Services Effectiveness Research Program (SERP)

Duke University School of Medicine
Department of Psychiatry and Behavioral Sciences

Current and Recent Projects

Title: Effectively Implementing Psychiatric Advance Directives

Sponsor: National Institute of Mental Health & John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment

Principal Investigator(s): Jeffrey Swanson, PhD; Marvin Swartz, MD

SERP Investigators & Collaborators: Eric Elbogen, PhD; Richard Van Dorn, PhD; Ryan Wagner, PhD; Lorna Moser, PhD; Christine Wilder, MD; Allison R. Gilbert, PhD

Project Description: We conducted a randomized trial of Facilitated Psychiatric Advance Directives (F-PAD), a manualized service intervention that provides orientation, consultation, and structured personal assistance to people who wish to complete legal PADs and/or assign Health Care Power of Attorney (HCPA) for their mental healthcare during any future periods of decisional incapacity. We also observed the process of PAD implementation in a one-year follow-up of subjects enrolled in the study. Specifically, N=469 subjects with severe mental illness (SMI) in community-based treatment were enrolled and randomly assigned to one of two groups: (A) the F-PAD intervention group; or (B) a usual care control group. With a one-month follow-up assessment, we examined the short-term effects of the F-PAD intervention on PAD/HCPA initiation, completion, PAD structure and instructional content. With follow-up assessments at 1 month, 6 months, and 12-months, we examined whether and how PADs are implemented and the effect of PADs on several outcomes. By analyzing these data with multivariate regression and other appropriate statistical modeling techniques, and by standard systematic textual analysis of qualitative interview transcripts, we accomplished the following specific aims:

  1. Evaluate the effectiveness of a manualized, pilot-tested service intervention (F-PAD).
  2. Evaluate the content and structure of PAD documents.
  3. Examine the effects of the F-PAD intervention and PAD/HCPA structure and content on consumers' engagement in the outpatient treatment process.
  4. Examine PAD implementation around mental health crises.

Analyze, summarize, and disseminate basic information about a state's experience in implementing PADs within a public system of care for persons with SMI.