Promoting Self-Determination through Self-Directed Care in Texas: A Randomized Controlled Trial of Money-Follows-the-Person Financing
The purpose of this project is to implement and evaluate a Self-Directed Care pilot program in which adults with serious mental illnesses directly control the funds spent on their recovery. This "money follows the person" model allows individuals to take control of their own recovery by giving them authority over life planning and personal budgets. The primary question to be addressed by the evaluation is whether this new program increases the quality of participants' mental health and quality of life, while being cost-effective.
People with severe mental illness in the Dallas region who consent to be in the project will be randomly assigned to one of two study conditions. Participants randomized into the control condition will receive services as usual through the area's current managed care providers. In the experimental study condition, participants will have access to services as usual and, in addition, they will be provided with tools for person-centered planning and creation of an individual budget tied to specific recovery goals. The person-centered plan will be developed by the participant and consist of goals related to mental wellness, employment, education, social integration, and other areas affecting recovery and quality of life. Next, participants will create individual budgets that detail anticipated expenditures and tie them to the goals described in their plans. The amount of the budget will be calculated based on the average annual cost per person of outpatient mental health services, currently estimated at $4,000 per year. Medications, crisis services, inpatient care, case management, and other services will remain available through the current service system.
Once their budgets are approved, participants will have access to these funds for a period of two years. They will work with support brokers to identify and access services and supports to achieve their recovery goals. Finally, a fiscal intermediary will assist participants by handling payroll and withholding taxes for service providers hired by participants, and by supplying vouchers for approved goods and services. Fiscal intermediary services will be delivered by an organization independent of the support broker and any service providers that participants may wish to use.
Evaluation of the SDC program will include participant 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, 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 study will be completely voluntary, and all research participants will be financially compensated for their time. An advisory committee composed primarily of people in recovery, including SDC participants and administrators, will help to guide the study.
ABOUT the TX SDC Project [PDF, 262K]
