Efficacy of Mental Health Self-Directed Care Financing

NCT ID: NCT03582813

Last Updated: 2020-03-26

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

216 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-03-01

Study Completion Date

2013-03-01

Brief Summary

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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.

Detailed Description

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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. Adults with serious mental illness served in the Texas public health system will be randomly assigned to SDC versus services as usual and assessed at baseline, 12-month, and 24-month follow-up. Mixed effects random-regression analysis will test for longitudinal changes in outcomes between the two study conditions. Differences in service costs will be analyzed using generalized linear models with negative binomial and zero-inflated negative binomial distribution. Non-traditional expenditures by the SDC participants will be examined descriptively. Service satisfaction in both study conditions will be assessed at one- and two-year follow-up.

Conditions

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Mental Illness Persistent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

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..
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Research interviewers were blinded to study condition

Study Groups

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Self-directed care

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..

Group Type EXPERIMENTAL

Self-directed care

Intervention Type BEHAVIORAL

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

Services as usual

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

Group Type ACTIVE_COMPARATOR

Services as usual

Intervention Type BEHAVIORAL

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

Interventions

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Self-directed care

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

Intervention Type BEHAVIORAL

Services as usual

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

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* 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
* 18 years or older
* able to understand spoken English.

Exclusion Criteria

* 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)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Disability, Independent Living, and Rehabilitation Research

FED

Sponsor Role collaborator

Substance Abuse and Mental Health Services Administration (SAMHSA)

FED

Sponsor Role collaborator

University of Illinois at Chicago

OTHER

Sponsor Role lead

Responsible Party

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Judith A. Cook

Professor of Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Judith A Cook, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Illinois at Chicago, Department of Psychiatry

References

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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.

Reference Type BACKGROUND
PMID: 29407723 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 19374464 (View on PubMed)

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

Reference Type BACKGROUND
PMID: 649936 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 8636897 (View on PubMed)

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.

Reference Type RESULT
PMID: 30630401 (View on PubMed)

Other Identifiers

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H133B050003

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2008-0970

Identifier Type: -

Identifier Source: org_study_id

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