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Consumer-Directed Care for Beneficiaries With Mental Illness: Lessons From New Jersey's Cash and Counseling Program

Dr. Shen, Dr. K. Mahoney, and Ms. Norstrand are affiliated with the Graduate School of Social Work, Dr. Smyer is with the Department of Psychology, Dr. E. Mahoney is with the William F. Connell School of Nursing, all at Boston College. Dr. Simon-Rusinowitz is with the Department of Health Services Administration, University of Maryland, College Park. Dr. Shinogle is with the Institute for Policy Analysis and Research, University of Maryland, Baltimore County. Ms. Schauer and Mr. del Vecchio are with the Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Send correspondence to Dr. Shen at the Graduate School of Social Work, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA 02467 (e-mail: shenc{at}bc.edu).

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.

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