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|
|Number of pages||14|
|Journal||Intellectual and Developmental Disabilities|
|State||Published - Apr 1 2019|
- HCBS waivers
- Intellectual and developmental disabilities
- Participant direction
- Qualitative thematic analysis
- Service costs
PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.