Promoting Self-Determination through Self-Directed Care in Texas
This study is one of the first to implement and rigorously evaluate a mental health Self-Directed Care (SDC) program. It was conducted in partnership with the Texas Department of State Health Services, Beacon Health Options, the North Texas Behavioral Health Authority, and the former NorthStar Program in Dallas.
SDC is a way of providing care in which people who receive public mental health services directly control the funds spent on their recovery. They create a person-centered recovery plan and a budget for the purchase of goods and services to achieve their life goals. People's options are expanded by creating opportunities beyond what is available from traditional mental health service providers. Program staff help participants to hire providers and make purchases that lead to greater mental health recovery.
Our randomized controlled trial study found that, when compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent non-traditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants compared with control group participants.
Read a peer-reviewed article about these findings.
Learn how participants used their personal budgets to address self-care and the social determinants of health.
Download our Self-Directed Care Implementation Manual, listen to a podcast on the manual, and watch a how-to webinar.
Visit our SDC Online Policy Toolkit.
SDC is a way of providing care in which people who receive public mental health services directly control the funds spent on their recovery. They create a person-centered recovery plan and a budget for the purchase of goods and services to achieve their life goals. People's options are expanded by creating opportunities beyond what is available from traditional mental health service providers. Program staff help participants to hire providers and make purchases that lead to greater mental health recovery.
Our randomized controlled trial study found that, when compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent non-traditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants compared with control group participants.
Read a peer-reviewed article about these findings.
Learn how participants used their personal budgets to address self-care and the social determinants of health.
Download our Self-Directed Care Implementation Manual, listen to a podcast on the manual, and watch a how-to webinar.
Visit our SDC Online Policy Toolkit.
Hear Dr. Judith Cook reflect on our SDC study
Presented by Temple University Collaborative on Community Inclusion, Collab Chats Podcast (22 minutes)
Listen to this Pages to Practice Podcast on our SDC study
Presented by Lisa Dixon, MD, MPH (Editor, Psychiatric Services) & Josh Berezin, MD, MS (Podcast Editor, Psychiatric Services From Pages to Practice); 13 minutes