feedback from clinician and client focus groups on the efficiency and effectiveness of consultations, and the results from client surveys exploring various aspects of their satisfaction with the program.

Planning and Development Process

CommonGround typically entails an 11-step implementation plan, with multiple detailed substeps (more information on this process can be obtained from the program developer). A brief overview of selected major steps include the following:

  • Establishing leadership team: A team of physicians, clinic staff, and information technology personnel typically oversees program development and implementation.
  • Conducting readiness assessment: The team conducts an assessment to determine whether the organization is ready to adopt CommonGround, which requires a shift to a culture of shared decisionmaking.
  • Designating champion(s): The leadership team designates one or two champions (one of whom should be a senior staff person) to oversee the implementation within a particular site.
  • Hiring, training peer specialists: If no current employee can serve as a peer specialist, the organization hires and trains someone to serve in this role, which can either be a part-time or full-time position. The peer specialist attends an 8-hour onsite training session and receives a written job description.
  • Implementing hardware/software: The team arranges for the purchase or re-allocation of computer equipment, tablets, and study carrels (if needed); and for relevant individuals to receive training on the software.
  • Training medical staff: The medical staff participates in a 3-hour onsite training session to learn about the program. The clinicians learn to use the software, learn to read the clients' CommonGround report and incorporate it into their “exam,” and learn to write a shared decision that meets fidelity standards.
  • Notifying clients: Those adopting the program send a letter to clients describing CommonGround and its availability to them going forward.

Resources Used and Skills Needed

  • Staffing: The program typically requires the hiring of one or more peer specialists to cover clinic hours.
  • Costs: Upfront development costs include the purchase of computers or tablets and fees associated with initial training. Ongoing costs include the salary and benefits of the peer specialist (if needed), a monthly per-user licensing fee, and a yearly coaching and software support fee. (Updated August 2014.)

Funding Sources

Adopting clinics have either funded the program internally or obtained external grants to support it. In some instances, managed care companies have been willing to finance adoption of the program. In some states, peer staff can bill for their consultations, which helps to cover the costs of their compensation.

Tools and Resources

Interested adopters can contact Pat Deegan for access to implementation and shared decisionmaking tools.

Information about CommonGround, including a 3-minute demonstration video, is available at
http://www.patdeegan.com/commonground.

The Ottawa Personal Decision Guide is available at http://decisionaid.ohri.ca/decguide.html.

The AHRQ publication entitled Antidepressant Medicines—A Guide for Adults With Depression is available at http://www.effectivehealthcare.ahrq.gov/ehc/products/7/10/AntidepressantsConsumerGuide.pdf.

Getting Started with This Innovation

  • Assess organizational readiness for adoption: Because adopting CommonGround requires a willingness to promote a culture change within the institution, the organization should conduct a readiness assessment before implementation. This assessment includes an evaluation of the computer literacy of staff, access to Internet-enabled computers, willingness to hire peer staff, medical director interest, and experience with implementation of evidence-based practices.
  • Develop framework for employing peer staff: The institution must develop policies and procedures to support and guide use of peer staff, such as determining whether they will be allowed to access medical records.
  • Recognize as systemic intervention, and prepare accordingly: CommonGround involves clinicians, case managers, receptionists and peer staff, and therapists, and affects the treatment planning process and communication among caregivers and between caregivers and patients. This type of systemic intervention requires organizational leaders to define staff roles and to promote a culture that focuses on recovery and shared decisionmaking.
  • Avoid concurrent adoption of technologies: Do not implement this program simultaneously with the adoption of other electronic technologies (such as an electronic medical record), as the concurrent adoption of distinct technologies can often be highly disruptive for staff.

Sustaining This Innovation

  • Sustain focus via program champion: This individual can help staff learn to use the various features of the software and keep them focused on the value of shared decisionmaking. The program champion can also attend a monthly program webinar that provides training and technical support.
  • Review monthly data: Those adopting the program can tap into comparative data on software use and outcomes, thus allowing users to compare their own clinic’s experience with the program with that of others using it.

Spreading This Innovation

As of August 2014, this program is being used by 111 organizations (including State hospitals, public sector outpatient clinics, peer centers, and assertive community treatment teams) in California, Indiana, Kansas, Massachusetts, New Jersey, New York, Oregon, Pennsylvania, and West Virginia; 58 of these organizations use the Web-based software program, while 52 use the paper-based tools only.


Contact the Innovator

Note: Innovator contact information is no longer being updated and may not be current.

