The Cash and Counseling model of self-directed long-term care: Effectiveness with young adults with disabilities.
BACKGROUND
Young adults with disabilities face numerous barriers to independence and achieving markers of adulthood. Qualitative evidence suggests that flexible, self-directed budgets for purchasing home and community-based services might help fill an identified service gap and help improve the transition to adulthood for this group.


OBJECTIVE
Our aim was to evaluate the effectiveness of the Cash and Counseling model of self-directed budgets for young adults with long-term care disabilities by analyzing secondary data from the Cash and Counseling Demonstration and Evaluation randomized control trial.


METHODS
We compared nine-month community involvement, satisfaction rating, health status rating compared to peers, and unmet needs outcomes using bivariate and multivariate logistic regression. Our sample included 456 participants aged 18 to 30 randomized to treatment groups with the opportunity to receive Cash and Counseling (n = 207) or control groups eligible for agency-based care (n = 249), whether self-reported (n = 128) or by proxy (n = 328).


RESULTS
Multivariate logistic regression models showed that compared to controls at nine-month follow-up, treatment group members had significantly greater odds of being very satisfied with life, when care was received, the care arrangement, transportation, help around the house and community, personal care, and getting along with paid attendants, and significantly lower odds of unmet needs with medication and routine health care at home and with transportation.


CONCLUSIONS
Cash and Counseling performed better than or comparable with agency-based care for young adults with long-term care disabilities, suggesting its viability as a service option for this population.
School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02472, USA; Essentia Institute of Rural Health | 6AV-2, 502 East Second Street, Duluth, MN 55805, USA. Electronic address: melissa.harry@bc.edu.
Melissa L
ML
Harry
School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02472, USA; National Resource Center for Participant-Directed Services, 314 Hammond Street, Chestnut Hill, MA, 02472, USA.
Kevin J
KJ
Mahoney
National Resource Center for Participant-Directed Services, 314 Hammond Street, Chestnut Hill, MA, 02472, USA; William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02472, USA.
Ellen K
EK
Mahoney
School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02472, USA.
Ce
C
Shen
D000293:Adolescent; D000328:Adult; D002017:Budgets; D003376:Counseling; D006233:Persons with Disabilities; D005260:Female; D005380:Financing, Government; D066086:Health Services for Persons with Disabilities; D006699:Home Care Services; D006801:Humans; D057187:Independent Living; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D010549:Personal Satisfaction; D015397:Program Evaluation; D055815:Young Adult
Disability; Home and community-based services; Long-term care; Self-directed budget; Young adult