Browsing by Author "Robertson, Allison G"
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Item Open Access Extended-release naltrexone and drug treatment courts: Policy and evidence for implementing an evidence-based treatment.(J Subst Abuse Treat, 2017-02-28) Robertson, Allison G; Swartz, Marvin SWith insufficient access to treatment and a tradition of criminalizing addiction, people with substance use disorders - including opioid dependence - are more likely to be incarcerated than they are to receive the treatment they need. Drug treatment courts aim to address this problem, engaging their participants in substance use treatment in lieu of incarceration. Drug courts offer an especially important window of opportunity to connect opioid-dependent participants to extended-release naltrexone (XR-NTX), at a time when they are under highly-structured court supervision and required to detoxify from opioids to participate. Given the high cost of XR-NTX and high rates of uninsurance in the drug court population, new rigorous cost-effectiveness evidence is needed to demonstrate the extent to which XR-NTX improves program outcomes, including by reducing recidivism. With that new evidence, drug courts and the counties in which they are situated can make informed and difficult policy decisions about funding XR-NTX for some of their highest-risk community members.Item Open Access Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.(Psychiatr Serv, 2017-04-03) Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; Swartz, Marvin SOBJECTIVE: Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. METHODS: A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. RESULTS: The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. CONCLUSIONS: Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.Item Open Access Implementing Psychiatric Advance Directives: The Transmitter and Receiver Problem and the Neglected Right to Be Deemed Incapable.(Psychiatric services (Washington, D.C.), 2020-12-18) Swartz, Marvin S; Swanson, Jeffrey W; Easter, Michele M; Robertson, Allison GPsychiatric advance directives (PADs) can help adults with serious mental illnesses preserve their autonomy and avoid involuntary interventions during an incapacitating mental health crisis. A PAD is a legal document prepared while mentally competent and states the person's treatment preferences to be implemented during a future crisis, ideally with the advocacy of an authorized proxy decision maker. PADs have been available in the United States for more than three decades but have yet to be robustly implemented in practice. This Open Forum describes PADs metaphorically as a device for remote communication among the person with mental illness, a proxy decision maker, and health care providers. Barriers to PAD usage occur on both "transmitter" and "receiver" sides and must be addressed to advance PAD implementation.