Use of Leverage to Improve Adherence to Psychiatric Treatment in the Community

Monahan, John; Redlich, Allison D.; Swanson, Jeffrey W.; Robbins, Pamela Clark; Appelbaum, Paul S.; Petrila, John; Steadman, Henry J.; Swartz, Marvin S.; Angell, Beth; McNiel, Dale E.

doi:10.1176/appi.ps.56.1.37

Cited by 190 publications

(143 citation statements)

References 19 publications

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“…Other team members were trained in motivational interviewing. Ideally, each team would have at least one full-time substance abuse (Monahan et al, 2005) specialist associated with the clinical ward for dually diagnosed patients (DD Ward) which was set up in 2004 as part of the transmural care system. In conjunction with other regions, we have set up a program to train former patients as future co-workers; the first of these started working in 2006.…”

Section: Further Developments and Resultsmentioning

confidence: 99%

FACT: A Dutch Version of ACT

Veldhuizen

2007

Community Ment Health J

195

201

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Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill in the community. We have opted for a Dutch version named ÔFunctionÕ ACT or FACT. In a FACT team, ACT is one of the functions that the team can perform. For more stable long-term patients FACT provides coordinated multidisciplinary treatment and care by individual case management. Unstable patients at risk of relapse are followed with assertive outreach care by the same team, working with a shared caseload for this subgroup. This article describes the service model and everyday practice in FACT.

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Section: Further Developments and Resultsmentioning

confidence: 99%

FACT: A Dutch Version of ACT

Veldhuizen

2007

Community Ment Health J

195

201

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“…The data set has been described previously (15). In brief, 1,011 patients from publicly funded mental health programs were sampled from five sites: Chicago; Durham, North Carolina; San Francisco; Tampa, Florida; and Worcester, Massachusetts.…”

Section: Methodsmentioning

confidence: 99%

Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

Busch¹,

Redlich²

2007

Psychiatric Services

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Objective-This study explored whether parents treated in public mental health settings perceived that they might lose child custody or visitation if they were not adherent to treatment.Methods-Interview data were gathered from 1,011 adult outpatients from five community mental health centers located in five states in different U.S. regions.Results-Among parents with children younger than 16 (N=187), 19% perceived in the past six months that they might lose child custody or visitation if they were not adherent to treatment. Twothirds of the identified sources of this perception were family, themselves, or individuals outside the treatment, welfare, or legal systems.Conclusions-These preliminary data indicate that the perception of possible loss of child custody or visitation for nonadherence to treatment is not uncommon among patients treated in these public mental health settings and that "informal" sources are often the perceived source. Further study regarding the effects of this perception on patient and family outcomes is needed.

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“…Other Covariates-Independent variables were selected for analysis on the basis of prior studies of the correlates of psychiatric advance directives (10,20 …”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…Other Covariates-Independent variables were selected for analysis on the basis of prior studies of the correlates of psychiatric advance directives (10,20). We dichotomized covariates if warranted by their distribution or nonlinear association with the outcomes.…”

Section: Short-term Outcomementioning

confidence: 99%

Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness

Swanson

Swartz

Elbogen³

et al. 2006

Am J Psychiatry

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116

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Objective-Studies show a high potential demand for psychiatric advance directives but low completion rates. The authors conducted a randomized study of a structured, manualized intervention to facilitate completion of psychiatric advance directives.Method-A total of 469 patients with severe mental illness were randomly assigned to a facilitated psychiatric advance directive session or a control group that received written information about psychiatric advance directives and referral to resources in the public mental health system. Completion of an advance directive, its structure and content, and its short-term effects on working alliance and treatment satisfaction were recorded.Results-Sixty-one percent of participants in the facilitated session completed an advance directive or authorized a proxy decision maker, compared with only 3% of control group participants. Psychiatrists rated the advance directives as highly consistent with standards of community practice. Most participants used the advance directive to refuse some medications and to express preferences for admission to specific hospitals and not others, although none used an advance directive to refuse all treatment. At 1-month follow-up, participants in the facilitated session had a greater working alliance with their clinicians and were more likely than those in the control group to report receiving the mental health services they believed they needed.Conclusions-The facilitation session is an effective method of helping patients complete psychiatric advance directives and ensuring that the documents contain useful information about patients' treatment preferences. Achieving the promise of psychiatric advance directives may require system-level policies to embed facilitation of these instruments in usual-care care settings.A psychiatric advance directive is a legal document that allows a patient to consent to or refuse future mental health treatment in the event of an incapacitating psychiatric crisis by documenting advance instructions or appointing a surrogate decision maker (1). Laws on psychiatric advance directives were intended to support patients' self-determination at times when they are particularly vulnerable to loss of autonomy, to help them ensure that their preferences are known, and to minimize unwanted or involuntary treatment (2, 3). Advocates for psychiatric advance directives hope that the very process of preparing these documents will enhance patients' sense of trust and collaboration with providers, thereby improving the therapeutic alliance and engagement with treatment (4, 5).Address correspondence and reprint requests to Dr. Swanson, Box 3071, Duke University Medical Center, Durham, NC 27710; jeffrey.swanson@duke.edu.. NIH Public Access Author ManuscriptAm J Psychiatry. Author manuscript; available in PMC 2013 August 20.Published in final edited form as: Am J Psychiatry. 2006 November ; 163(11): 1943-1951. doi:10.1176/appi.ajp.163.11.1943 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptStructu...

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Use of Leverage to Improve Adherence to Psychiatric Treatment in the Community

Cited by 190 publications

References 19 publications

FACT: A Dutch Version of ACT

FACT: A Dutch Version of ACT

Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness

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