title: A qualitative analysis of implementing shared decision making in Child and Adolescent Mental Health Services in the United Kingdom: Stages and facilitators.
abstract: OBJECTIVE
  To explore the implementation of shared decision making (SDM) in Child and Adolescent Mental Health Services (CAMHS), and identify clinician-determined facilitators to SDM.
  
  
  METHODS
  Professionals from four UK CAMHS tried a range of tools to support SDM. They reflected on their experiences using plan-do-study-act log books. A total of 23 professionals completed 307 logs, which were transcribed and analysed using Framework Analysis in Atlas.Ti.
  
  
  RESULTS
  Three states of implementation (apprehension, feeling clunky, and integration) and three aspects of clinician behavior or approach (effort, trust, and flexibility) were identified.
  
  
  CONCLUSIONS
  Implementation of SDM in CAMHS requires key positive clinician behaviors, including preparedness to put in effort, trust in young people, and use of the approach flexibly.
  
  
  CONCLUSIONS
  Implementation of SDM in CAMHS is effortful, and while tools may help support SDM, clinicians need to be allowed to use the tools flexibly to allow them to move from a state of apprehension through a sense of feeling "clunky" to integration in practice.
authors.affiliation: EBPU, Anna Freud Centre and UCL, London, UK Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
authors.forename: Neus
authors.initials: N
authors.lastname: Abrines-Jaume
authors.affiliation: Anna Freud Centre and UCL, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Midgley
authors.affiliation: EBPU, Anna Freud Centre and UCL, London, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Hopkins
authors.affiliation: EBPU, Anna Freud Centre and UCL, London, UK.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Hoffman
authors.affiliation: Common Room Consulting Ltd, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Martin
authors.affiliation: Child Outcomes Research Consortium, London, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Law
authors.affiliation: EBPU, Anna Freud Centre and UCL, London, UK EBPU@annafreud.org.
authors.forename: Miranda
authors.initials: M
authors.lastname: Wolpert
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D002648:Child; D002662:Child Health Services; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010358:Patient Participation; D036301:Qualitative Research; D006113:United Kingdom
keywords: Child and Adolescent Mental Health Services; Shared decision making; child mental health; implementation; plan-do-study-act