“Getting A Good Life”: The Challenges For Agency Transformation So That They Are More Person Centered

Michael J. Kendrick

Keynote Presentation: Conference On Agency Transformation: The Disability Sub-Conference Of The International Initiative On Mental Health Leadership (IIMHL), San Francisco, California, USA, September 15-16, 2011

Introduction


Michael J. Kendrick

Keynote Presentation: Conference On Agency Transformation: The Disability Sub-Conference Of The International Initiative On Mental Health Leadership (IIMHL), San Francisco, California, USA, September 15-16, 2011

Introduction

Operationalization Of Individualization

We live at a point in history where within the span of a few generations we have seen great advances in the kinds of lives that are possible within communities for persons in sectors as diverse as mental health disability, aging, children, service to minorities etc. This is not an illusion, as much of this progress has been real and has often been achieved with great difficulty. Nonetheless, we can also say that satisfaction with such gains is tempered by the realization that the lives of many people still fall short of what their fellow citizens routinely enjoy by way of lifestyles that suit them and access to the core benefits of being within community. The ongoing interest in agency transformation is an extension of the recognition and concern that we are still not where we want to be in terms of optimizing the actual life possibilities of people.

The dramatic and widespread rise of complex bureaucratic service agencies and systems, particularly in recent decades, is a new historical phenomenon that has major impacts on people’s lives. In particular, the rise of technocratic culture in our corporations and governments has considerably influenced how these entities function. Though a striking number of formal services began as “bottom up” small grass roots citizen initiatives largely in the local self-help mode, their character today is increasingly corporate, expansionist and arguably quite remote from the control and priorities of service users and families. Amongst a great many service users and families as well as many professionals there is a perception that today’s agencies are not performing in terms of their expressed commitments to the people they support. This concern with the overstated nature of agency and systems rhetoric relative to actual agency performance in people’s lives, highlights the need to evolve the thinking and practice of agencies to better align with the new goals and hopes that are emerging for people’s lives.

It is notable that there are a small number of agencies that have been quite systematic over several decades in their ability to reliably generate promising individual options. At the same time, there are many agencies that have adopted such goals, but have not as yet worked out credible methods to ensure individualization beyond initial efforts at some kind of person centered planning. In other words, there is a performance gap between desired outcomes and actual results. Another point of concern is the continued persistence of a large number of agencies still offering sizable numbers of group based, pre-set or “fixed” models of service in contrast to exclusively individualized options. There is also a fear with many supporters of individual options that the more conventional group based service models have become irretrievably entrenched and unresponsive to service user preferences for more individualized options. We can see this play out in the flourishing of conventional day programs, group homes, nursing homes and institutional and quasi-institutional settings despite decades of professional, agency and government declarations that “person centered” options would and should gradually replace these.

People cannot be faulted for wanting such declarations of “person centeredness” to be true. After all, who amongst us does not want people to have good or even better lives? It is this challenge of nurturing further forms of effective agency transformation that reliably accelerates these outcomes. By analyzing why progress has been so slow given that personalized solutions seem to have won the rhetorical battle, we might be better able to make headway. One such difficulty is that many people might not share the same interpretation, as a practical matter, of what the actualization of these goals should look like in practice. We casually use various shorthand terms such “personalized”, “person centered” and “individualized”, but with very little specification of what precise form they might or should take in substantive operational terms. Consequently, we have had the stated goals for services evolve, but without sufficient commensurate change in the detail of how services still operate. Consequently, many services and agencies have been relabeled by themselves as “personalized”, but still largely operate as standardized, group or fixed models, but perhaps with some negotiability in place to address a few individualizing concerns. An example of this would be agencies that devote extensive efforts to formalized person centered planning, but lack the precise and dependable means for implementing what aims such planning generate. This “implementation” or “operational” gap is precisely the challenge we now face in regard to agency transformation.

