CENTRE FOR INCLUSION AND CITIZENSHIP
TIM STAINTONCENTRE FOR INCLUSION AND
CITIZENSHIPUNIVERSITY OF BRITISH
COLUMBIA
Lessons from the global experience with individualized finding and self-determination
initiatives
ELEMENTS OF A SELF DETERMINATION BASED SYSTEM
Personal decision making support
Supported Decision Making and Representationfamily and trusted advisors advocacy
Independent planning and facilitation support
Individualized funding
Funder
Funding allocationis based on a PLAN
Contracts
Community Supports and Services
Provider Agencies
Personal Assistants
Commercial/Generic Resources
INDIVIDUAL
Basic IF ModelBasic IF Model
Employs Purchases
PLAN
Models and Variations
Direct Funding
Host Agencies, Fiscal Intermediaries
Fixed Amount (Illinois)
Catalyst funding (LAC)
Microboards, family governance models
User led support models
Personal budgets (UK) allocation of funding given to users after an
assessment. Users can either take a direct payment, or -while still choosing how their care needs are met and by whom - leave councils with the responsibility to commission the services or a combination of the two.
Individual budgets (UK) funding from multiple sources pooled together for
use by the individual.
OVERVIEW OF RESEARCH
majority of evidence across jurisdiction supports better outcomes (cost/benefit) and higher user satisfaction
US and UK evidence suggests that over a relatively short time cost of IF systems produce increasing cost savings and efficiencies, though in some cases IF is initially cost neutral or slightly higher
Cost savings are dependent on implementation structures and realizing savings elsewhere in the system (i.e. reducing case management)
.
…OVERVIEW OF RESEARCH
Research indicates indirect savings in areas such as health care utilization, crisis etc
IF can be used to support all level and types of disabilities
IF can be applied to most if not all types of services
no notable issues of abuse or misuse of funds
…OVERVIEW OF RESEARCH
support resources to handle employer and/or budget management responsibilities key where IF uptake highest
beliefs and practices of field staff working for government bodies has a strong impact on IF uptake and outcomes
Shortages of personal assistants/support workers significant challenge that can be mitigated by ability to hire family and friends
…OVERVIEW OF RESEARCH
importance of strong policy base upon which to build and promote the use of IF options
focus on creative, innovative use of funds + community and support network development can reduce dependence on paid supports and enhance satisfaction
one study noted improvements in quality of care when workers reporting to end user vs. an agency
Challenges and Issues
IF in isolation of broader support and system change
Transitional funding Unbundling
System Inertia Culture change Resistance from professionals,
government,providers
Unionized Environments Support staff
Staffing Shortages, wage rates, families, crisis cover,
training
Lack of both planning/facilitation support and financial management support hinders both uptake and success (particularly amongst those with ID)
Underfunding
Agencies using IF simply to fund traditional services
Restricting options/stifling innovation Staffing, family/network based management options
‘All in all out’ approaches
Onerous reporting/auditing/oversight
WHAT MAKES IT WORK…
Integrated Structure- Decision making rights and support Planning and Facilitation support (as required) Individualized funding options Governance options
Seeing IF as one tool for an inclusive life- systems should be community oriented not service or funding oriented
Foster and support innovation
Small is beautiful-encourage and support individual and family based models of support and governance Microboards, family governed supports, self
managed supports
‘Good enough’ system of reporting and oversight The ‘perfect’ system of oversight and
monitoring will inevitably stifle innovation and restrict self determination
Personal network development and support (critical if isolated individuals are to benefit)
Encourage user/family led support systems for IF users and families (contracting, management, training, advice)
Support to manage IF
Informed and committed staff (Government/agency etc.)
Flexibility and responsiveness (changing needs, goals etc.)
Back-up systems for support
THANK YOU
DIVERSITY INCLUDES
Tim Stainton, Centre for Inclusion and Citizenship
University of British [email protected]