Mental Illness Persistent
Conditions
Keywords
self-directed care, mental health services, mental health recovery, behavioral health service financing
Brief summary
Self-directed care (SDC) programs give people with disabilities control over public funds to purchase traditional behavioral health and non-traditional services in order to remain outside of institutional settings. The purpose of this study is to determine the effects of this model on participant outcomes, service costs, and user satisfaction among people with serious mental illness.
Detailed description
Self-directed care (SDC) programs give people with disabilities control over public funds to purchase traditional behavioral health and non-traditional services in order to remain outside of institutional settings. The purpose of this study is to determine the effects of this model on participant outcomes, service costs, and user satisfaction among people with serious mental illness. Adults with serious mental illness served in the Texas public health system will be randomly assigned to SDC versus services as usual and assessed at baseline, 12-month, and 24-month follow-up. Mixed effects random-regression analysis will test for longitudinal changes in outcomes between the two study conditions. Differences in service costs will be analyzed using generalized linear models with negative binomial and zero-inflated negative binomial distribution. Non-traditional expenditures by the SDC participants will be examined descriptively. Service satisfaction in both study conditions will be assessed at one- and two-year follow-up.
Interventions
BEHAVIORALSelf-directed care
Traditional and non-traditional behavioral health services are chosen from within and outside the public mental health system
BEHAVIORALServices as usual
Traditional behavioral health services are chosen from along those delivered at the patient's community mental health agency
Sponsors
National Institute on Disability, Independent Living, and Rehabilitation Research
Substance Abuse and Mental Health Services Administration (SAMHSA)
University of Illinois at Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Research interviewers were blinded to study condition
Intervention model description
Self-directed care is a model of service delivery in which service recipients are allocated a individual budget from which they purchase mental health and other services and material goods needed to help them recover from their mental illness and remain outside of restrictive settings such as hospitals..
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* receiving mental health services at a Texas Department of State Health Services-funded mental health program * diagnosis of serious mental illness consistent with federal Public Law 102-32 * assigned to a level of care eligible for a package of comprehensive clinical and rehabilitation services known as Service Package 3 * 18 years or older * able to understand spoken English.
Exclusion criteria
* cognitive impairment * homeless at time of recruitment * history of violent behavior resulting in arrest and conviction in the past 10 years * active substance use in the absence of substance use treatment * enrollment in Medicare or dual beneficiary * finances controlled by a third party (e.g., representative payee)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recovery From Mental Illness | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | This outcome is measured by the Recovery Assessment Scale (RAS). Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-Response format ranging from strongly disagree to strongly agree. The minimum value for the RAS is 41 and the maximum is 205, with higher scores indicating a better outcome. Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and not being dominated by one's residual psychiatric symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Coping Mastery | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | Change in subjects' sense of personal control over important life outcomes as measured by the Coping Mastery Scale. Higher values equal better coping mastery. Minimum = 2 and maximum = 49. |
| Perceived Autonomy Support | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | Perceived support for autonomously motivated change measured by the Learning Climate Questionnaire of Williams & Deci. Measures change in perception that service environment is supportive of autonomy to make decisions and choices. Higher score equals better autonomy support. Minimum = 4 and maximum = 105. |
| Change in Self-esteem | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | Feelings of self-worth and confidence in general abilities as measured by the Rosenberg Self-Esteem Scale . Higher vales equal better self=esteem. Minimum = 10 and maximum = 40. |
| Number of Participants Enrolled in Classes | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | Change in education participation status as measured by U.S. Department of Education's definition of school enrollment: enrolled in classes requiring registration and fee payment versus not enrolled in classes. Higher value = enrolled in classes. Minimum = 0 and maximum = 1. |
| Change in Mental Health Service Cost | First 12 months of study participation; Second 12 months of study participation; total 24 months of study participation | Mental health service cost is measured by the amount of reimbursement for a paid claim from the Texas Department of State Health Services Data Warehouse, It represents the amount of dollars paid for delivery of a discrete behavioral health service. Higher value = higher cost. Minimum = 1 and maximum = 5,493. |
| Number of Participants With Employment | Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention) | Change in employment status as measured by Bureau of Labor Statistics definition of paid employment: with paid employment versus without paid employment. Higher value equals with paid employment. Minimum = 0 and maximum = 1. |
Participant flow
Recruitment details
Eligible participants ( who were active Texas Department of State Health Services (DSHS) were recruited at community mental health agencies by local research staff between March 2009 and September 2010.
