兰德-加利福尼亚州多县精神病学高级指令创新项目评估-2024年早期实施和成果（英）

DANIEL SICONOLFI, JULIA BANDINI, CRISTINA GLAVE, ALEJANDRO ROA CONTRERAS, SKYE A. MINER, COURTNEY ANN KASE, JACOBO PEREIRA-PACHECO, NICOLE K. EBERHARTEvaluation of California’s Multi-County Psychiatric Advance Directives Innovation ProjectEarly Implementation and Outcomes, 2024–2025Psychiatric advance directives (PADs) allow individuals with mental health conditions to document preferences for care that they might not otherwise be able to communicate during a crisis. For example, PADs may allow an individual to specify preferred treatments, pre-ferred approaches to communication and deescalation, desired surrogate decisionmakers or advocates, and other important health information (e.g., concurrent medications or allergies). Despite their potential benefits, PADs have had relatively limited awareness and uptake (The Joint Commission, 2020; Substance Abuse and Mental Health Services Administration [SAMHSA], 2019).As a legal document, a PAD can be cumbersome to complete. Additionally, the preferences and values captured by a PAD may draw from an individual’s past experiences with mental health treat-ment and hypothetical future scenarios (e.g., significant symptoms that constitute a crisis). Reflect-ing on these past experiences can be distressing, and envisioning future scenarios may be difficult. Given the low levels of awareness and potential challenges in completing a PAD independently, PAD initiatives have typically included outreach and facilitation—for example, by clinicians, advocates, or peer workers (Swanson et al., 2006; Tinland et al., 2022). Peer workers (e.g., Peer Support Special-ists) are individuals with lived experience related to mental health or substance use needs, or family members of an individual with mental health or substance use needs, who provide a variety of sup-ports within communities (California Mental Health Services Authority, undated). Prior research and evaluation on the facilitation of PADs have focused less on peer workers than on other facilita-tors (e.g., health care providers), with a few recent exceptions (e.g., Tinland et al., 2022).Evaluation Report2In 2021 and 2022, seven California counties began collaborating on a Mental Health Services Act Innovation Project intended to increase the avail-ability and uptake of PADs among individuals with mental health needs, supported by peer worker facili-tation. The participating counties were Contra Costa, Fresno, Mariposa, Monterey, Orange, Shasta, and Tri-City.1 The PADs Innovation Project developed a new, universal PAD template for Californians, drawing on extensive stakeholder input from individuals with lived experience and advocates. In tandem with the new template, the Innovation Project funded the creation of a web-based platform for individuals to create, store, update as desired, and potentially share their PAD. During this phase of the project, participating counties engaged in beta testing of the platform with small, defined groups of priority popu-lati