Promoting Self-Determination for Individuals with Disabilities Through Self-Directed Services
Promoting Self-Determination for Individuals with Psychiatric Disabilities through Self-Directed Services: A Look at Federal, State and Public Systems as Sources of Cash-Outs and Other Fiscal Expansion Opportunities (pdf format).
This paper examines promising interconnections between the concepts of recovery, self-determination, and self-directed care. It reviews five principles of self-determination, noting how freedom, authority, support, responsibility, and confirmation operate to enhance individual choice and enable people with psychiatric disabilities to build meaningful lives. The paper then explores the major systems in the U.S. that can serve as sources of cash-out funding, as well as those that would be most affected by widespread adoption of self-directed care, along with some of the barriers to change that are present in these systems. The systems discussed include Medicaid, Community Mental Heath Block Grants, State general revenue and legislative systems, public housing, fiscal agents and intermediaries, federal-State vocational rehabilitation, workforce development, public disability income support, the Ticket to Work, the banking system and Individual Development Accounts, and the system of technology. The paper concludes with a series of recommendations for next steps in adopting this mental health care financing mechanism for self-determination, including the important role of peer-to-peer services in operating these programs.