This impasse may lessen considerably if we can update our definitions of what we mean by both a “good life” and a “good service” in operational instead of aspirational terms. There is a undoubtedly a widespread desire to see that service users and families routinely have available to them authentic individualized and enhanced lifestyle and support options, but the actualization of this consensus has been deeply impaired by our inability to become more substantive in both recognizing and installing the actual proven approaches best suited for achieving these aims. “Agency transformation” is no exception in terms of a term laden with definitional and operational ambiguity. We use such terms as if it is self-evident what is meant. The better we become at clarifying what we mean, the easier it will be to know better what it is that we should do to achieve real results with them. Obviously, there are many conceivable kinds of agency transformations, so we need to specific as to which ones we are currently seeking and what methods are best for getting us there.

What Kind Of Agency Transformation Is Being Sought?

In order to accomplish such an ambitious goal as would be the widespread individualization of community lifestyles and supports, we obviously would need more of the types of both agencies and service systems that have the kind of “person centered” capacities that are now routinely at present in at least a small minority of agencies. We could become more strategic at agency transformation on the premise that if we can now increasingly provide such options for small numbers, we can eventually work out how to do this with much larger numbers. We nevertheless would need expanded personal, organizational and community capacity to reliably generate and sustain personalized existential results in people’s lives i.e. to help people “get a (good/better) life”, one-person-at-a-time. Nonetheless, though this aim is not easily defined, partly because the ultimate outcome i.e. “a good life” is inherently difficult to describe, we can still see valid evidence of actual changes in agency performance in this direction where people have set this as their purpose and persevered.

The ability to specify and eventually satisfactorily address what a given individual may need or want in life is in itself inherently challenging, as individual people will vary widely in their life circumstances and their life requirements at a given moment. Our usual global descriptors for satisfying needs and wants suitably are normally quite opaque when it comes to any precision about what they might mean for a given person. Though we use terms like “person centered”, “personalized”, “individualized”, “tailored”, “targeted” and so on with great ease, they are largely of scant utility in creating definition except for their important function of providing a contrast with group and fixed models of service.

While we may frame the challenge more universally as being something along the lines of “each according to their needs and aims in life”, such a broad goal lacks the kind of specificity that would make it easier to appreciate in a more tangible sense what are the precise personal, agency and community capacities that are being sought. Not being able to identify and describe these capacities substantively greatly compounds the likely challenges involved in bringing them about for greater numbers. Obviously, personal fulfillment, while achievable in so many ways in life for all of us, does not readily line itself up in perfect synchronization with our bureaucratic systems. The lives of ordinary people and the quite different ways our communities work are all important dimensions of the challenges agencies face. Yet, as demanding as this ambition is, it should not be jettisoned just because our agencies currently operate in ways that are unhelpful. Rather, the focus should be to narrow this gap between what people need and the capacities that are proven thus to have been instrumental in addressing these needs. To this end, we cannot routinely achieve better lives for people if we remain stuck in service models and approaches that have unfortunately been persistently unsuccessful achieving credible person centered outcomes.

It is this latter function of drawing contrast with conventional or established service models that has probably been most helpful relative to the use of “person centered” terminology. It has enabled advocates and proponents to establish the litmus test that an authentically individualized option can be generated both “one person at a time” and that this can be done “from scratch”. These rough measures alone would make it possible to at least somewhat distinguish individualized arrangements from non-individualized ones. Even so, it would be mute on whether the arrangements were actually beneficial given that people can be poorly supported “one person at a time” in lives that are not very satisfying i.e. a mismatch for what that person needs. Similarly, many service models that are standardized in nature may actually share the values that could conceivably enliven people’s lives even though their operational models and practices are contrary in nature.

