Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness of DECIDE in Patient-Provider Communication, Therapeutic Alliance & Care Continuation
Brief Summary: The purpose of this study is to learn more about how patients and healthcare providers interact in order to improve shared decision making. The investigators plan to test an intervention with two separate educational components-one for patients and one for providers-designed to encourage patients to ask questions and increase their level of involvement in their own care, while simultaneously training providers to be more receptive to patients' questions and concerns. Patients in the intervention group will receive three short (30-45 minute) trainings focused on developing and asking questions and will be interviewed three times over the course of the intervention to see how it has affected the quality of their care. Providers receiving the intervention will participate in three separate trainings, including a 12-hour group workshop, an additional two hour training, and six hours of individual instruction, including personalized feedback based on three audio-recorded patient visits. Previous studies looking at patient engagement and involvement in decision-making have shown that increased engagement is linked with improved outcomes, but that providers are sometimes not prepared to develop a collaborative relationship with patients. The investigators think that training both patients and providers to work together and communicate more effectively will improve quality of care and increase patient satisfaction more than interventions that focus on only one side of the clinical encounter. One of the major goals in studying patient-provider communication is to improve shared decision-making and see how it contributes to racial and ethnic disparities in mental health care, since minority patients have been shown to be less involved in care and have been shown to be perceived and treated differently by providers.


Options:
A: Inclusion Criteria:

* currently receive services in the VASDHS PRRC

  * i.e., seen in the clinic in the past month and/or completed a PRRC group during the past trimester
* have an SMI diagnosis per the electronic medical record

  * e.g., schizophrenia, schizoaffective disorder, delusional disorder, and major depressive disorder with psychotic features
* agree to have a subset of treatment appointments audiotaped

Exclusion Criteria:

* having primary substance use or organic neurological disorder diagnosis
* are determined by PRRC and/or study staff to be at significant risk of exacerbation of symptoms, suicidal ideation, or other risk due to study participation
* have a history and/or current risk of violence that PRRC and/or study staff determine to be too high risk to manage effectively at the PRRC's outpatient clinic location (which has less police presence than the primary VASDHS hospital location)
B: Patient Inclusion Criteria:

-Patients ages 18-80 who are receiving mental health treatment at one of the collaborating clinics.

Patient Exclusion Criteria:

-Patients will be excluded if they screen with mania, psychosis, or suicidality to ensure their safety and minimize the stress of receiving the intervention. Patients over the age of 65 will be assessed with a cognitive functioning screening instrument and excluded if possible cognitive impairment is indicated.

Provider Inclusion Criteria:

-Providers will be permitted to participate in this study if they are regular, paid staff that provide behavioral health services at any of the participating clinics. No other criteria will be required.
C: Inclusion Criteria:

* Age 60 years and older
* Moderate to severe levels of worry

Exclusion Criteria:

* Currently receiving psychotherapy
* Currently practicing yoga
* Active alcohol/substance abuse
* Dementia
* Current psychotic symptoms
* Active suicidal ideation with plan and intent
* Hearing loss that would prevent a person from participating in telephone/class sessions
D: Inclusion Criteria:

At least three visits to the General Mental Health Clinic's BHIP team in prior year

Exclusion Criteria:

Chart evidence of dementia

Answer: B