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Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

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Date
2017-04-03
Authors
Easter, Michele M
Swanson, Jeffrey W
Robertson, Allison G
Moser, Lorna L
Swartz, Marvin S
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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 article
Subject
Advance directives/proxies
Assertive community treatment
Community mental health services
Recovery
Staff relationships/roles
Permalink
https://hdl.handle.net/10161/14229
Published Version (Please cite this version)
10.1176/appi.ps.201600423
Publication 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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Scholars@Duke

Easter

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
Gilbert

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.
Swanson

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
Swartz

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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