Florida Self-Directed Care: A Descriptive Study of Participants' Service Utilization and Outcomes

Background and Purpose: Florida Self-Directed Care (FloridaSDC) is a public mental health services program for indigent adults diagnosed with a severe and persistent mental illness. Promoted nationally as “recovery-oriented” and “person-centered,” SDC differs from traditional community-based mental health services in its “money follows the person” approach. Program participants control the public dollars allotted for their care, making decisions regarding the types of services and providers they feel will best assist them in achieving their self-identified recovery goals. Research regarding SDC participants’ outcomes is limited. FloridaSDC presents a unique research opportunity in that it is currently the largest and most established SDC program in the country. The overarching purpose of this study is to examine participants’ service utilization and outcomes; this is the first study to report participant-centered outcome indicators (i.e., self-reported goal achievement). Specifically the study assesses whether self-reported goal achievement scores correlate with conventional, provider-driven outcome indicators (i.e., days in the community, days worked, Functional Assessment Rating Scale (FARS) scores) and examines how participants’ utilization of traditional (e.g., medication management) and nontraditional (e.g., exercise programs) services correlates with their self-rated goal achievement scores and other conventional outcome indicators.

Methods: Data were collected through a review of the clinical and fiscal records of a convenience sample of 80 (30%) of 264 participants served during the 2009-2010 fiscal year. Quantitative techniques utilized include descriptive statistics and Spearman’s rank order correlation.

Results: During the four quarters of the study period, participants’ mean goal achievement scores ranged from 4.9 (SD=2.4) to 5.5 (SD=2.2) (on a scale of zero to 10). Nearly all participants spent 30/30 days in the community during each quarter of the study period. The mean number of days worked (of the last 30) each quarter ranged from 3.0 (SD=5.7) to 4.0 (SD=6.8); however, the median was consistently zero across quarters. There was no evidence of an association between participants’ goal achievement scores and FARS index scores or days worked. There was also no statistically or clinically significant correlation between participants’ goal achievement scores and type or amount of service utilization. The mean goal achievement score for participants (N=29) who utilized non-traditional services only (M=4.2, SD=1.7, CI=3.5, 4.8) was slightly lower than that of those (N=16) who utilized both traditional and non-traditional services (M=6.0, SD=1.6, CI=5.1, 6.8). One interesting finding of this study is the negative correlation between participant’s mean FARS Disability index scores and their mean total service expenditures (r_s=-.26, p=.02, CI=-.39, .04). The more severely a participant was rated on the FARS Disability Index, the fewer program dollars he or she spent to utilize available services.

Implications: This study provides a wealth of information regarding participants’ service utilization and outcomes. These data have important implications for improving program planning and service delivery efforts. For example, it seems evident that staff may need to collaborate more closely with participants, who have more severe FARS scores, in order to provide support for accessing services. Additional implications will be discussed.