Participants by arm
| Arm | Count |
|---|---|
| Self-directed Care Subjects receive traditional behavioral health and non-traditional services via a self-directed care model in which they develop a person-directed plan and create a budget for the purchase of medically necessary goods and services. Program staff acting as service brokers help them secure needed goods and services from within or outside the public behavioral health provider system. A fiscal intermediary manages financial resources to pay providers and enable the purchase of approved goods..
Self-directed care: Traditional and non-traditional behavioral health services are chosen from within and outside the public mental health system | 114 |
| Services as Usual Subjects receive traditional behavioral health services as usual via the traditional service delivery system and its network of providers.
Services as usual: Traditional behavioral health services are chosen from along those delivered at the patient's community mental health agency | 102 |
| Total | 216 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 18 | 21 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Services as Usual | Total | Self-directed Care |
|---|---|---|---|
| Age, Continuous | 41.6 Years STANDARD_DEVIATION 9.5 | 41.6 Years STANDARD_DEVIATION 9.7 | 41.6 Years STANDARD_DEVIATION 10 |
| Diagnosis Category Bipolar I or II Disorder | 22 Participants | 55 Participants | 33 Participants |
| Diagnosis Category Co-Occurring Substance Abuse | 17 Participants | 37 Participants | 20 Participants |
| Diagnosis Category Major Depressive Disorder | 45 Participants | 88 Participants | 43 Participants |
| Diagnosis Category Schizophrenia | 35 Participants | 73 Participants | 38 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 11 Participants | 33 Participants | 22 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 91 Participants | 183 Participants | 92 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| High school diploma/General Equivalency Degree | 66 Participants | 142 Participants | 76 Participants |
| Mental Health services cost in year prior to study | 3,996 Dollar Amount STANDARD_DEVIATION 3.83 | 4,204 Dollar Amount STANDARD_DEVIATION 3.55 | 4,390 Dollar Amount STANDARD_DEVIATION 3.29 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 52 Participants | 103 Participants | 51 Participants |
| Race (NIH/OMB) More than one race | 3 Participants | 6 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 47 Participants | 107 Participants | 60 Participants |
| Sex: Female, Male Female | 58 Participants | 134 Participants | 76 Participants |
| Sex: Female, Male Male | 44 Participants | 82 Participants | 38 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 3 / 114 | 2 / 102 |
| other Total, other adverse events | 12 / 114 | 11 / 102 |
| serious Total, serious adverse events | 1 / 114 | 0 / 102 |
Outcome results
Primary
Recovery From Mental Illness
This outcome is measured by the Recovery Assessment Scale (RAS). Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-Response format ranging from strongly disagree to strongly agree. The minimum value for the RAS is 41 and the maximum is 205, with higher scores indicating a better outcome. Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and not being dominated by one's residual psychiatric symptoms.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Self-directed Care | Recovery From Mental Illness | T1 - Baseline (pre-intervention) | 148.0 score on a scale | Standard Deviation 20.45 |
| Self-directed Care | Recovery From Mental Illness | T2 - 12 months later (intervention mid-point) | 151.88 score on a scale | Standard Deviation 21.77 |
| Self-directed Care | Recovery From Mental Illness | T3 - 24 months later (end of intervention) | 152.17 score on a scale | Standard Deviation 21.18 |
| Services as Usual | Recovery From Mental Illness | T1 - Baseline (pre-intervention) | 152.81 score on a scale | Standard Deviation 22.21 |
| Services as Usual | Recovery From Mental Illness | T2 - 12 months later (intervention mid-point) | 154.56 score on a scale | Standard Deviation 20.03 |
| Services as Usual | Recovery From Mental Illness | T3 - 24 months later (end of intervention) | 153.62 score on a scale | Standard Deviation 22.02 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in self-perceived Recovery and that this effect would be maintained overtime;p-value: <0.01Mixed Effects Random Regression
Secondary
Change in Mental Health Service Cost
Mental health service cost is measured by the amount of reimbursement for a paid claim from the Texas Department of State Health Services Data Warehouse, It represents the amount of dollars paid for delivery of a discrete behavioral health service. Higher value = higher cost. Minimum = 1 and maximum = 5,493.
