Background and Context*: Californians with a mental health conditions continue to face high rates of recidivism exacerbated by inpatient non-voluntary hospitalization, homelessness, and incarceration. These problems persist despite the state’s efforts to avoid or reduce high rates of involuntary hospitalizations and incarceration, without appreciable success. To address these issues, the California Mental Health Services Oversight and Accountability Commission (MHSOAC) utilized their “Innovation Funds” to test and demonstrate the accessibility and use of psychiatric advanced directives (PADs) by people with mental health challenges (Peers) and public and private stakeholder agencies who serve them. PADs are a form of self-determination that results in creation of a legal document that specifies the preferences that Peers have for treatment and support when they are in crisis situations and unable to make their own decisions. A key feature of the PADs Innovation Project is the development of a web-based application that is expected to improve more rapid access and use of PADs by Peers and also by community stakeholder agencies including law enforcement and first responders who may encounter Peers when they are in crisis. PADs Innovation Funds were provided to 7 California counties (Orange, Monterey, Mariposa, Contra Costa, Tri-City, Fresno, and Shasta) to implement their PADs projects. Peer pilot populations to be served through the project in these 7 counties are those with significant challenges affecting their successful community integration and recovery, including homelessness, criminal justice involvement and other conditions, in addition to their mental health challenges.
Summary of the Project: The Orange County Health Care Agency has contracted with BBI for a three-year period to evaluate the processes and outcomes associated with development, implementation, and dissemination of the PADs web-based technology platform using funds provided by the MHSOAC. BBI will conduct its evaluation in each of the 7 California counties participating in the project. BBI’s evaluation also intends to identify key implementation and knowledge dissemination factors that challenge or enable the easy access to training, materials, creation, storage, and review of PADs on its web-based platform. BBI will explore how improved availability and use of PADs through its innovative technology features contributes to positive systems and services changes needed to overcome the barriers to effective treatment, rehabilitation, recovery and support needed by Californians with mental health challenges. We will use a mixed methods evaluation approach that includes interviews and focus groups with Peers and interviews with County PADs Managers and community stakeholders to obtain their perspectives on the development, implementation, and effective use of the PADs technology platform.
How the Project Addresses Areas of Need: The objective of our evaluation is to determine how the proposed PADs web-based platform is accessible and useable by the 7 counties’ designated Peer priority populations and their community stakeholder agencies who are likely to respond to them when they are in crisis. The project is unique in demonstrating how a quickly available, Peer-directed PADs legal document might reduce the need for involuntary institutionalization, improve appropriate responses by law enforcement and other first responders, and reduce the chances for physical and emotional harm to Peers and those that serve them during crisis situations.
Project Outcomes: The evaluation will provide valuable insight into the processes necessary to develop a PADs web- based platform, how it facilitates self-determination among county-designated peer priority populations, and barriers and facilitators to its use by both peers and community stakeholder agencies. These findings will enhance the potential for the PADs web-based platform’s replicability and sustainability within California, and in other states. Research findings will also have the potential to inform future policy development and efficacy of community – based, self- directed mental health services. A reference list citing relevant peer-reviewed articles on PADs.
BBI’s Chairman, Dr. Peter Blanck notes: “BBI’s evaluation will provide valuable insight into the processes necessary to develop a PADs web-based platform, how it facilitates self-determination among county-designated priority populations, and the barriers and facilitators to its use by peers and community stakeholder agencies. These findings will enhance the potential for PADs web-based platforms’ replicability and sustainability within California, and in other states. BBI’s research findings will also have the potential to inform future policy development and efficacy of community – based, self- directed mental health services”.
For More Information: For More information on the PADs Evaluation Project, contact Dr. Gary Shaheen, Project Director at email@example.com or Nanette Goodman, BBI Director for Research at firstname.lastname@example.org.
* Portions of this Background and Context have been excerpted from: Sahota, K. (2023). Multi-County PADs Innovation Project Annual Report Fiscal Years 2021-22 through 2022-23. Concepts Forward Consulting.