Values-based practice (VBP) is a set of skills, principles and knowledge. VBP has been a key part of the changes to training in adult mental health, particularly in the recovery programme and person-centred care.

VBP gives a structure to the practice of shared decision making, in particular, the need to consider both values and evidence when engaged in making decisions with children, young people, carers and the wider system.

Values are about what matters or is important to us. The Report of the Commission for Values-based CAMHS describes what people really want from services (RCPsych 2016).

• In clinical encounters, children, young people and parents wanted better relationships that were more collaborative, non-judgemental and focused on self-reliance
• People did not want problems overly 'medicalised'
• They also valued good communication and involvement in decision making that was focused on goals that mattered to them (particularly around school, the future and friends)
• Professionals said they sometimes felt under valued and often excluded from decisions, and school staff in particular felt disconnected from other parts of the CAMHS system
• Whole system integration was poor overall

VBP is a process that supports clinical decisions where diverse values are in play. It consists of ten key elements:

Four clinical skill areas

• Awareness: Awareness of values and of differences of values
• Knowledge: Knowledge retrieval and its limitations
• Reasoning: Used to explore the values in play rather than to ‘solve’ dilemmas
• Communication: Especially for eliciting values of conflict resolution

Two aspects of clinical relationships

• Person-values-centred care: Care centred on the actual, rather than the assumed, values of the patient (while at the same time being aware of the values of other people involved)
• Extended Multidisciplinary Team (MDT): MDT role extended to include a range of value perspectives as well as of knowledge and skills. Seek the likely views of other agencies as well as your own

Three principles linking values and evidence

• Two feet principle: All decisions are based on the two feet of both values and evidence
• Squeaky wheel principle: We notice values when they cause difficulties (like the squeaky wheel) but (like the wheel that doesn’t squeak) they are always there and operative
• Science-driven principle: Advances in medical science drive the need for VBP because they open up choices and with choices go values

Partnership in shared decision making

Decisions in VBP (although informed by clinical guidelines and other evidence based sources) are ultimately to be made by those directly concerned, working together in partnership.

Note: VBP aspires to include all key persons indecision making. Often this is not possible in clinical practice. Those present may need to raise questions such as; "What are X's values and opinions on this matter?" or "What would Y say if they were here today" and "Who else has important views, values or information about this matter?".

Partnership decisions made in this way recognise difference of opinion (real and potential), but do not necessarily delay decision making.

Questions:

1. What do you think we mean by ‘values’ in a working context?
2. What are some values that are important to you?
3. How do you explore the values of your patients and their parents?
4. How do you help them weigh up the two footprints, values and evidence?
5. In a Multidisciplinary team (MDT) what are the values you think everyone can share?
6. Do you think the team you work in are clear about their shared values? If not, how do you approach this?
7. In your work, do you see evidence of decisions made in partnership with patients and those in your working environment?

References and further reading

MindEd , free open access online learning; collection of topics on values, collaborative working, partnership and leadership in children and young people’s care and services, for any adult working with children and young people.

Values Based Mental Health

The Collaborative Care Model

Partnership, Collaboration and DeliveringHigh-quality Care

Evidence-based Clinical Decision-making

Communicating With Families

Coll X, Papageorgiou A, Stanley A et al.Communication Skills in Mental Health Care: An Introduction. CRC Press, 2012

The National Institute for Mental Health inEngland (NIMHE) and the Care Services Improvement Partnership (CSIP). 3 Keys to a shared approach in mental health assessment. 2008; London: Department ofHealth View document

Neighbour R. The Inner Consultation: How toDevelop an Effective and Intuitive Consulting Style. 2nd edn. Routledge, 2015

Royal College of Psychiatrists. Values-Based Child and Adolescent Mental Health System Commission. What really matters in children and young people’s mental health: full report. 2016; London: RCPsych View document

Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. 3rd edn. Boca Raton,Florida: CRC Press, 2013