The purpose of the this project is to implement and evaluate a Self-Directed Care (SDC) pilot program (Program) through a collaborative effort led by the Department of State Health Services Mental Health and Substance Abuse Division.
Self-Directed Care is a model in which adults with serious mental illnesses more directly control the funds spent on their recovery. As promoted by the President’s New Freedom Commission on Mental Health, this “money follows the person” model allows individuals to take personal control of their recovery by giving them authority over life planning and associated personal budgets.
The primary question to be addressed by the evaluation is whether this Program increases the quality of participants’ mental health and well-being, while being cost-effective. The evaluation will be a randomized controlled trial, the most rigorous study design methodology available.
Qualification and Participation
In this Program, NorthSTAR enrollees who meet adult service package 3 criteria and who consent to be in participants in the Program, will be randomly assigned to one of two study conditions. Participants who are randomized into the control condition (number of participants =150) will receive services as usual through Value-Options existing provider network. In the experimental study condition, participants (number of participants =150) will be provided with the tools they need to engage in person-centered planning (PCP), create an individual budget tied to specific recovery goals, and purchase services directly from community providers.
The PCP is developed by SDC participants, usually in conjunction with supportive others, and consists of goals related to mental wellness, employment, education, community integration, or other areas affecting recovery and quality of life. Next, the individual creates a personal budget which details anticipated expenditures and ties them to the goals described in the PCP. The amount of the budget will be calculated based on the annual cost per person of outpatient mental health services provided at adult service package 3. This amount excludes expenses such as medications, emergency, and inpatient care, which remain available through the current service system.
Once the budget is approved by the SDC program director, participants have access to these funds and work with an SDC advisor, who assists them in identifying and accessing services and supports to achieve PCP goals. Finally, Value Options, a financial intermediary (FI), will assist the individual by directly paying service providers and supporters hired by participants, and by providing vouchers for approved goods and services tied to the participant’s goals for mental health recovery. SDC services are provided by an organization independent of ValueOptions and any service providers that SDC participants may wish to use.
Guidance and Evaluation
Evaluation of the Program will include assessments at three time points: Program intake, 12-months and 24-months post-intake. Outcomes include access to and use of services, Program and service costs, clinical indicators, recovery, and rehabilitation outcomes such as employment, education, social integration, and quality of life. All participants will be followed for a period of two years. Participation in the Program will be completely voluntary, and participants will be free to withdraw from the SDC program.
The Program will be guided by an Advisory Committee composed of people in recovery, state mental health administrators, researchers, service providers, family members, and other advocates. The Advisory Committee will have input into research questions, subject recruitment procedures, study protocols, protection of human subjects, interpretation of findings from statistical and qualitative analyses, and dissemination of results.
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