Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield).
Psychiatr Serv. 2023 Oct 1;74(10):1027-1036. doi: 10.1176/appi.ps.20220508. Epub 2023 Mar 29.
Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness.
Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models.
Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high.
Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care.
自我管理护理（SDC）是一种治疗模式，在此模式下，接受者自行管理指定用于提供服务的资金。该模式的设计目的是在不增加传统服务成本的情况下，实现优于传统服务的参与者结果。作者研究了该模式对无医疗保险、收入低、患有严重精神疾病的成年人的结果、服务成本和用户满意度的影响。
公共心理健康系统中的成年人（N=42）被随机分配（1:1）接受 SDC 或常规服务，并在基线和 6 个月和 12 个月随访时进行评估。结果包括心理健康自我管理的感知能力、满足和未满足的需求、自主支持程度、自我感知的恢复和就业。混合效应随机回归分析测试了两种研究条件下结果的纵向变化差异。使用负二项回归模型分析服务成本差异。
与对照组相比，SDC 参与者报告在感知能力、满足和未满足的需求、自主支持、从症状控制中恢复和就业方面有更大的改善。两组之间的人均总服务成本或个别服务成本没有差异。最常见的非传统购买是医疗、牙科和视力服务（33%）和健康与健康支持（33%）。对 SDC 服务的满意度很高。
心理健康 SDC 服务实现了优于常规治疗的参与者结果，使用和成本相同，用户满意度高。该模式可能非常适合接受公共行为健康护理的无保险、低收入成年人的需求。
