Florida Self-Directed Care (FloridaSDC) is a state-funded mental health services program for adults diagnosed with a severe and persistent mental illness (SPMI), who rely upon public assistance to access mental health services. Self-directed care (SDC) is a relatively new approach to service delivery in the mental health arena. Modeled after the Cash and Counseling program for individuals with disabilities, SDC differs from traditional community-based mental health services in its “money follows the person” approach. Individuals enrolled in SDC programs control the public dollars allotted for their care, making decisions regarding the types of services and service 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. FloridaSDC presents a unique research opportunity in that it is currently the largest and most established SDC program in the United States.
The purpose of this exploratory study is to provide a more holistic, in-depth understanding of FloridaSDC participants than is currently available in the existing literature. This study examines participants’ demographic characteristics and mental health, physical health, and substance use histories, as well as their recovery goals, service choices, and outcomes, including goal achievement. Quantitative and qualitative data were collected from the clinical and fiscal records of a purposive sample (n=80) of the FloridaSDC participants (N=264) served during the 2009-2010 fiscal year and still enrolled in the program at the time of this study. The majority of study participants were female (n=49, 61.3%), white (n=61, 76.3%), divorced (n=37, 46.3%) or single (n=34, 42.5%), living alone (n=42, 52.5%), and diagnosed with a mood disorder (n=54, 67.5%). Participants ranged in age from 29 to 70, with a mean age of 51.4 years (SD=9.07). With respect to educational level, 26 (32.5%) participants held a high school diploma, and 21 (26.3%) completed some college. The majority of participants (n=67, 83.8%) reported having an employment history, although 48 (60.0%) were disabled (as opposed to being employed) during the study period. Study participants’ had a mean annual family income of $10, 260 (SD=$4,842). A total of 64 (80%) individuals received psychiatric disability income.
Key findings suggest that poverty is a major barrier to recovery for FloridaSDC participants, who spent the bulk of their allotted budgets on goods and services to meet their basic needs and maintain independent living. This study also identified an inverse relationship between the severity of participants’ symptomology and functioning and their total expenditures, suggesting that those who are the most troubled may be the least likely to make use of FloridaSDC funds to access desired services. Finally, the highly personalized nature of participants’ self-reported recovery goals and the degree of consistency between participants’ service expenditures and their self-identified barriers to goal achievements reinforce the utility and importance of person-centered planning and individualized budgeting. Additional recommendations for policy, practice, and future research are discussed.