Time frame: First 12 months of study participation; Second 12 months of study participation; total 24 months of study participation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Self-directed Care | Change in Mental Health Service Cost | Residential Support: Year 1 | 58 Dollar Amount | Standard Deviation 336 |
| Self-directed Care | Change in Mental Health Service Cost | Case Management: Year 2 | 3 Dollar Amount | Standard Deviation 15 |
| Self-directed Care | Change in Mental Health Service Cost | Residential Support: Year 2 | 58 Dollar Amount | Standard Deviation 371 |
| Self-directed Care | Change in Mental Health Service Cost | Diagnostic services: Year 2 | 14 Dollar Amount | Standard Deviation 43 |
| Self-directed Care | Change in Mental Health Service Cost | Substance Abuse Treatment: Year 1 | 44 Dollar Amount | Standard Deviation 227 |
| Self-directed Care | Change in Mental Health Service Cost | Peer Services: Year 1 | 11 Dollar Amount | Standard Deviation 64 |
| Self-directed Care | Change in Mental Health Service Cost | Substance Abuse Treatment: Year 2 | 55 Dollar Amount | Standard Deviation 385 |
| Self-directed Care | Change in Mental Health Service Cost | Psychosocial Rehab: Year 1 | 311 Dollar Amount | Standard Deviation 783 |
| Self-directed Care | Change in Mental Health Service Cost | Medication Management: Year 1 | 182 Dollar Amount | Standard Deviation 205 |
| Self-directed Care | Change in Mental Health Service Cost | Peer Services: Year 2 | 15 Dollar Amount | Standard Deviation 101 |
| Self-directed Care | Change in Mental Health Service Cost | Medication Management: Year 2 | 111 Dollar Amount | Standard Deviation 162 |
| Self-directed Care | Change in Mental Health Service Cost | Psychotherapy: Year 2 | 133 Dollar Amount | Standard Deviation 346 |
| Self-directed Care | Change in Mental Health Service Cost | Medications: Year 1 | 1071 Dollar Amount | Standard Deviation 2047 |
| Self-directed Care | Change in Mental Health Service Cost | Inpatient Care: Year 1 | 223 Dollar Amount | Standard Deviation 1270 |
| Self-directed Care | Change in Mental Health Service Cost | Medications: Year 2 | 902 Dollar Amount | Standard Deviation 2414 |
| Self-directed Care | Change in Mental Health Service Cost | Psychosocial Rehab: Year 2 | 130 Dollar Amount | Standard Deviation 421 |
| Self-directed Care | Change in Mental Health Service Cost | Non-Traditional Services: Year 1 | 679 Dollar Amount | Standard Deviation 516 |
| Self-directed Care | Change in Mental Health Service Cost | Inpatient Care: Year 2 | 72 Dollar Amount | Standard Deviation 476 |
| Self-directed Care | Change in Mental Health Service Cost | Non-Traditional Services: Year 2 | 667 Dollar Amount | Standard Deviation 658 |
| Self-directed Care | Change in Mental Health Service Cost | Psychotherapy: Year 1 | 229 Dollar Amount | Standard Deviation 454 |
| Self-directed Care | Change in Mental Health Service Cost | Total Including Non-Traditional Services: Year 1 | 2998 Dollar Amount | Standard Deviation 3128 |
| Self-directed Care | Change in Mental Health Service Cost | Psychiatric Crisis Services:Year 1 | 121 Dollar Amount | Standard Deviation 453 |
| Self-directed Care | Change in Mental Health Service Cost | Total Including Non-Traditional Services: Year 2 | 2241 Dollar Amount | Standard Deviation 2960 |
| Self-directed Care | Change in Mental Health Service Cost | Case Management: Year 1 | 26 Dollar Amount | Standard Deviation 165 |
| Self-directed Care | Change in Mental Health Service Cost | Total Excluding Non-Traditional Services: Year 1 | 2319 Dollar Amount | Standard Deviation 3316 |
| Self-directed Care | Change in Mental Health Service Cost | Psychiatric Crisis Services: Year 2 | 70 Dollar Amount | Standard Deviation 269 |
