At a NAMI 2008 convention workshop, Clarence Jordan and a colleague, Tom Lane, national director, consumer and recovery services for Magellan Health Services public sector division, spoke about self-directed care (SDC). It's a revolutionary concept yet to go mainstream. Self-directed care programs give people in recovery much greater choice, direction and control over the services they receive. The workshop explored the benefits, challenges and impact of these programs that foster recovery and resiliency.
The Magellan pilot offered services in Iowa, Tennessee, and Pennsylvania. The principles of self-directed care are recovery, choice, responsibility, control and accountability. What separates this program from traditional treatment? With self-directed care, individuals can choose from a wider range of supports and have the flexibility to spend money allocated for their care in new ways.
This truly innovative approach, for example, would allow a person in recovery to buy things not often provided for with other funds, such as dental work, eye glasses, health spa, tuition assistance and suitable clothing for work. Items that are strictly prohibited would be any kind of indebtedness, court fines or fees, drugs to include tobacco products or other items deemed unassociated with the individual recovery plan.
SDC program components include person-centered planning that is strengths-based, offers coaches, individual budgeting, tracking of expenditures (individual and aggregate), has an expanded provider network and expanded service array, and oversight and quality improvement. The self-directed care could be funded by community reinvestment dollars, and wouldn't jeopardize any other health benefits the member receives. The funds would be given in addition to those monies.
In the Magellan program, participants are chosen from pilot agencies or community mental health centers; they are persons who currently receive services from that agency and who wish to volunteer. The agencies place bulletins in their newsletters, local community newspaper, posters and any other notification soliciting interested parties. Interested persons go through an orientation whereby they are given all the details of the program, at which point they are free to become a volunteer or walk away. The volunteers who sign on are under no obligation to complete the program and can opt out at any point. The funds are secured through a fiduciary and released only when recovery goals are identified which meet program guidelines.
The pilot ends on December 31st of this year, or continues until the allotted amount of funds is exhausted, whichever comes first.
Clarence Jordan understood that having things you need when you need them turns your life around. He asked, "How would like to see the sun on your face again? The butterfly on a bush?" The benefit of self-directed care is that the money follows the patient; it's not locked in to one provider. That gives the person the freedom to fine-tune his treatment as he goes along.
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