Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.
Abstract
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.
Type
Journal articleSubject
Advance directives/proxiesAssertive community treatment
Community mental health services
Recovery
Staff relationships/roles
Permalink
https://hdl.handle.net/10161/14229Published Version (Please cite this version)
10.1176/appi.ps.201600423Publication Info
Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; & Swartz,
Marvin S (2017). Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive
Community Treatment Teams. Psychiatr Serv. 10.1176/appi.ps.201600423. Retrieved from https://hdl.handle.net/10161/14229.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Michele Easter
Assistant Professor in Psychiatry and Behavioral Sciences
At the Services Effectiveness Research Program, I am a co-investigator, analyst, and
manager for projects on mental health/substance use services and policy research.
Our group conducts longitudinal studies of criminal justice outcomes and crisis-driven
service utilization to assess the effects of policies (e.g., mental health-based firearms
disqualification) and services (e.g., medication-assisted treatment for substance
dependence). As the Behavioral Health Core of the Wilson Center for Scienc
Allison Gilbert
Associate 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.
Jeffrey W. Swanson
Professor in Psychiatry and Behavioral Sciences
Jeffrey Swanson is Professor in Psychiatry and Behavioral Sciences at Duke University
School of Medicine. He is a faculty affiliate of the Wilson Center for Science and
Justice at Duke Law School, the Center for Firearms Law at Duke Law School, and the
Center for Child and Family Policy at Duke Sanford School of Public Policy. Swanson
holds a PhD in sociology from Yale University. He is a social scientist researcher
who collaborates across disciplines to build evidence for interventions, poli
Marvin Stanley Swartz
Professor of 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, criminal justice outcomes for persons with mental
illnesses, violence and mental illness and antipsychotic medications. I also served
as member of the MacArthur Foundation Research Network on Mandate
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