| Self-directed Care | Change in Mental Health Service Cost | Total Excluding Non-Traditional Services: Year 2 | 1574 Dollar Amount | Standard Deviation 2938 |
| Self-directed Care | Change in Mental Health Service Cost | Skills Training: Year 1 | 4 Dollar Amount | Standard Deviation 19 |
| Self-directed Care | Change in Mental Health Service Cost | Diagnostic services: Year 1 | 36 Dollar Amount | Standard Deviation 67 |
| Services as Usual | Change in Mental Health Service Cost | Substance Abuse Treatment: Year 2 | 90 Dollar Amount | Standard Deviation 504 |
| Services as Usual | Change in Mental Health Service Cost | Diagnostic services: Year 2 | 14 Dollar Amount | Standard Deviation 43 |
| Services as Usual | Change in Mental Health Service Cost | Psychotherapy: Year 1 | 23 Dollar Amount | Standard Deviation 118 |
| Services as Usual | Change in Mental Health Service Cost | Psychotherapy: Year 2 | 12 Dollar Amount | Standard Deviation 70 |
| Services as Usual | Change in Mental Health Service Cost | Skills Training: Year 1 | 27 Dollar Amount | Standard Deviation 71 |
| Services as Usual | Change in Mental Health Service Cost | Psychosocial Rehab: Year 1 | 646 Dollar Amount | Standard Deviation 1394 |
| Services as Usual | Change in Mental Health Service Cost | Psychosocial Rehab: Year 2 | 177 Dollar Amount | Standard Deviation 416 |
| Services as Usual | Change in Mental Health Service Cost | Case Management: Year 1 | 31 Dollar Amount | Standard Deviation 141 |
| Services as Usual | Change in Mental Health Service Cost | Case Management: Year 2 | 39 Dollar Amount | Standard Deviation 149 |
| Services as Usual | Change in Mental Health Service Cost | Peer Services: Year 1 | 9 Dollar Amount | Standard Deviation 41 |
| Services as Usual | Change in Mental Health Service Cost | Peer Services: Year 2 | 13 Dollar Amount | Standard Deviation 89 |
| Services as Usual | Change in Mental Health Service Cost | Inpatient Care: Year 1 | 344 Dollar Amount | Standard Deviation 1405 |
| Services as Usual | Change in Mental Health Service Cost | Inpatient Care: Year 2 | 269 Dollar Amount | Standard Deviation 1385 |
| Services as Usual | Change in Mental Health Service Cost | Psychiatric Crisis Services:Year 1 | 168 Dollar Amount | Standard Deviation 407 |
| Services as Usual | Change in Mental Health Service Cost | Psychiatric Crisis Services: Year 2 | 162 Dollar Amount | Standard Deviation 574 |
| Services as Usual | Change in Mental Health Service Cost | Residential Support: Year 1 | 23 Dollar Amount | Standard Deviation 166 |
| Services as Usual | Change in Mental Health Service Cost | Residential Support: Year 2 | 69 Dollar Amount | Standard Deviation 386 |
| Services as Usual | Change in Mental Health Service Cost | Substance Abuse Treatment: Year 1 | 203 Dollar Amount | Standard Deviation 1029 |
| Services as Usual | Change in Mental Health Service Cost | Diagnostic services: Year 1 | 26 Dollar Amount | Standard Deviation 54 |
| Services as Usual | Change in Mental Health Service Cost | Medication Management: Year 1 | 303 Dollar Amount | Standard Deviation 229 |
| Services as Usual | Change in Mental Health Service Cost | Medication Management: Year 2 | 200 Dollar Amount | Standard Deviation 282 |
| Services as Usual | Change in Mental Health Service Cost | Medications: Year 1 | 1387 Dollar Amount | Standard Deviation 2574 |
| Services as Usual | Change in Mental Health Service Cost | Medications: Year 2 | 1218 Dollar Amount | Standard Deviation 2993 |
| Services as Usual | Change in Mental Health Service Cost | Non-Traditional Services: Year 1 | 0 Dollar Amount | Standard Deviation 0 |
