Psychiatric advance directives (PADs) allow competent persons to declare their treatment preferences and designate a proxy decision maker in advance of a mental health crisis when they may lose capacity to make reliable healthcare decisions. Fifteen states have adopted PAD legislation, yet little research has been conducted to answer emerging policy questions: What is the demand for PADs among consumers? Is formal assistance necessary to facilitate effective PADs? Do PADs conform with clinical judgments of appropriate treatment? How are PADs actually used and enforced in practice settings? Do PADs with certain features enhance treatment engagement, improve the process of care surrounding psychiatric crises, and provide a greater sense of autonomy for persons with severe mental illness (SMI)? Might PADs have negative consequences, e.g., if prepared without adequate comprehension or instructions, or if not implemented as planned? The proposed study will address these questions as follows: (1) Conduct a randomized trial of Facilitated Psychiatric Advance Directives (F-PAD), a manualized, pilot-tested intervention to assist consumers in completing PADs; (2) Examine the implementation of PADs over 1 year) in a sample of N=400 consumers with SMI in North Carolina. Subjects will be randomly assigned to the FPAD intervention or a """"""""usual care"""""""" control group. F-PAD subjects will be given individualized orientation and assistance in completing a template-structured PAD and healthcare power of attorney (HCPA) document if they wish. Control subjects will receive a brief orientation to PADs (as part of informed consent to the study), written material, an opportunity to attend a group education meeting about PADs, and the telephone number of a consumer organization that provides consultation regarding PADs. Clinicians and proxies will also be given orientation regarding PADs. Subjects and their clinicians will be followed up with a structured interview at 1 month and 12 months to examine the rate of completion of PADs/HCPA, their structure and content, subsequent treatment engagement and crisis management outcomes. PAD/HCPA documents will be electronically stored with the U.S. Living Will Registry, which provides automated access to advance care documents. The proposed study will provide information about a state's experience with PADs so that policymakers may be guided in implementing PADs elsewhere.
| Tueller, Stephen J; Johnson, Kiersten L; Grimm, Kevin J et al. (2017) Effects of sample size and distributional assumptions on competing models of the factor structure of the PANSS and BPRS. Int J Methods Psychiatr Res 26: |
| Johnson, Kiersten L; Desmarais, Sarah L; Tueller, Stephen J et al. (2016) A longitudinal analysis of the overlap between violence and victimization among adults with mental illnesses. Psychiatry Res 246:203-210 |
| Van Dorn, Richard A; Desmarais, Sarah L; Grimm, Kevin J et al. (2016) The latent structure of psychiatric symptoms across mental disorders as measured with the PANSS and BPRS-18. Psychiatry Res 245:83-90 |
| Desmarais, Sarah L; Van Dorn, Richard A; Johnson, Kiersten L et al. (2014) Community violence perpetration and victimization among adults with mental illnesses. Am J Public Health 104:2342-9 |
| Wilder, Christine M; Elbogen, Eric B; Moser, Lorna L et al. (2010) Medication preferences and adherence among individuals with severe mental illness and psychiatric advance directives. Psychiatr Serv 61:380-5 |
| Van Dorn, Richard A; Scheyett, Anna; Swanson, Jeffrey W et al. (2010) Psychiatric advance directives and social workers: an integrative review. Soc Work 55:157-67 |
| Van Dorn, Richard A; Swanson, Jeffrey W; Swartz, Marvin S (2009) Preferences for psychiatric advance directives among Latinos: views on advance care planning for mental health. Psychiatr Serv 60:1383-5 |
| Van Dorn, Richard A; Swanson, Jeffrey W; Swartz, Marvin S et al. (2008) Reducing barriers to completing psychiatric advance directives. Adm Policy Ment Health 35:440-8 |
| Swanson, Jeffrey W; Swartz, Marvin S; Elbogen, Eric B et al. (2008) Psychiatric advance directives and reduction of coercive crisis interventions. J Ment Health 17:255-267 |
| Wilder, Christine M; Elbogen, Eric B; Swartz, Marvin S et al. (2007) Effect of patients'reasons for refusing treatment on implementing psychiatric advance directives. Psychiatr Serv 58:1348-50 |
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