Transcript Self-Determination Overview

Self-Determination
Overview
Susan Fox
Human Services Research Institute, Inc.
April, 2003
Principles
Freedom
Authority
Support
Responsibility
Freedom
Freedom to choose service provider
Freedom to choose service
coordinator/service broker/case manager
Freedom to live where I want, with whom I
want
Freedom to decide who works with me
Freedom to decide what I do each day
Authority
Authority to manage an
individual budget
Authority to hire, fire,
manage staff
Support
Support from family and friends
Support from service providers and staff
Support to live and work as I choose
Support to learn skills needed to live a full
life
Support to receive adequate health care
Responsibility
Responsibility to spend public monies
wisely
Responsibility to treat staff with respect
and dignity
Responsibility to work in partnership with
providers and staff
Responsibility to make informed choices
that are reasonable and prudent
Policy Considerations
Conflict of Interest
Flexible Individual Budgeting
Personally Directed and Controlled
Planning Process
Independent Support Brokerage
Autonomous Fiscal Intermediary Services
Meaningful Activities and Lives
System Structure and Function
Conflict of Interest
Person must be able to freely choose
among different alternatives
Staff supporting person, such as support
brokers, must be able to work
independently for the person, for the direct
benefit of the person
Flexible Individual Budgeting
System must support people to control their
resources, either directly or with chosen support
Budget should be individually created through
an open process
Individual should have control over personnel
Flexibility to allow movement of funds between
budget line items
Funding to support administration of funds at
both agency and individual level
Person Centered Planning Process
Planning process must respect and reflect
the central role of the person
Authority for decision making rests with the
individual (and/or chosen network of
support)
Independent Support Coordination
Separate from service provision
Work for the benefit of the person, not
the agency
Autonomous Fiscal Intermediary
Perform a variety of fiscal functions: pay
bills, employer of record, bill Medicaid
Works for the individual
Independent of service provision
Meaningful Jobs, Meaningful Lives
Live in “own” home: i.e. apartment,
house, trailer that the person rents,
leases or owns
Meaningful employment that moves from
“getting a job” to “producing income”
System Structure and Function
Costs of fiscal intermediary
Independent service brokerage
Financial liability for employees of individuals
Provide for recovery of “sunken costs”: long term debts
and mortgages of agency facilities and homes
Costs to support data and record keeping systems
24 hour crisis response capacity
Conflicts of interest
Develop systems that do not supplant individual control
Self Determination Requires:
Public policies that provide opportunities
for individuals and their families to express
self-determination
Leadership development among
consumers, policy makers, and service
providers
Personal skills, knowledge, and supports
for individuals and families to take
maximum advantage of opportunities
NH’s System Change: Multiple
Levels of Change
Self Advocates Initiatives
Family Support and Family Leadership
Direct Support Providers Initiatives
Provider Level Initiatives
State Level Policy Initiatives
Cross-Disability Initiatives
State Level Policy Initiatives
State Law Changes (RSA 171-A)
Rule Changes (He-M 503)
Medicaid Waiver Changes ( Consolidated
Services)
Contract Changes (Self Determination
Language)
Outcome Measures and Quality Assurance
New State Initiatives: Family Directed
Independence Plus Waiver for Children
Consolidated Developmental
Services
Provision of assistance and resources to individuals with
developmental disabilities and their families in order to improve and
maintain the individual’s opportunities and experiences in living,
working, socializing, recreating and personal growth, safety and
health. Consumers whose services will be funded through this
service category will have full freedom and control in choosing their
own provider(s) for each and every aspect of their services. These
services will not be provided to recipients by parents of minor
children or spouses. In cases where services are provided by other
relatives or friends these individuals shall be fully qualified providers.
Health and Safety
“Choice is not a reason for a person to live
in an unsafe place.
Choice is not a reason for a person to live
in filth.
Choice is not a reason for a person to
smell bad.
Choice is not a reason for a person to
inflict self-harm.”
– John O’Brien