Abstract
This study investigates the impacts of an intensive care coordination intervention for adults with severe mental illness who have guardians. Program impacts on medical and legal outcomes were assessed using interrupted time series analysis. Program participation was associated with statistically significant reductions in the level and trend of psychiatric hospitalizations, number of days in psychiatric hospitals, emergency room visits, and arrests. Days incarcerated did not change significantly. The decrease in medical and legal outcomes may be associated with decreased spending on these services. The program and other intensive care coordination interventions for this population warrant further replication and research.
Highlights
Guardians are court-appointed representatives who have the authority to make legal, medical, and financial decisions for individuals who lack the capacity to make essential decisions for themselves
Using data that GAL gathers about each client’s current and past health and legal outcomes, as well as demographic and administrative data, the current study evaluated whether an extended period of program participation was associated with changes in psychiatric hospitalizations, days hospitalized, emergency room visits, arrests, and days incarcerated
A quasi-experimental approach demonstrated that intensive care coordination was associated with substantial positive changes in health and legal outcomes for adults with severe mental illness who require a guardian
Summary
Guardians are court-appointed representatives who have the authority to make legal, medical, and financial decisions for individuals who lack the capacity to make essential decisions for themselves. The appointment of a guardian is intended to improve the client’s quality of life through activities such as securing needed medical care or equipment, paying bills, resolving legal issues, enhancing socialization opportunities, helping to establish a residence, and providing emotional support (Teaster et al 2009; Vera Institute of Justice 2015). A subset of these findings was presented on November 18, 2018, as part of the following panel discussion: Jett, C., Levine, E., & Capitani, J. Cost–benefit analyses of providing guardians to hospital patients and guardianship program participants. Moye (Chair), Decision making for those without capacity and surrogates: Legal, financial, and healthcare perspectives. Symposium conducted at the Annual Scientific Meeting of the Gerontological Society of America, Boston, MA
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