Patricia E. Deegan, PhD
Director
Pat Deegan, PhD & Associates LLC
P.O. Box 208
Byfield, MA 01922
E-mail: pat@patdeegan.com



Innovator Disclosures

Dr. Deegan has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

MacDonald-Wilson KL, Deegan PE, Hutchison HL, et al. Integrating self-management strategies into mental health service delivery: empowering people in recovery. Psychiatr Rehabil J. 2013 Dec;36(4):258-63. [PubMed] (Added August 2014.)

Deegan PE, Rapp C, Holter M, et al. Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv. 2008;59(6):603-5. [PubMed] Available at: http://ps.psychiatryonline.org/article.aspx?articleid=99448External Link.

Deegan PE, Drake RE. Shared decision making and medication management in the recovery process. Psychiatr Serv. 2006;57(11):1636-9. [PubMed]

Deegan PE. A Description of a Web Application to Support Recovery and Shared Decision Making in Psychiatric Medication Clinics. Unpublished manuscript.

Footnotes

  1. Dartmouth-Hitchcock Medical Center. Center for Shared Decision-Making. About Shared Decision Making [Web site]. Available at: http://www.dartmouth-hitchcock.org/medical-information/decision_making_help.html.

  2. Deegan PE, Drake RE. Shared decision making and medication management in the recovery process. Psychiatr Serv. 2006;57(11):1636-9. [PubMed] 

  3. Interview with Patricia Deegan, June 9, 2010.

  4. O'Connor AM, Rostom A, Fiset V, et al. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ. 1999;319:731-4. [PubMed] 

  5. Hamera E, Pallikkathayil L, Baker D, et al. Descriptive study of shared decision making about lifestyle modifications with individuals who have psychiatric disabilities. J Am Psychiatr Nurses Assoc. 2010;16(5):280-7. [PubMed] 

  6. Deegan PE, Rapp C, Holter M, et al. Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv. 2008;59(6):603-5. [PubMed] Available at: http://ps.psychiatryonline.org/article.aspx?articleid=99448 (link is external)

  7. Goscha RJ. Finding Common Ground: Exploring the Experiences of Client Involvement in Medication Decisions Using a Shared Decision Making Model. Unpublished manuscript (doctoral dissertation).

  8. Community Care Behavioral Health, Pittsburgh, PA. Unpublished data.

Patients Benefit When Clinicians Share Decisionmaking

By Dominick Frosch, PhD
Associate Investigator
Palo Alto Medical Foundation Research Institute 

Clinicians are increasingly engaging patients in decisionmaking about their treatment options. When the best option isn't clear based on the evidence and/or the choices have tradeoffs that are sensitive to patients' preferences, decisions should be made by the physician and patient together. For example, the Dartmouth-Hitchcock Medical Center program fully integrates shared decisionmaking into breast cancer care and helps patients with early-stage breast cancer make informed choices between several treatment options, including a lumpectomy and a mastectomy, which have similar survival rates.

The term “shared decisionmaking” was first coined in 1982 by President Reagan's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. The commission described shared decisionmaking as “discussions between professional and patient that bring the knowledge, concerns, and perspective of each to the process of seeking agreement on a course of treatment. Simply put, this means that the physician or health professional invites the patient to participate in a dialogue in which the professional seeks to help the patient understand the medical situation and available courses of action, and the patient conveys his or her concerns or wishes.” 1

Over the last 20 years, the pace of research on shared decisionmaking has increased significantly, owing to the medical community's interest in determining which clinical decisions are suitable for engaging patients in a dialogue and the most effective strategies for accomplishing that goal.

Research on decision support aids for patients facing health treatment or screening decisions has also increased. A 2009 Cochrane review found a total of 55 randomized control trials on patient decision aids since the 1980s. Decision aids performed better than usual care on several measures including increased patient knowledge and lower decisional conflict related to feeling uninformed and unclear about personal values. Examples of decision support interventions from the Dartmouth-Hitchcock Medical Center innovation include DVDs and booklets to help patients understand the various breast cancer treatment options and formulate questions for the surgeon, and a questionnaire that assesses the patient's breast cancer knowledge, values, and preferred treatment options.

To date, there has been very little work on shared decisionmaking with patients who have mental illness. The CommonGround innovation by Pat Deegan and Associates is unique in creating decision support interventions for this vulnerable population. Persons with mental illness are often assumed to be incapable of engaging in decisionmaking processes; however, it is clear from this innovation that they can and want to engage in treatment decisions and their participation is beneficial. Before meeting with a clinician, the patient uses a decision support tool to generate a consultation report and self-management suggestions for reference during the clinical consultation. A peer specialist helps patients identify treatment preferences and how to communicate them effectively to clinicians. This type of shared decisionmaking could be generalized to other patients with chronic conditions. For example, patients with diabetes often have multiple treatment options with no clearly superior one. However, I would like to see the innovators collect more data to understand the long-term impact on mental health outcomes.

