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.
Access to a coach who is a peer specialist is instrumental in giving the client hope that he can reach his goals. One of the most important first steps is to determine what those goals are and then devise a plan for achieving these goals. The peer specialist/coach listens carefully, enhances motivation, clarifies information, promotes collaboration and stimulates thinking, as well encourages different views and reinforces gains. The coach stays positive to uplift and inspire the person receiving services.
The beauty of the Magellan pilot and other programs like it is that, according to Clarence, "it takes into consideration all that the member is, and all that he can be." The goals are person-centered, use words that he easily understands, are appropriate to his culture, and consistent with the participant's desire for self-determination and self-sufficiency.
Strengths include environmental factors that will increase the likelihood of success: community supports, family/relationship support/involvement and work. Also, by identifying our best qualities and motivation strategies that worked well in the past we can jettison what didn't work and focus on what does. We all have competencies, accomplishments and values, as well as interests and activities such as sports and arts which contribute to our success.
The three Magellan pilots served in Iowa and Tennessee individuals with serious mental illness, and in Pennsylvania, families of children with autism spectrum disorders who receive intensive behavior health rehabilitation services. The preliminary outcomes are encouraging: in Tennessee, participants generally report strong levels of satisfaction after initial self-directed care training and establishing goals with their coach. In Iowa, approximately half of the SDC participants have increased their residential status and monthly income, and approximately one quarter have increased their employment status. Of those in the Iowa program, more than half have attained their overall intensive psychiatric rehabilitation goal. The Pennsylvania pilot demonstrated that at mid-point, more than one-third of the children with autism showed some improvement towards the goals as rated by their self-directed care coach on the Goal Attainment Scale. Improvement on goals (i.e., increased interactions with others) was related to increased SDC expenditures, as well as decreased parental self-report of stress.
For more information about this and other Magellan initiatives, log on to www.magellanhealth.com. It is clear to me that this is the wave of the future and we need to lobby our elected officials to think outside of the pill bottle and create legislation to fund these vital services. After the NAMI 2008 convention blog series winds down, I will revisit the concept of goal-setting as it relates to recovery.
Published On: July 04, 2008