Abstract
Self-directed home and community based services (HCBS) waiver services and supports for people with intellectual and developmental disabilities (IDD) have become a viable and widely used method of service provision in the United States. Grounded in theories of self-determination, previous literature on self-direction has suggested high satisfaction and positive outcomes for people who use self-directed programs as well as cost savings for state IDD service systems. This study explored the ways in which state IDD service administrators think about how self-direction may be used as a method of achieving cost savings while providing opportunities for people with IDD and their families to exercise choice and control. Informed by 54 high-level IDD service administrators in 34 states, and guided by a thematic analysis approach to data interpretation, the study found evidence that administrators typically see strong potential for self-direction to have cost-savings benefits, while also fostering choice. In the current political climate, the need for cautious fiscal stewardship may become a stronger driving force behind self-direction for people with IDD in the United States.
Translated title of the contribution | Fiscal stewardship, choice, and control: The context of self- directed services for people with intellectual and developmental disabilities (IDD) in the United States |
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Original language | Spanish |
Pages (from-to) | 158-171 |
Number of pages | 14 |
Journal | Intellectual and Developmental Disabilities |
Volume | 57 |
Issue number | 2 |
DOIs | |
State | Published - Apr 1 2019 |
Keywords
- HCBS waivers
- Intellectual and developmental disabilities
- Participant direction
- Qualitative thematic analysis
- Self-determination
- Self-direction
- Service costs
PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.