title: Consumer-directed care for beneficiaries with mental illness: lessons from New Jersey's Cash and Counseling program.
abstract: 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.
authors.affiliation: Graduate School of Social Work, Boston College, Chestnut Hill, MA 02467, USA. shenc@bc.edu
authors.forename: Ce
authors.initials: C
authors.lastname: Shen
authors.forename: Michael
authors.initials: M
authors.lastname: Smyer
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Mahoney
authors.forename: Lori
authors.initials: L
authors.lastname: Simon-Rusinowitz
authors.forename: Judith
authors.initials: J
authors.lastname: Shinogle
authors.forename: Julie
authors.initials: J
authors.lastname: Norstrand
authors.forename: Ellen
authors.initials: E
authors.lastname: Mahoney
authors.forename: Carole
authors.initials: C
authors.lastname: Schauer
authors.forename: Paolo
authors.initials: P
authors.lastname: del Vecchio
mesh_terms: 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