Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.
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OBJECTIVE: 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.
Assertive community treatment
Community mental health services
Published Version (Please cite this version)10.1176/appi.ps.201600423
Publication InfoEaster, MM; Moser, LL; Robertson, Allison Gilbert; Swanson, JW; & Swartz, Marvin Stanley (2017). Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams. Psychiatr Serv. 10.1176/appi.ps.201600423. Retrieved from http://hdl.handle.net/10161/14229.
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Assistant Professor in Psychiatry and Behavioral Sciences
Research interests include mental health and substance abuse services and policy; links between mental illness, substance abuse and criminal justice involvement; effectiveness of criminal diversion and prison re-entry programs for adults with serious mental illness; and other legal and policy mechanism as mental health interventions.
Professor in Psychiatry and Behavioral Sciences
My major research interest is in examining the effectiveness of services for severely mentally ill individuals, including factors that improve or impede good outcomes. Current research includes: the effectiveness of involuntary outpatient commitment, psychiatric advance directives and antipsychotic medications. I also served as member of the MacArthur Foundation Research Network on Mandated Community Treatment. In this and related work we are examining the role legal tools such
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