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The ethical challenges of a randomized controlled trial of involuntary outpatient commitment.

Publication ,  Journal Article
Swartz, MS; Burns, BJ; George, LK; Swanson, J; Hiday, VA; Borum, R; Wagner, HR
Published in: J Ment Health Adm
1997

Involuntary outpatient commitment (OPC) is a civil justice procedure intended to enhance compliance with community mental health treatment, to improve functioning, and to reduce recurrent dangerousness and hospital recidivism. The research literature on OPC indicates that it appears to improve outcomes in rates of rehospitalization and length of stay. However, all studies to date have serious methodological limitations because of selection bias; lack of specification of target populations; unclear operationalization of OPC; unmeasured variability in type, frequency, and intensity of treatment; as well as other confounding factors. To address limitations in these studies, the authors designed a randomized controlled trial (RCT) of OPC, combined with community-based case management, which is now under way in North Carolina. This article describes ethical dilemmas in designing and implementing an RCT of a legally coercive intervention in community-based settings. These ethical dilemmas challenge the experimental validity of an RCT but can be successfully addressed with careful planning and negotiation.

Duke Scholars

Published In

J Ment Health Adm

DOI

ISSN

0092-8623

Publication Date

1997

Volume

24

Issue

1

Start / End Page

35 / 43

Location

United States

Related Subject Headings

  • Research Subjects
  • Reproducibility of Results
  • Randomized Controlled Trials as Topic
  • Patient Selection
  • Outcome Assessment, Health Care
  • North Carolina
  • Mentally Ill Persons
  • Humans
  • Health Services Research
  • Ethics, Medical
 

Citation

APA
Chicago
ICMJE
MLA
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Swartz, M. S., Burns, B. J., George, L. K., Swanson, J., Hiday, V. A., Borum, R., & Wagner, H. R. (1997). The ethical challenges of a randomized controlled trial of involuntary outpatient commitment. J Ment Health Adm, 24(1), 35–43. https://doi.org/10.1007/BF02790478
Swartz, M. S., B. J. Burns, L. K. George, J. Swanson, V. A. Hiday, R. Borum, and H. R. Wagner. “The ethical challenges of a randomized controlled trial of involuntary outpatient commitment.J Ment Health Adm 24, no. 1 (1997): 35–43. https://doi.org/10.1007/BF02790478.
Swartz MS, Burns BJ, George LK, Swanson J, Hiday VA, Borum R, et al. The ethical challenges of a randomized controlled trial of involuntary outpatient commitment. J Ment Health Adm. 1997;24(1):35–43.
Swartz, M. S., et al. “The ethical challenges of a randomized controlled trial of involuntary outpatient commitment.J Ment Health Adm, vol. 24, no. 1, 1997, pp. 35–43. Pubmed, doi:10.1007/BF02790478.
Swartz MS, Burns BJ, George LK, Swanson J, Hiday VA, Borum R, Wagner HR. The ethical challenges of a randomized controlled trial of involuntary outpatient commitment. J Ment Health Adm. 1997;24(1):35–43.

Published In

J Ment Health Adm

DOI

ISSN

0092-8623

Publication Date

1997

Volume

24

Issue

1

Start / End Page

35 / 43

Location

United States

Related Subject Headings

  • Research Subjects
  • Reproducibility of Results
  • Randomized Controlled Trials as Topic
  • Patient Selection
  • Outcome Assessment, Health Care
  • North Carolina
  • Mentally Ill Persons
  • Humans
  • Health Services Research
  • Ethics, Medical