107 The effects of supported housing for individuals with mental disorders The application contained information about health problems, functional limitations, background characteristics, and the type of care applied for. Applications were assigned to assessors by planners within each regional office, based on the assessors’ contemporaneous workload. Information about health or care needs was not taken in consideration by the planner for allocating applications. The traveling time of assessors and foreign language fluency could be taken into account to determine assessor assignment. Assessors had considerable discretionary power to apply generic rules to specific cases: within pre-set boundaries, they decided which additional information to collect and how to reach a decision. The assessor decided about (a) the type of long-term care, (b) the intensity of care and (c) the duration of eligibility, ranging between several months and 15 years. When the eligibility period finished there should be a new application; individuals could also submit a new application at any time. The application was first screened to determine its validity and, if so, whether it could be approved by a back office employee3 or whether it should be reviewed by an assessor. In the latter case, the screener also determined the type of assessment procedure: abridged or extended4. An abridged assessment procedure consisted of desk research and phone interviews. Information used by the assessor included the information filled out on the application form and, if applicable, information about prior long-term care use or information collected in previous applications. The assessor could additionally collect or verify information via phone interview with the individual, household and family members, the health insurer, and care providers. On top of this, an extended assessment procedure would include a face-to-face interview and a review by a multidisciplinary team, including medical professionals. Most applications would be defined as regular and handled within 6 weeks, with a smaller number of applications classified as priority and being handled in a shorter time-frame. Importantly, the scope of the needs-assessment agency would be limited to the eligibility decision, with assessors having no further interaction with applicants or providers about the actual admission to supported housing. Providers of supported housing are private non-for-profit organizations, often specialised in providing services to particular diagnoses (e.g. autism, personality disorders or substance use problems), psychosocial problems or dual diagnosis (e.g. mild intellectual disability in combination with a mental disorder). Providers could specify entry criteria beyond eligibility (to ensure a good match 3 Back-office employees handle delegated reassessments (Herindicatie via taakmandaat – HIT) and applications for types of care for which a predefined procedure is available (Standaard Indicatieprotocol – SIP), which are often directly approved. A small number of these application might be checked by assessors: HITs would be checked before the approval is granted and SIPs afterwards. 4 Long-term care applications to CIZ could also be assessed through a standard assessment procedure. This procedure is similar to the abridged assessment with an additional a face-to-face interview. The number of standard assessments in our population was residual and hence these were excluded (Table A1 in the appendix). 4
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