SelfDetermination Overview

1
Self-Determination Overview

• Susan Fox
• Human Services Research Institute, Inc.
• April, 2003

2
Principles

• Freedom
• Authority
• Support
• Responsibility

3
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

4
Authority

• Authority to manage an individual budget
• Authority to hire, fire, manage staff

5
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

6
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

7
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

8
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

9
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

10
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)

11
Independent Support Coordination

• Separate from service provision
• Work for the benefit of the person, not the agency

12
Autonomous Fiscal Intermediary

• Perform a variety of fiscal functions pay bills,
  employer of record, bill Medicaid
• Works for the individual
• Independent of service provision

13
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

14
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

15
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

16
NHs 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

17
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

18
Consolidated Developmental Services

• Provision of assistance and resources to
  individuals with developmental disabilities and
  their families in order to improve and maintain
  the individuals 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.

19
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 OBrien