A Case for Self-Directed Care: Floridasdc Participants' Self-Identified Recovery Goals and Resources and Barriers Impacting Goal Achievement

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. SDC differs from traditional community-based mental health services in its “money follows the person” approach. Participants control the public dollars allotted for their care, making decisions regarding the services and providers they feel will best assist them in achieving their self-identified recovery goals. Research regarding SDC is limited, particularly with respect to participants and their goals for program success. The purpose of this naturalistic descriptive study, which is the first of its kind, is to examine participants’ self-identified recovery goals as well as the internal and external resources and barriers they feel may impact their goal achievements.

Methods: FloridaSDC records are largely completed by participants, presenting a unique opportunity to collect participant-centered data not currently reported in the literature. Data were collected through a review of the clinical records of a convenience sample of 136 (44%) of the 309 participants served during the fiscal year. A majority of the study participants were white (n=103, 75.7%), female (n=80, 58.8%), divorced (n=59, 43.4%) or single (n=56, 41.2%), living alone (n=60, 44.1%), and diagnosed with a mood disorder (n=91, 68.4%).  Taking a generic qualitative approach, conventional content analysis was utilized to code, sort, and label thematically participants’ stated goals and resources/barriers reported in their self-assessment completed upon enrollment. Although doing so is not strictly qualitative, the frequency with which participants used particular words (e.g., fear) or expressed key themes (e.g., self-sufficiency) was counted to examine the degree to which goals, strengths, or barriers are shared by participants.

Results: FloridaSDC participants identified goals in the domains of mental wellness (n=117, 86%), physical wellness (n=91, 67%), work/productive activity (n=90, 66%), and substance abuse (n=17, 13%). Content analysis of the goal statements within each broad domain demonstrated the individualized nature of participants’ goals as well as their shared interests and concerns, which largely centered on themes of living independently and obtaining desired services. Across goal domains, participants consistently reported having internal psychological and emotional strengths, personal characteristics, behaviors, and relevant experience, knowledge, skills, and abilities that would help them achieve their goals. External resources identified included community resources, mental health providers, and informal support networks. Interestingly participants identified a greater number of resources than barriers. Internal barriers fell into four sub-categories, including psychological/emotional, mental illness/symptoms, behavioral, and physical. The external barriers most consistently identified by participants were financial insecurity and lack of transportation.

Implications: This study is unique in that it provides insight into participants’ goals and desired outcomes for program participation as well as their assessment of the internal and external resources and barriers which they feel will facilitate or hinder their goal achievements in various domains. Participants’ desires to achieve mental wellness, independence, and self-sufficiency resonate throughout this study, and their self-reported goals, resources, and barriers reflect highly personalized visions of recovery and reinforce the importance of self-directed service delivery and person-centered program evaluation.