Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.
Date
2017-04-03
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
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
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Easter, Michele M, Jeffrey W Swanson, Allison G Robertson, Lorna L Moser and Marvin S Swartz (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.
Collections
Scholars@Duke
Michele Easter
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 Science & Justice at Duke School of Law, our research agenda focuses on reducing criminal justice contact among people with mental illness and substance use disorders. We also collaborate with community partners to study and promote the use of psychiatric advance directives. Currently, my research interests center on people with mental illness, substance use, and/or unmet social needs who are stuck in a 'revolving door' of incarceration, crisis care, and detox; I hope this work will make a positive difference in the lives of people in Durham and beyond. I am also interested in the conceptualization of illness and recovery by people with behavioral disorders, specifically the extent to which they endorse and identify with biologically-based explanatory models. My dissertation was on how women with eating disorders understand and interpret the idea that genes play a role in eating disorders.
Jeffrey W. Swanson
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, policies and laws to improve outcomes for adults with serious mental illnesses in the community, and to reduce firearm-related violence and suicide. He is an author of over 250 publications on subjects including the social environmental context of violence in mental illness, implementation of state firearm restrictions related to mental health adjudications, effectiveness of involuntary outpatient commitment, and psychiatric advance directives. Swanson led the research group that published the first empirical evaluations of risk-based, temporary firearm removal laws in Indiana and Connecticut, precursors to Extreme Risk Protection Order laws that were later adopted in many states. He received the 2020 Isaac Ray Award from the American Psychiatric Association and the American Academy of Psychiatry and Law for outstanding contributions to the psychiatric aspects of jurisprudence. He received the 2011 Carl Taube Award from the American Public Health Association for outstanding contributions to mental health services research. Swanson serves on the Executive Steering Committee of the Consortium for Risk-Based Firearm Policy. He previously served as a member of the John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment and the Methods Core of the Robert Wood Johnson Foundation Public Health Law Research Program. He has delivered numerous endowed lectures including the P. Browning Hoffman Memorial Lecture in Law and Psychiatry at the University of Virginia School of Law and the Raymond W. Waggoner Lecture on Ethics and Values in Medicine at the University of Michigan. Swanson frequently comments on gun violence in the national media and serves as a consultant to policymakers at the federal and state levels.
Allison Gilbert
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.
Marvin Stanley Swartz
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 Mandated Community Treatment. In this and related work we are examining the role legal tools such as Psychiatric Advance Directives may play in improving outcomes for persons with severe mental illness. In this regard, I served as Co-PI with Jeffrey Swanson of a NIMH study examining the effectiveness of Psychiatric Advance Directives and a MacArthur Foundation grant supporting their dissemination. We are also evaluating New York's Assisted Outpatient Treatment Program (Kendra's Law) and estimating the cost of criminal justice involvement in severely mentally ill individuals.
I am also involved in clinical trials in schizophrenia and served as Co-PI of the NIMH funded Clinical Antipsychotics Trials of Intervention Effectiveness study investigating the role of antipsychotics in treatment outcomes in schizophrenia and Alzheimer’s Disease.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.