Nonetheless, if an agency or systems can be held accountable for establishing an individualized arrangement “from scratch” if required, then the resultant question of the quality of that arrangement, as tested against the needs and aspirations of the given focus person, would remain as a logical second challenge for these agencies and systems. In other words, the challenge is two tiered. It is first to create a genuine individualized arrangement and secondly to ensure that it fits well with the lifestyle and support aims and needs of the specific person. Obviously, these challenges are entwined with each other and it is possible to fail or succeed with both, though any such success or failure is likely to be a matter of degree, as neither appears to be dichotomous variables easily answerable by a simple yes or no.

Further Dimensions Of The Systemic Individualization Challenge

For agencies and systems the initial challenge described here would have various implied dimensions if considered in the light of any systemic aim that individualized options be increasingly normative i.e. widespread rather than available only to a few. These dimensions would likely be operationalized in the following ways;

1. That the agency (or system) would have within itself the capacity to routinely create individualized options with a person “from scratch”. The reasons for this aim have already been mentioned and are obvious.

2. That the agency (or system) could routinely convert existing group or fixed models of service to individualized ones as requested. If this capacity were lacking then individualized options would only be available with new monies, as this “model conversion” task, as it relates to a given person, would imply the ability of the agency to “unbundle” existing monies currently committed to group/fixed models of service for use exclusively within individualized options.

3. That the agency (or system) could not only create these options it could also sustain and evolve these options indefinitely.

4. That the agency (or system) could generate an individualized option for all persons being served, including persons who might be considered notably poor candidates for individualization i.e. persons who are allegedly “difficult to serve”. Otherwise, individualization would only be feasible for some rather than all.

5. That such agencies and systems could sustain these individualized options across multiple jurisdictions and time periods with varying political, economic and leadership climates i.e. under all likely conditions. Otherwise, these agency or systems capacities would not be robust enough to dependably thrive in both favorable and unfavorable environments.

6. That the agency (or system) could have within itself the capacity to deliver individualized arrangements at an average cost that would be competitive in the aggregate with aggregate costs for group or fixed models of service.

7. That the individualized arrangements created assure comparable security for the people being supported relative to their specific vulnerabilities via the use intentional safeguards.

What We Know About Agency And Systems Capacities Thus Far In Regards To These Challenges

1. That the agency (or system) would have within itself the capacity to routinely create individualized options with a person “from scratch."

It is readily apparent, in multiple jurisdictions, that such individualized options have been routinely created, maintained and expanded in overall numbers on an indefinite basis. We also know that we now have comparatively more rather than less individualized arrangements. Further, that increasing numbers of agencies and funders have expanded their capacities in this regard and that this trend shows no sign of coming to a standstill. Notably, it is hard to identify a jurisdiction in which individualized options are shrinking as a matter of long term policy as opposed to short term budget cuts. In other words, the individualization of services is a trend that is expanding rather than diminishing.

2. That the agency (or system) could routinely convert existing group or fixed models of service to individualized ones as requested.

This capacity is more problematic, as much of the expansion of individualized options seems to be fueled more with unobligated “new” monies rather than through monies that have become “unbundled” from existing service models. Nonetheless, there are examples of both agencies and funders who have converted from group/fixed models of service to intentionally individualized ones. Notably, many of these instances of service model “conversion” date back decades. Nevertheless, the comparatively fewer instances of the use of conversion of older models to new individual options suggest that this strategy is likely more challenging to agencies and systems initially because of having to undo something at the same time as one creates its replacement. It does give weight to perceptions that the degree of entrenchment of existing models of service makes it difficult, though not impossible, to replace them or we would not have so many “conversion” examples in the first place. It also suggests that too few agencies and systems have the kinds of firsthand experience with such conversions that would make such conversions move from the category of being “occasional” to “routine”, thereby probably lessening their level of confidence that conversion could be realistically normative part of their functioning.

3. That the agency (or system) could not only create these options, it could also sustain and evolve these options indefinitely.