| Services as Usual | Change in Mental Health Service Cost | Non-Traditional Services: Year 2 | 0 Dollar Amount | Standard Deviation 0 |
| Services as Usual | Change in Mental Health Service Cost | Total Including Non-Traditional Services: Year 1 | 3189 Dollar Amount | Standard Deviation 4608 |
| Services as Usual | Change in Mental Health Service Cost | Total Including Non-Traditional Services: Year 2 | 2303 Dollar Amount | Standard Deviation 4266 |
| Services as Usual | Change in Mental Health Service Cost | Total Excluding Non-Traditional Services: Year 1 | 3189 Dollar Amount | Standard Deviation 4608 |
| Services as Usual | Change in Mental Health Service Cost | Total Excluding Non-Traditional Services: Year 2 | 2303 Dollar Amount | Standard Deviation 4266 |
Secondary
Change in Self-esteem
Feelings of self-worth and confidence in general abilities as measured by the Rosenberg Self-Esteem Scale . Higher vales equal better self=esteem. Minimum = 10 and maximum = 40.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Self-directed Care | Change in Self-esteem | T1 - Baseline (pre-intervention) | 23.97 score on a scale | Standard Deviation 5.78 |
| Self-directed Care | Change in Self-esteem | T2 - 12 months later (intervention mid-point) | 25.74 score on a scale | Standard Deviation 5.64 |
| Self-directed Care | Change in Self-esteem | T3 - 24 months later (end of intervention) | 25.42 score on a scale | Standard Deviation 5.75 |
| Services as Usual | Change in Self-esteem | T1 - Baseline (pre-intervention) | 24.57 score on a scale | Standard Deviation 5.49 |
| Services as Usual | Change in Self-esteem | T2 - 12 months later (intervention mid-point) | 25.74 score on a scale | Standard Deviation 5.53 |
| Services as Usual | Change in Self-esteem | T3 - 24 months later (end of intervention) | 25.19 score on a scale | Standard Deviation 5.59 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in self-esteem that would be maintained longitudinallyp-value: 0.031Mixed Effects Random Regression
Secondary
Coping Mastery
Change in subjects' sense of personal control over important life outcomes as measured by the Coping Mastery Scale. Higher values equal better coping mastery. Minimum = 2 and maximum = 49.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Self-directed Care | Coping Mastery | T1 - Baseline (pre-intervention) | 2.60 score on a scale | Standard Deviation 0.5 |
| Self-directed Care | Coping Mastery | T2 - 12 months later (intervention mid-point) | 2.67 score on a scale | Standard Deviation 0.52 |
| Self-directed Care | Coping Mastery | T3 - 24 months later (end of intervention) | 2.79 score on a scale | Standard Deviation 0.51 |
| Services as Usual | Coping Mastery | T1 - Baseline (pre-intervention) | 2.66 score on a scale | Standard Deviation 0.46 |
| Services as Usual | Coping Mastery | T2 - 12 months later (intervention mid-point) | 2.69 score on a scale | Standard Deviation 0.61 |
| Services as Usual | Coping Mastery | T3 - 24 months later (end of intervention) | 2.60 score on a scale | Standard Deviation 0.6 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in coping mastery that would be maintained longitudinallyp-value: <0.01Mixed Effects Random Regression
Secondary
Number of Participants Enrolled in Classes
Change in education participation status as measured by U.S. Department of Education's definition of school enrollment: enrolled in classes requiring registration and fee payment versus not enrolled in classes. Higher value = enrolled in classes. Minimum = 0 and maximum = 1.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Self-directed Care | Number of Participants Enrolled in Classes | T1 - Baseline (pre-intervention) | 7 Participants |
| Self-directed Care | Number of Participants Enrolled in Classes | T2 - 12 months later (intervention mid-point) | 5 Participants |