Shared decisionmaking is also being used with people with serious, possibly terminal illnesses. The Advanced Illness Coordinated Care Program by Care Support of America incorporates decision support to help patients who do not yet qualify for hospice care to better understand their illness, communicate with providers, and obtain any palliative care they need. The program increased the percentage of patients completing advance directives and reduced hospitalizations. Without advanced directives, patients are more likely to die in a hospital after undergoing heroic measures. Most patients prefer to die at home, which they are more likely to do if they receive palliative care. This intervention shows that when patients are more comfortable facing end-of life choices, they are more likely to develop advance directives.

This intervention is significant also because clinicians typically have difficulty discussing end-of-l ife decisions with seriously ill patients. As a result, patients with advanced or terminal illnesses may not receive the care or support they need and may delay getting advanced directives.

This intervention could be adopted by closed systems similar to Kaiser, which has a simpler financial structure than fragmented systems. I would also like to see the innovators determine whether the program costs of $550 per patient were offset by decreased hospitalizations and emergency room visits.

References

1 Makoul G, Clayman ML. An integrative model of shared decisionmaking in medical encounters. Patient Edu Couns. 2006;60(3):301-312.

Disclosure Statement: Dr. Frosch has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this commentary.

Developers

Pat Deegan, PhD & Associates

Pat Deegan, PhD & Associates is located in Byfield, MA.

Comments

By Kathleen Flynn-Bisson, MA, MCHES on
I have been given the opportunity to teach theatre to some incredible people recovery from mental illness and the focus of my classes is to give a voice to the voiceless. I'm thrilled Common Ground is doing the same.

By YC Lai on
The CommonGround program elegantly brings together the following elements with their separate benefits: touchscreen-enabled interactive multimedia engages patients over multiple senses and presents a gentle learning curve. Decision-making tools are familiar to clinicians and they not only help save time but are evidence based. Peer counselors are examples of recovery and serve to encourage and empower patients to participate more actively in treatment and self-care. CommonGround is the most complete solution to my professional concerns that I have encountered to date.

By Pat Justis on
I am excited by this work but do want to ask that the AHRQ site consider not using the term "the mentally ill." People do not want their wholeness to be dwarfed by a label, so it is kinder and more humane to say "people living with mental illness." We do not call people with heart disease, "the heart diseased." I know my friend who lives with diabetes dislikes the term diabetic for the same reasons.This risks being perceived as nitpicky but my point is that language is powerful and we can use demeaning language through a lack of awareness. Let's stop the use of terms like "the mentally ill, diabetic and epileptic, and instead use language that retains the idea these are whole people with large identities beyond the illnesses they live with. Someone once called me out for using "wheelchair bound" and I was glad to become more aware of how I talked and wrote.

By Jonathan Delman on
CommonGround is a fantastic innovation for the mental health (psychiatric) world, where consumers/clients have been seen by providers as unwilling or incapable decision making partners. The fact is however that we have not been encouraged to participate, and studies show that we are very capable. (I'm a long-time consumer/client, as well as researcher/evaluator)My organization, Consumer Quality Initiatives, interviewed clinic clients about their experience using CommonGround, and they were overall very enthusiastic and found it to be user friendly. Most found the support in developing a Power statement to be very helpful in identifying the treatment they wanted. This in and of itself is a significant step forward in establishing shared decisioin makining as the norm in psych care. We are now observing how psychiatrists are able to work with an emppowered consumer. CommonGround is designed to provide support in that area, and I'm looking forward to seeing the results.Jonathan Delman, JD, MPH, PhD(cand.)