Given the striking longevity of the survival of many individualized options in multiple jurisdictions and the sustained growth of them in absolute terms, there seems little doubt that such options could be viable indefinitely. Though the demonstrated programmatic sustainability of individualized options is apparent, it is not clear whether such options can be expanded systemically to include proportionately greater numbers of the total numbers being served by all models of service. Nonetheless, should such an expansion take place, then there seems little doubt that such options could be routinely sustained once they are created given the pattern observed to-date.

4. That the agency (or system) could generate an individualized option for all persons being served, including persons who might be considered notably poor candidates for individualization i.e. persons who are allegedly “difficult to serve.”

It is apparent on close examination that many agencies and systems are currently supporting individuals in their individualized options that historically would have been supported exclusively in group or fixed models of service. Not uncommonly, at least a small number of such persons would have fitted the category of being seen as “very difficult to serve”. This illustrates that there has been the capacity to support some such individuals on a sustained basis. What is not clear is whether this capacity would continue to be present for proportionately larger numbers of such persons assuming increased growth of individualized options overall, since this kind of systemic target has not been attempted as yet.

5. That such agencies and systems could sustain these individualized options across multiple jurisdictions and time periods with varying political, economic and leadership climates i.e. under all likely conditions

The attempt to expand individualized options has occurred successfully in multiple jurisdictions and at differing time periods both through the use of new monies and conversion of service model strategies. Though the record is incomplete at this stage in regards to systemic scale initiatives, there have not arisen insuperable programmatic issues that have essentially made the exercise unviable in instances where the attempt has been made. So, while the precise degree of robustness of these varying initiatives remains largely unknown on a comparison basis with each other, it is clear that long term viability has not been a concern of any consequence, particularly once these initiatives are actually underway.

6. That the agency (or system) could have within itself the capacity to deliver individualized arrangements at an average cost that would be competitive in the aggregate with aggregate costs for group or fixed models of service.

The fact that individualized options have had a sustained existence on a routine basis once established, generally suggest that they are cost competitive in multiple jurisdictions and are able to manage the pricing concerns of funders as a regular matter. This is not meant to suggest that some instances of excessive cost individual situations exist for a time where agencies and funders “throw money at people” without enduring merit. However, the fact that these instances are not normative in an overall sense suggests that these occasional excesses are eventually corrected. Though many persons offer or subscribe to sweeping statements that widespread individualization is not viable, there are no definitive studies or “studies of studies” that uphold such claims. The actual cost related studies available at this point in regards to individualized options instead tend to show that they can and are managed within cost competitive aggregate parameters.

That the individualized arrangements created assure comparable security for the people being supported relative to their specific vulnerabilities via the use intentional safeguards.

There is a burden of proof that rests with proponents of change. One dimension of understandable anxiety from families and others would be whether or not individualization might conceivably result in the placement of people into situations that increase their overall vulnerability in comparison with conventional service models. The increasing number of individualized arrangements would seem to have settled this question, at least for those “opting in” at this point in time. Even so, the issue remains a real one as tragedies are not dictated by aggregate statistics, but rather by unfortunate circumstances that may only affect a handful of people. Consequently, individualized options must necessarily meet this challenge “one person at a time” indefinitely or their credibility will suffer.

Can Agency (And System) Capacity For Individualization Be Increased As A Pro Active Strategy?

The uncertainties concerning the precise agency (or system) capacities that matter most for the creation of individualization of lifestyle and supports could be a factor creating hesitancy as to proceeding with expanded individualization, particularly in regards to agency rates of conversion to individualization. The answer to this question will first depend upon the following three key agency policy decisions:

1. The first is whether agencies and systems make a decision to freeze any growth in existing models thereby creating the capacity to proportionately expand individualization.

2. The second will be whether they subsequently decide upon some sort of phased replacement of existing service models with individualized ones.

3. The third is whether they make appropriate investments in staff, service users and families to understand, support and plat meaningful roles in relation to the transition to individualized options.

