Study: MH Self-Direction Shows Promising Results for Housing and Employment Outcomes

NYAPRS Note: A newly web posted study suggests that when people with more extensive mental health conditions are afforded a portion of public funds to advance their recovery, they are supported to make advances in their employment and independent housing goals.

Note the attachment that shows that the Florida based study participants used their funds to address transportation, employment and housing needs, as well as to purchase computers, dental care, dental care, therapy and psychiatric medications.

New York is currently operating two self-direction pilots at NYAPRS member agencies Independent Living and Community Access that are expected to position self-direction to become a Medicaid funded Home and Community Based Service here. NYAPRS has long been a very strong self-direction proponent; I’m very pleased to serve as the current Chair of the Mental Health Self-Direction National Advisory Committee.

Mental Health Self-Direction Shows Promising Results for Housing and Employment Outcomes

Contact: Bevin Croft, Human Services Research Institute

Cambridge, Massachusetts, May 15, 2018 – Self-direction, or self-directed care, is a newer service delivery model for people with serious mental health conditions who use publicly funded services. In self-direction, people control a portion of funds normally spent on their treatment to purchase a range of goods and services to meet recovery goals within the context of their unique life circumstances. Purchases might include transportation, supports for housing, employment, or education, or even mental health treatment from a provider of the person’s choosing.

New research from the Human Services Research Institute (HSRI) suggests that mental health self-direction can help support people to live and work in their communities. To explore the effects of self-direction on important functional outcomes like employment and housing, HSRI researchers and colleagues looked at approximately four years’ worth of data from the nation’s largest and longest-standing self-direction effort, FloridaSDC. They found that compared with nonparticipants, self-directing participants were more likely to improve, or maintain at high levels, engagement in paid work and independent housing.

“Self-direction is emerging as a promising model of mental health service delivery, and it aligns with the field’s growing focus on using individualized, person-centered care to effect recovery,” says Bevin Croft, Research Associate at HSRI and the study’s Principal Investigator. This research adds to a growing body of evidence that shows self-direction can help people achieve better outcomes.

The study, published online today in the journal Psychiatric Services, is part of a Demonstration and Evaluation of Self-Direction in Mental Health study that explores mental health self-direction in six states, funded by the Robert Wood Johnson Foundation and the New York State Health Foundation with support from the Substance Abuse and Mental Health Services Administration.

The Human Services Research Institute (HSRI) ( is a nonprofit, mission-driven organization that works with government agencies and others to improve health and human services and systems, enhance the quality of data to guide policy, and engage stakeholders to effect meaningful systems change.

Housing and Employment Outcomes for Mental Health Self-Direction Participants

Bevin Croft, M.P.P., Ph.D., Nilüfer İsvan, Ph.D., Susan L. Parish, Ph.D., Kevin J. Mahoney, Ph.D.



In self-direction, participants control individual budgets, allocating service dollars according to needs and preferences within program parameters to meet self-defined recovery goals. Mental health self-direction is associated with enhanced wellness and recovery outcomes at lower or similar cost than traditional service arrangements. This study compared outcomes of housing independence and employment between individuals who participated in self-direction and those who did not.


This quasi-experimental study involved administrative data from 271 self-directing participants. Using coarsened exact matching with observed demographic, diagnostic, and other characteristics, the authors constructed a comparison group of non–self-directing individuals (N=1,099). The likelihood of achieving positive outcomes between first and last assessments during the approximately four-year study period was compared for self-directing and non-self-directing individuals.


Self-directing participants were more likely than nonparticipants to increase days worked for pay or maintain days worked at 20 or more days in the past 30 days (number needed to treat [NNT]=18; small effect size) and maintain or attain independent housing (NNT=16; small effect size), when analyses controlled, to the extent possible, for observed individual characteristics.


Based on data from the nation’s largest and longest-standing program of its kind, results suggest that mental health self-direction is associated with modest improvements or maintenance of positive outcomes in employment and housing independence. This research adds to the literature examining self-direction in the context of mental health and begins to fill the need for a greater understanding of self-direction’s relationship to outcomes of interest to service users and families, providers, and system administrators.

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