By Darlene Karpaski on
It's nice to see Commonground recognized as a healthcare innovation. In our eyes, it is a powerful multi-level innovation that transforms mental health care from the point of client contact up through the highest levels of the organization.We implemented it in our Pittsburgh based adult outpatient mental health clinic in March of 2008 and our clients and staff have been extremely satisfied with the outcomes and the process. Although computers are the interface for completing the report, we have had few denials from our clients since Pat Deegan and Associates makes the work so client friendly. Clients have a choice to either read through the report or listen in on headphones and the computer touch screens are a breeze. Most of our population is not computer literate but with the assistance of peer staff who work in the Commonground Shared Decision Making in Psychiatry Support Center our clients are learning about managing their medications and concerns at the same time they are learning how to use a computer! Our peer staff share their meaningful experiences to help our clients discover their own personal medicine and bring new courage and awareness into the medical visit.Our clients have reported having their thoughts more organized before seeing the doctor and so they are able to be more engaged in the process than just passively waiting to answer the doctors questions. In other words, because the doctor and client are both looking at the report together, they don't have to spend that 15 minute meeting just getting to the basics of what is happening with the client. They begin by already having the mental status exam, medication adherence and concerns about taking medications recorded.This makes the time more focused on answering client questions, discussing treatment options and risks and benefits and coming to a shared decision. My favorite aspect of this intervention is that the client has a copy of their own report and are no longer in the dark as to what the doctor is looking at while talking to them. In addition, this is the only document in our mental health arena that is completed by the client from the client point of view. In a system, where providers look and rely exclusively on other provider's points of view in making decisions "about" the client, we are the most fortunate center to fully and tangibly recognize the voice of the client in our work.Because this intervention is so client centered and holistic in nature, clients are beginning to see that in addition to medication adherence there are things that they can do to improve mood, reduce anxiety, concentrate, reduce the impact of voices etc. For many years, doctors and clients only focused on the medications as the answer. So clients became focused on getting the right medicine or right dose and putting the trust in the doctor that they could make them right again. Yet medication adherence wasn't always sound and even when clients fully adhered it didn't seem to be the complete answer to recovery. As we know, recovery isn't something we take, but something that those of us who have been diagnosed with mental illness do to help ourselves. So, in many ways using Commonground is like helping to gently and persistently awaken clients from a deep trance of dependency and passivity that is a consequence of the system we had in place for many years.Many of our doctors, clinicians, service coordinators, psychosocial rehabilitation and mobile medications programs have all transitioned away from giving people answers on how to be well to learning the client's personal medicine (things that people do to help themselves feel better). By helping clients access and learn to consistently use their own good intelligence, we have practically shifted (not philosophically) from the "provider as expert" role to a "facilitator role" that illuminates and honors the clients own historically helpful behaviors. So, instead of trying to "get people to use/try our ideas" we are coaching them to use their own wellness activities (things within their repertoire of behavior and are based on "their values and beliefs"). We are building a fire beneath client's feet and illuminating them in their rightful role as "expert."Of the many mental health best practices I have implemented in organizations, Commonground is the most tangible, transformative and empowering tool for providing authentic client centered services. It's been a true honor working with Pat Deegan and Associates and Community Care in establishing a full Peer Run Shared Decision Making Center in Psychiatry in our organization. We feel we have the very best partners in building recovery into the very infrastructure of how we do business.

By Gail Kubrin, MD on
I would like to make comments about Common Ground based on my experience working with this system at TCVMHMR, Inc, an urban community mental health center just outside of Pittsburgh, PA. I had the opportunity to work with Pat Deegan and the Common Ground approach from the time it was first introduced to TCVMHMR in March 2008 until I left that Agency in January 2010 for another position. I was enthusiastic about this program from the beginning and was part of the team that implemented its use at the Agency. It was usedthere(and still is being used) at a busy outpatient adult mental health clinic serving about 700 consumers.My professional experiences with Common Ground were more positive and wideranging than I had anticipated, even given that I already considered myself to be a recovery oriented clinician. The Common Ground approach was very helpful in fostering positive and organized communication between myself and my patients. The program, including the peer mentors, were helpful in decreasing anxiety, increasing knowledge and organization, and empowering consumers to be more genuinely involved in the decision making process of a medication visit. The concepts of Personal Medicine as well as the Power Statement helped people to be more committed to taking an active role in their lives and in their treatment. This in turn made my job more fulfilling because the medication visit was more like a partnership than a dictatorship. Obviously, the more involved and informed the individual, the more likely they are to adhere to treatment, to be open about concerns, to be honest about fears, side effects etc. This kind of dialogue was encouraged and occurred even in individuals who had significant thought disorder and had previously been rather uncommunicative. The program also seemed to allow people to bring up issues that may have been somewhat threatening or embarrassing without the aid of the computer report. In addition, the Common Ground program provides a rich source of information about recovery, mental illness, medications, drug and alcohol programs as well as medical illnesses common in individuals with severe and persistent mental illness.Initially the Common Ground approach did take somewhat longer than the usual medication visit. However, once I became familiar with the program, the time was similar to the usual med check but the quality was generally much improved. The areas of concern were easier to identify at a given visit and progress was easier to track from visit to visit by using the report generated by the client as well as the shared decision that we made at each visit. In addition, by seeing the individual's Power Statement and Personal Medication information, I learned many things about each individual and what is most important to him or her. This is not only interesting but also crucial to help individuals stay motivated to continue in treatment and working toward those goals that are most important to them.The use of Common Ground involves a commitment of time and money but I am convinced that the improved quality of care obtained is well worth it. Although I am not currently at a facility that uses Common Ground, that may change in the future. And it has certainly changed the way I think about medication treatment with my patients.
Original Publication: 07/07/10

Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last Updated: 08/27/13

Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: 07/09/13

Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read Health Care Innovations Exchange Disclaimer.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information: verify here.