This last decision is often overlooked as being some sort of a “frill” in comparison to the organizational/structural questions of service model transformation. However, when one considers that people are often fearful of changes they do not understand, the probability of their potential unfamiliarity with what could come afterward and their suspicion of any official pronouncements that things will be necessarily be better, it becomes reasonable to assume that any “people resistance” that emerges may well be justified. In other words, it may be both more respectful of people and beneficial to better long term outcomes to earn the support of the people affected rather than to engage in a presumptive top down imposition of change. While this may mean a more time intensive start to any process of agency transformation, it offers hope that any proposed change be addressed mindfully. Any change in practice will be preceded by changes in thinking and outlook and this necessity should not be assumed to have happened simply because at least some organizational leaders are initially in favor of the change.

Innovation Adoption/Diffusion Curves And Their Implications

Another important aspect of change processes arises from what has been learned from innovation adoption curve studies popularized by Everett Rodgers in the early 1960’s. One such point is that adoption of change comes much easier once early adopters have established persuasively successful examples of a given innovation. So, the more difficult period in agency transformation will likely be the earlier rather than later phases of service model conversion. If the early models are unpersuasive, inferior or simply fail, the process of adoption will most certainly stymied. On the other hand, if quality rather than the scale of early examples is consciously made a priority, this will be very helpful in getting to more widespread adoption by properly skeptical early and late adopters.

Managing The Consequences

In an article in 2002, "Integrating Models of Diffusion of Innovations," Barbara Wejnert details two categories of consequences that may be implicated in the adoption of innovations. These are the calculations of public versus private consequences and benefits versus costs. In regard to the public consequences of the adoption of individualization, it is important to consider the possible consequences for the collective interests that may be involved such as organizations, governments and social movements and the private interests that would include the individual lives of service users, families, staff and others implicated in any change. Even if the public and collective interests are convinced that the change is a good one, there remain many private personal interests at work in how this change might be evaluated at a personal impact level. These interests are distinct in that their evaluation of potential consequences may differ considerably from any public consensus. We have seen this played out repeatedly in conflicts around the closure of institutions and we should not expect any less conflict when it comes to replacing mini-institutional service models within the community.

The cost benefit calculation applies to both public and private appraisals of the merits and costs of any proposed change. These costs may be both of the cash and non-cash kind. Obviously, even positive changes may bring costs of either a direct or indirect nature into play, not the least of which may be things like heightened uncertainty, anxiety about loss, discomfort with change and conflict, a preference for security over other values such as quality, political fears and so forth. In the arena of actual cash costs, we do not have the luxury, at the moment, of having this proposed conversion process completed on such a widespread basis such that all the actual costs are now apparent in retrospect. Instead, we are facing a prolonged period of uncertainty as to what the actual cost benefit details end up being in practice, at least in terms of systemic patterns. Similarly, at the level of individuals, particularly aging service users and families, we have to anticipate that the individualization of supports involving self-direction models of implementation do most certainly look to many of them as constituting a net increase in work and demands upon them. To the already weary, who are comparatively comfortably ensconced in more standardized models of service, these conventional models of service are the “bird in the hand” and any talk of taking this perceived advantage away will most clearly encourage reaction and resistance.

The Challenges Of Quality In Individualized Options

It has already been said that agencies can expand their capacity to create individualized supports that are in better alignment with a given person’s existential needs and their prospects for personal fulfillment. If agencies are to be more engaged in transforming themselves in regards to the roles they could helpfully play in people’s lives, it is important that they be able to see more clearly what it is they are already doing and could do better with, what they are largely not doing that is nonetheless vitally needed and what they are presently doing that could be abandoned because it is not helping. In effect, the more we can specify what these dimensions of quality are, the more evident it will become as to what the end product of their efforts would actually look like. Undoubtedly, this goes beyond the words used to how they might be reliably interpreted in practice. There are in reality many more factors involved than this occasion will permit us to address in regards to what agency are currently doing or need to be done that could be done better in a qualitative sense, so we may have to settle for some major ones that could serve as instructive examples. What follows is a brief attempt to do this.

