Evaluation of California's Multi-County Psychiatric Advance Directives Innovation Project: Early Implementation and Outcomes, 2024-2025.

Psychiatric 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. Over the past several years, seven California counties have been collaborating on a Mental Health Services Act Innovation Project intended to increase the availability and uptake of PADs among persons with mental health needs, supported by peer worker outreach and facilitation. In this study, RAND researchers evaluate three aspects of the PADs Innovation Project pilot. First, they present findings from an assessment of post-training outcomes and experiences with real-world PAD facilitation, using surveys and interviews with peer workers. Second, they describe PAD creation rates and outcomes across the participating counties, using a combination of administrative metadata from the PAD platform, a brief user survey contained within the PAD platform, and a follow-up interview and survey with a subset of individuals who created a PAD. Third, they report the perspectives of county implementation staff, who provided overall reflections on the implementation of beta testing through interviews. Finally, the authors summarize their findings and provide a set of recommendations for future PAD implementation.