Efficacy of Mental Health Self-Directed Care Financing

NCT03582813 | Completed Results

• 2 other identifiers: 2008-0970H133B050003
• Study Type: interventional
• Target: 216
• Locations: 0 countries
• Sites: N/A

Brief Summary

Self-directed care (SDC) programs give people with disabilities control over public funds to purchase traditional behavioral health and non-traditional services in order to remain outside of institutional settings. The purpose of this study is to determine the effects of this model on participant outcomes, service costs, and user satisfaction among people with serious mental illness.

Conditions

Mental Illness Persistent

Keywords

self-directed care; mental health services; mental health recovery; behavioral health service financing

Outcome Measures

Primary Outcomes (1)

• Recovery From Mental Illness

  This outcome is measured by the Recovery Assessment Scale (RAS). Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-Response format ranging from "strongly disagree" to "strongly agree". The minimum value for the RAS is 41 and the maximum is 205, with higher scores indicating a better outcome. Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and not being dominated by one's residual psychiatric symptoms.

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

Secondary Outcomes (6)

• Change in Self-esteem

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

• Coping Mastery

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

• Perceived Autonomy Support

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

• Number of Participants With Employment

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

• Number of Participants Enrolled in Classes

  Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)

Study Arms (2)

Self-directed care

EXPERIMENTAL

Subjects receive traditional behavioral health and non-traditional services via a self-directed care model in which they develop a person-directed plan and create a budget for the purchase of medically necessary goods and services. Program staff acting as service brokers help them secure needed goods and services from within or outside the public behavioral health provider system. A fiscal intermediary manages financial resources to pay providers and enable the purchase of approved goods..

Behavioral: Self-directed care

Services as usual

ACTIVE COMPARATOR

Subjects receive traditional behavioral health services as usual via the traditional service delivery system and its network of providers.

Behavioral: Services as usual

Interventions

Self-directed care BEHAVIORAL

Traditional and non-traditional behavioral health services are chosen from within and outside the public mental health system

Self-directed care

Services as usual BEHAVIORAL

Traditional behavioral health services are chosen from along those delivered at the patient's community mental health agency

Services as usual

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• receiving mental health services at a Texas Department of State Health Services-funded mental health program
• diagnosis of serious mental illness consistent with federal Public Law 102-32
• assigned to a level of care eligible for a package of comprehensive clinical and rehabilitation services known as Service Package 3
• years or older
• able to understand spoken English.

You may not qualify if:

• cognitive impairment
• homeless at time of recruitment
• history of violent behavior resulting in arrest and conviction in the past 10 years
• active substance use in the absence of substance use treatment
• enrollment in Medicare or dual beneficiary
• finances controlled by a third party (e.g., representative payee)

Sponsors & Collaborators

• University of Illinois at Chicago: lead
• National Institute on Disability, Independent Living, and Rehabilitation Research: collaborator
• Substance Abuse and Mental Health Services Administration (SAMHSA): collaborator

Related Publications (5)

• Scanlan JN, Hancock N, Honey A. The Recovery Assessment Scale - Domains and Stages (RAS-DS): Sensitivity to change over time and convergent validity with level of unmet need. Psychiatry Res. 2018 Mar;261:560-564. doi: 10.1016/j.psychres.2018.01.042.

  PMID: 29407723 BACKGROUND

• Davis C, Kellett S, Beail N. Utility of the Rosenberg self-esteem scale. Am J Intellect Dev Disabil. 2009 May;114(3):172-8. doi: 10.1352/1944-7558-114.3.172.

  PMID: 19374464 BACKGROUND

• Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978 Mar;19(1):2-21. No abstract available.

  PMID: 649936 BACKGROUND

• Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: a test of self-determination theory. J Pers Soc Psychol. 1996 Apr;70(4):767-79. doi: 10.1037//0022-3514.70.4.767.

  PMID: 8636897 BACKGROUND

• Cook JA, Shore S, Burke-Miller JK, Jonikas JA, Hamilton M, Ruckdeschel B, Norris W, Markowitz AF, Ferrara M, Bhaumik D. Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness. Psychiatr Serv. 2019 Mar 1;70(3):191-201. doi: 10.1176/appi.ps.201800337. Epub 2019 Jan 11.

  PMID: 30630401 RESULT

Results Point of Contact

• Title: Dr. Judith A. Cook, Director
• Organization: Center on Mental Health Services Research and Policy, University of Illinois at Chicago, Department of Psychiatry

jcook@uic.edu

312-355-3921

Study Officials

• Judith A Cook, PhD

  University of Illinois at Chicago, Department of Psychiatry

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Research interviewers were blinded to study condition
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Psychiatry

Model Details: Self-directed care is a model of service delivery in which service recipients are allocated a individual budget from which they purchase mental health and other services and material goods needed to help them recover from their mental illness and remain outside of restrictive settings such as hospitals..

Study Record Dates

• First Submitted: May 21, 2018
• First Posted: July 11, 2018
• Study Start: March 1, 2009
• Primary Completion: March 1, 2013
• Study Completion: March 1, 2013
• Last Updated: March 26, 2020
• Results First Posted: March 26, 2020

Record last verified: 2020-03

Data Sharing

• IPD Sharing: Will not share