Consumer-directed care for beneficiaries with mental illness: lessons from New Jersey's Cash and Counseling program.
OBJECTIVE
Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) programs in New Jersey, Arkansas, and Florida suggests that consumers' control over personal care greatly improves their satisfaction with care arrangements and their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with a diagnosis of mental illness. This study examined the effectiveness of the CCDE program for those with a diagnosis of mental illness.


METHODS
This study examined nonelderly Medicaid beneficiaries in New Jersey with a diagnosis of mental illness and compared and contrasted the experiences of those in New Jersey's CCDE program (N=109) and those who received services provided by an agency (N=119). Logistic regression analyses were performed on baseline and nine-month follow-up data.


RESULTS
By examining outcome measures--including satisfaction with care arrangements, consumers' perceptions of paid caregivers' attitudes, unmet needs, adverse events, and satisfaction with life--this study offers evidence that, from the perspective of consumers, the CCDE program is appropriate for participants with a mental illness diagnosis. For most outcome measures the CCDE program demonstrated a positive effect after baseline characteristics were controlled for. The analysis of measures of adverse events, health problems, and general health status did not yield statistically significant differences between the control group and the treatment group, indicating that CCDE care was at least as safe as agency-directed care.


CONCLUSIONS
Considering the growing need for long-term care services and the limited resources available, a consumer-directed option can be a valuable alternative for persons with a diagnosis of mental illness.
Shen
Ce
C
Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, USA. shenc@bc.edu
Smyer
Michael
M
Mahoney
Kevin J
KJ
Simon-Rusinowitz
Lori
L
Shinogle
Judith
J
Norstrand
Julie
J
Mahoney
Ellen
E
Schauer
Carole
C
del Vecchio
Paolo
P
D000293:Adolescent; D000328:Adult; D003256:Community Participation; D003376:Counseling / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D009515:New Jersey; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D014481:United States; D055815:Young Adult