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Schedule:
Saturday, January 13, 2018
Marquis BR Salon 6 (ML 2) (Marriott Marquis Washington DC)
* noted as presenting author
Background and Purpose: The 2014 Residential Information Systems Project estimates IDD prevalence at 1.47% of the United States population. In place of institutional services, 90% of individuals with IDD receive home and community-based services (HCBS) (Ng et al., 2015). Within the HCBS context, self-direction has emerged as a model of service delivery that provides individual with IDD greater control over their supports and daily lives. The purposes of this study were to describe how program administrators understand self-direction as well as the salient forces that influence implementation self-directed service options.
Methods: Data were collected over a one-year period (2015-2016) via phone interviews with state-level developmental disabilities program administrators and directors implementing self-directed programs. Representatives from 34 of 41 states offering self-direction participated in the study. Directed content analysis incorporated theoretical and empirical a priori categories as well as categories inductively derived from the data set. The research team included a primary coder, a peer reviewer, and an auditor.
Results: Program administrators presented a unique understanding of self-direction. Aspects of self-direction as described by administrators—including flexibility, self-determination, individualization, and rationalization of service delivery systems—are well-grounded in the self-direction literature. However, administrators’ responses also challenge the self-direction literature by favoring employer authority over budget authority, deemphasizing person-centered planning, and conceptualizing self-direction as a spectrum of options. Salient forces impacting implementation included culture, legislation, advocacy, program design, resources, and technological coherence.
Conclusions and Implications: The results of this study extend the current understanding of self-direction in the United States. Administrators’ perceptions of self-direction reflect both the progress that self-determination movement has made in reframing disability supports and the challenges of facilitating self-determination in a fiscally conservative policy environment. Additionally, administrator experiences can help disability advocates target critical areas in the implementation process to expand opportunities for self-determination for all individuals with disabilities.
Methods: Data were collected over a one-year period (2015-2016) via phone interviews with state-level developmental disabilities program administrators and directors implementing self-directed programs. Representatives from 34 of 41 states offering self-direction participated in the study. Directed content analysis incorporated theoretical and empirical a priori categories as well as categories inductively derived from the data set. The research team included a primary coder, a peer reviewer, and an auditor.
Results: Program administrators presented a unique understanding of self-direction. Aspects of self-direction as described by administrators—including flexibility, self-determination, individualization, and rationalization of service delivery systems—are well-grounded in the self-direction literature. However, administrators’ responses also challenge the self-direction literature by favoring employer authority over budget authority, deemphasizing person-centered planning, and conceptualizing self-direction as a spectrum of options. Salient forces impacting implementation included culture, legislation, advocacy, program design, resources, and technological coherence.
Conclusions and Implications: The results of this study extend the current understanding of self-direction in the United States. Administrators’ perceptions of self-direction reflect both the progress that self-determination movement has made in reframing disability supports and the challenges of facilitating self-determination in a fiscally conservative policy environment. Additionally, administrator experiences can help disability advocates target critical areas in the implementation process to expand opportunities for self-determination for all individuals with disabilities.