| Self-directed Care | Number of Participants Enrolled in Classes | T3 - 24 months later (end of intervention) | 11 Participants |
| Services as Usual | Number of Participants Enrolled in Classes | T1 - Baseline (pre-intervention) | 10 Participants |
| Services as Usual | Number of Participants Enrolled in Classes | T2 - 12 months later (intervention mid-point) | 5 Participants |
| Services as Usual | Number of Participants Enrolled in Classes | T3 - 24 months later (end of intervention) | 1 Participants |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report greater likelihood of enrollment in educational classes that would be maintained longitudinallyp-value: <0.0195% CI: [1.5, 11.44]Regression, Logistic
Secondary
Number of Participants With Employment
Change in employment status as measured by Bureau of Labor Statistics definition of paid employment: with paid employment versus without paid employment. Higher value equals with paid employment. Minimum = 0 and maximum = 1.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Self-directed Care | Number of Participants With Employment | T1 - Baseline (pre-intervention) | 16 Participants |
| Self-directed Care | Number of Participants With Employment | T2 - 12 months later (intervention mid-point) | 18 Participants |
| Self-directed Care | Number of Participants With Employment | T3 - 24 months later (end of intervention) | 19 Participants |
| Services as Usual | Number of Participants With Employment | T1 - Baseline (pre-intervention) | 13 Participants |
| Services as Usual | Number of Participants With Employment | T2 - 12 months later (intervention mid-point) | 6 Participants |
| Services as Usual | Number of Participants With Employment | T3 - 24 months later (end of intervention) | 6 Participants |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report greater likelihood of employment that would be maintained longitudinallyp-value: 0.04695% CI: [1.01, 4.74]Regression, Logistic
Secondary
Perceived Autonomy Support
Perceived support for autonomously motivated change measured by the Learning Climate Questionnaire of Williams & Deci. Measures change in perception that service environment is supportive of autonomy to make decisions and choices. Higher score equals better autonomy support. Minimum = 4 and maximum = 105.
Time frame: Study entry (pre-intervention), 12 months later (midpoint of intervention), & 24 months later (end of intervention)
Population: The number reflected in the Overall Number of Participants Analyzed pertains to the number of participants who completed the baseline interview.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Self-directed Care | Perceived Autonomy Support | T1 - Baseline (pre-intervention) | 4.74 score on a scale | Standard Deviation 1.72 |
| Self-directed Care | Perceived Autonomy Support | T2 - 12 months later (intervention mid-point) | 5.56 score on a scale | Standard Deviation 1.33 |
| Self-directed Care | Perceived Autonomy Support | T3 - 24 months later (end of intervention) | 5.44 score on a scale | Standard Deviation 1.54 |
| Services as Usual | Perceived Autonomy Support | T1 - Baseline (pre-intervention) | 4.65 score on a scale | Standard Deviation 1.82 |
| Services as Usual | Perceived Autonomy Support | T2 - 12 months later (intervention mid-point) | 4.85 score on a scale | Standard Deviation 1.57 |
| Services as Usual | Perceived Autonomy Support | T3 - 24 months later (end of intervention) | 4.83 score on a scale | Standard Deviation 1.84 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in perceived autonomy support that would be maintained longitudinallyp-value: 0.03Mixed Effects Random Regression