# Improving Collaborative Decision Making in Veterans with Serious Mental Illness

> **NIH VA IK2** · VA SAN DIEGO HEALTHCARE SYSTEM · 2022 · —

## Abstract

Recovery-oriented care is an imperative for the VA, particularly in mental health programming for Veterans with
serious mental illness (SMI). Collaborative decision-making (CDM) is a recovery-oriented approach to
treatment decision-making that assigns equal participation and obligation to patients and providers across all
aspects of decision-making, thereby empowering patients and facilitating better decision-making based on
patient values and preferences. CDM is associated with several important outcomes including improved
treatment engagement, treatment satisfaction, and social functioning. However, current levels of CDM among
Veterans with SMI are low, and there is not yet an evidence-based method to improve CDM. Improving
Veteran skill sets associated with engaging in CDM is a potential intervention strategy. Collaborative Decision
Skills Training (CDST) is a promising new intervention that was previously developed by the applicant for use
in adult civilians with SMI and found to improve relevant skills and improve sense of personal recovery.
The proposed study has two primary stages. First, a small, one-armed, open label trial will establish CDST's
feasibility will evaluate CDST among 12 Veterans with SMI receiving services at the VA San Diego
Psychosocial Rehabilitation and Recovery Center (PRRC) and identify and complete any needed adaptations
to CDST. Stakeholder feedback from Veterans, VA clinicians, and VA administrators will be collected to assess
Veteran needs and service context to identify any needed adaptations to the CDST manual or the delivery of
CDST to maximize its impact and feasibility. The developers of CDST (the applicant and Dr. William Spaulding,
a consultant) will review all feedback and make final decisions about adaptations to ensure that CDST retains
its essential components to protect against loss of efficacy. For example, a recommendation to adjust role-play
topics to better reflect the needs of Veterans would be accepted because it would increase CDST's relevance
without impairing its integrity, but a recommendation to remove all role-plays would not be accepted because it
would cause loss of a key component.
Second, CDST will be compared to active control (AC) using a randomized clinical trial of 72 Veterans. The
primary outcome measure will be functioning within the rehabilitation context, operationalized as frequency of
Veteran CDM behaviors during Veteran-provider interactions. Secondary outcomes are treatment attendance,
engagement, satisfaction, and motivation, along with treatment outcomes (i.e., rehabilitation goal attainment,
sense of personal recovery, symptom severity, and social functioning). Three exploratory outcomes will be
assessed: Veteran-initiated collaborative behaviors, acute service use and provider attitudes and behavior.
Veterans will be randomly assigned to CDST or AC conditions. Veterans in the both groups will attend eight
hour-long group sessions held over eight weeks. All Veterans will ...

## Key facts

- **NIH application ID:** 10400016
- **Project number:** 5IK2RX003079-03
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Emily Treichler
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10400016

## Citation

> US National Institutes of Health, RePORTER application 10400016, Improving Collaborative Decision Making in Veterans with Serious Mental Illness (5IK2RX003079-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10400016. Licensed CC0.

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