We Can't Case Manage Our Way out of Structural Segregation: Implementation of the Olmstead Decision in One State (WITHDRAWN)

Background and Purpose: In the United States, after Deinstitutionalization of the 1970s, a system of services focused on the needs and safety of people with intellectual and developmental disabilities (IDD) has developed into a robust institution comprised of public and nonprofit organizations that provide a complex array of housing, education, transportation, social activities, employment, and health services.  In 1995 this institution was challenged with the filing of Olmstead v. L.C., alleging discrimination due to unjustified segregation. The Supreme Court ruled in favor of the plaintiff in the Olmstead Decision (1999), requiring individuals with disabilities to be placed and served in community settings. Additional individual and group lawsuits expanded the term “institution” from psychiatric hospitals to Medicaid funded nursing and group homes, inclusion of individuals at risk for being institutionalized, and education, employment, and social activities.

Minnesota’s own IDD system was challenged by the Jensen Lawsuit, filed against the Minnesota Department of Human Services in 2009.  The 2011 settlement included a provision that Minnesota would develop a court approved Olmstead Plan. Approved in 2015, the plan is currently being implemented. This paper investigates the implementation of Olmstead in one state to identify barriers and solutions for policy implementation in human services institutions, to better inform strategies for meeting the fidelity of mandates and uphold the rights of target populations.

Methods:  This study sampled informants participating in the implementation of the Olmstead Plan who are recognized by their peers as effective actors within the sytem. In-depth, semi-structured interviews were conducted with each informant (N=30), protocol addressed individuals’ work experience within the IDD system, assessment of the implementation context, addressing key implementation issues and successes.  A strategic action fields approach to policy implementation framed the sampling and analysis strategy, analyzing responses for policy field actors (N=5), authorizing agency actors (N=6), service organization actors (N=14), and frontline workers (N=5).

Findings: Initial analysis found that the system is addressing implementation through both vertical management and horizontal networking strategies. Vertical strategies have focused on implementing person-centered practices and reorganizing frontline roles. Frontline workers do not have the structural power or agency to address the macro (labor and housing markets), exo (trade organizations, community-level politics), and meso (how communities react to people with IDD) conditions that are the major barriers to implementing the Olmstead Plan. Managers and leaders within the IDD system have power and authority to expand networks, at this time the emphasis on horizontal networks has focused on interorganizational relationships within the IDD system, rather than external political structures and community organizations.

Conclusion and Implication:  The findings have implications for theory, practice, and professional education. They suggest that research and practice need to shift focus from the frontlines as the place where policy implementation occurs to the actions and agency of management and leadership positions. This also provides a new perspective on how policy and policy implementation can be evaluated through how the system responds. In this case, shifting focus to how public human service institutions integrate themselves into communities.