Efficacy of Mental Health Self-Directed Care Financing (SDC-RCT)

University of Illinois

Status: Completed

Conditions: Mental Illness Persistent

Treatments: Behavioral: Services as usual; Behavioral: Self-directed care

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT03582813

H133B050003 (Other Grant/Funding Number)

2008-0970

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 216 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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216 participants in 2 patient groups

Self-directed care

Experimental group

Description:

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..

Treatment:

Behavioral: Self-directed care

Services as usual

Active Comparator group

Description:

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

Treatment:

Behavioral: Services as usual