(Some Examples Of) What Are Agencies Already Doing That Could Be Improved?

a) Ethical Partnering With Individuals And Families i.e. Creating “Right Relationship”

Many organizations are unaware that they must repeatedly earn the trust and cooperation that would serve as a foundation for the kind of intimate personal collaboration that is essential not only in regards to supports enactment but also lifestyle development. This can only come about if agencies and their staff are relatively consistent in understanding ethical conduct, demanding it of themselves, recognizing its absence or perversion, ceasing prescriptive conduct in favor of negotiability, increasing personal and organizational flexibility and demonstrating respect for people in ways that are genuine and persuasive. The making of partnerships that work, thrive and endure cannot be achieved by formal policies alone, but by developing and demonstrating reasonably constant personal and organizational integrity. Agencies do not have to saintly, just coherent in their words and deeds such that people can come to believe in them and their worth, because it permeates what they are and what they do.

Social Inclusion /Valued Social Participation

Though there has been considerable progress in terms of people with disabilities become better integrated in their communities, there remains a persistent reliance by many service providers on segregated support options with all of their predictable effects. Similarly, despite many inspiring examples of community group membership, use of natural supports and acquisition of valued social roles by persons with disabilities, the overall pattern of social isolation and marginality in people’s lifestyles remains central. Even the numbers and narrow range of types of personal relationships in people’s lives is very limited, so there remains much to be done notwithstanding what has been accomplished thus far.

The Effective Address Of People’s Important Personal Needs

Though on a superficial level people’s lives seem to have been improving, a careful look at the detail of people’s lives reveals that many people lack the essential ingredients of a good life such as employment, income, good health, a home of their own, value and respect, interesting leisure, personal growth and development, good safeguarding of vulnerabilities and so on. The fact that these needs can and have been met well in the lives of at least some people is heartening, but it also indicates that this is only for a few rather than the many.

(Some Examples Of) What Agencies Are Largely Not Now Doing That Is Needed?

Assistance To Establish Service User Controlled Entities To Ensure Service User/Family Empowerment, Mutual Moral Support And Innovation

Though we have made considerable progress in generating self-directed service arrangements, this has largely taken the form of expanded self-management of individual service arrangements. While this has been empowering in some key aspects, it has not resulted in as much innovation and improved lives as had been hoped for and has left many people burdened by the ongoing demands of management while still leaving service users isolated from others. Service users, both morally and psychologically, gain much by way of solidarity and practical support if the entities that they rely on are of their own making and reflect their values and priorities. Though a small number of these entities exist, they are vastly overshadowed by the magnitude and size of the agencies over which that they have no authority yet which operate in their name.

Routinely Obtaining Independent Personal Advocacy, Oversight And Evaluation Of Services And Service Quality Agreements Directed By Service Users In Terms Of Agency Performance

Though advocacy, evaluation and service performance agreements exist, they largely do not involves service users and families in any meaningfully directed way, as these functions are almost exclusively in the hands of third parties over which they largely have no say. Yet these functions are potentially vital safeguards against the dysfunctions of agencies and systems that structurally recapitulate the dependency, lack of resources and lack of authority they experience in services. In instances where this is deliberately not so, the effects are generally beneficial. Consequently, it begs the question why the people seen as being more vulnerable have been removed from oversight of their own safeguards. This is all the more worrying since we have many well established examples where this is not the case.

Investing Sizably In Values Education, Leadership And Integrity

We do see that values are at the essence of service quality and serve as its energizing and guiding catalyst. Yet, as a proportion of the total energies and resources of agencies they constitute only a tiny percentage of what agencies invest in. If they were as important as they claimed we could well expect to see more instances of values related education and engagement, values oriented leadership development and much more rigorous cross walking of values with actual practice to ensure values integrity. This dissonance tends to undercut the claims that values lead in organizational importance when they are clearly barely on the radar in terms of organizational priorities. How we can know this is simply by examining the agencies where values related outcomes in people’s lives are notable and recurrent and linking these to conscious agency investments in values enhancement and deepening.

