This report is based on a review of published and unpublished academic articles, presentations, and policy documents and on interviews with key informants. Literature and other documents were obtained by Internet search and by requesting information from experts on SDC and other consumer-directed service models. A 2007 ASPE report on the use of the SDC model in mental health care settings33 was a key source for information on SDC programs. Interviews with key informants--state and federal policymakers, academic experts, consumer advocates and consumers, private insurance representatives in companies serving the public sector, and SDC program representatives--were conducted by the authors from December 2011 to January 2012.
Key informants were nominated by ASPE staff. Nominations were based on knowledge of SDC and other consumer-directed services. Key informant interviews focused on conceptual advantages of mental health SDC compared to traditional mental health care, risks of SDC to consumers and to the quality of care, impacts on public budgets, key features of SDC programs, infrastructure and staffing needs, potential sources of financing, and implementation barriers. Interview questions were selected by the authors in consultation with ASPE staff and sent to each key informant in advance of the interview.
Thirty persons were invited to participate in key informant interviews. Eighteen did not respond to the initial invitation and were sent a second invitation. Reponses were eventually received from 13 of the invitees, two of whom declined the interview. These key informants included representatives of mental health SDC programs in four states, as well as persons with knowledge of multiple mental health SDC programs. Three of the key informants had specific expertise in the Cash and Counseling program model and other consumer-directed services. One key informant had direct experience as a participant in SDC.
Key informants had three options for communicating their responses to interview questions: telephone interview only (n=7), telephone interview and written response (2), and written response only (4). Although the list of prepared questions generally guided the interviews, key informants were allowed to skip any given question, some of their responses addressed issues that had not been raised in the prepared questions, and some ad hoc questions were posed depending on a key informant's prior response. Telephone interviews lasted between 17 and 156 minutes. These were audio-recorded and the recordings were subsequently reviewed to identify key points and common themes. Written summaries of key informant interviews were prepared and compared to the original recordings for completeness and accuracy.