(Some Examples Of) What Agencies Are Doing That Is Not Needed?

The Bureaucratization Of Services In Ways That Touch Service Users Lives Unhelpfully

There seems little interest from agencies in shielding service users from the many varieties of bureaucratic invasiveness, irritants and dysfunctions that now abound at much higher levels in agencies than might have been so twenty years ago. The ethic of service to others can include the quite reasonable commitment to make the overall processes of service “user friendly”. This seems to have been forgotten in recent times, as both agency and systems generated bureaucratic measures increasingly impact negatively on people’s lives, dignity and functioning to say nothing of agency staff themselves. Yet we see little pushback from agencies on this even when there is scope for both resistance and creativity in meeting legitimate bureaucratic demands. That leaves unhelpful bureaucracy with little to restrain it. Hardly something we want to see more of.

Agency Priorities Unrelated To Its Principal Service Mission i.e. Goal Displacement

There are innumerable “non-programmatic” agendas that can capture agency attention and energies that have very little to with their central mission i.e. benefitting consumers. It would be good to revisit these agendas with a view to their intended and unintended impacts. Examples of these would be things like agency branding, agency enlargement, agency capital acquisition, fundraising for non-service user related agendas, pursuing new contracts etc. What these and similar agendas have in common is building up the agency’s assets, visibility and size possibly on the presumption that “bigger is better”. Whatever the rationale, they do displace leadership focus and priority from service users to the agency’s advancement as a central task. Agencies without these distractions appear to have a much better track record on service user outcomes.

Custodial Preoccupations At The Expense Of Personal Growth

Much has been said informally about mini-institutionalization in community services and noting its presence even in individualized arrangements where people essentially live a lifestyle that could be called “an institution for one”. It would seem that there are sizable and dominant pressures for people to be cared for that routinely eclipse people “getting a life”. When such “care” acts to limit and impoverish people’s lives and is allowed to prevail, then clearly other agendas have taken hold that will not enhance people’s well-being. Like the canary in the mine, we will know it has become a problem when people begin to stagnate and decline in terms of their vitality, lifestyle and enjoyment of life. So, we have to choose between a solely custodial existence and one that offers people growth i.e. getting and enjoying a good life.

Conclusion

Though we are far from clear enough about the type of agency transformation we should attempt that might help us do better with our goal of people getting a good life, we can see that many agencies have already pioneered elements of much of what we need and their very existence should give us hope that these features can be emulated and expanded upon. We can also begin to define better what the important ingredients are in agency conduct and quality that will need strengthening as well as recognizing and undoing patterns we have developed that are not helpful. As many have shown, we do not need to change agencies on behalf of people with disabilities and their families as we have ample means at hand to do this entirely with them, but in a better kind of partnership. From that which is still small in scale we can draw much inspiration as to how to bring these advances to more people without diluting or distorting the eventual outcomes. Let us also ask what wisdom should guide this enlargement of opportunity, so that it actually lives up to its promise.

Related Reading

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Kendrick, Michael J., “Some Predictable Cautions Concerning The Over-Reliance and Overemphasis On Person Centered Planning”, The Frontline Of Learning Disability, Issue 58, Dublin, Ireland, April 2004

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Kendrick, Michael J.," The Key Dimensions of Quality In Individualised Lifestyles and Supports", Interaction, v.22/4, The Australian Institute On Intellectual Disability, Canberra, Australia, June 2009

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Contributor

Michael J. Kendrick PhD
Kendrick Consulting Intl

Email: kendrickconsult@attglobal.net


 

International Journal of Disability, Community & Rehabilitation
Volume 11, No. 1
www.ijdcr.ca
ISSN 1703-3381