Choice and Control over Resources: New Hampshire's Individual Career Account Demonstration Projects

Abstract

Part of the shift in society's response to disability from institutional care toward community inclusion has included an increasing emphasis on individual choice, empowerment, and self-determination (Hagner & Marrone, 1995; Silverstein, 2000; Wolf-Branigan, Daeschlein, Cardinal & Twiss, 2000). Wehmeyer (2002) conceptualized implementation of sell-determination as occurring on two levels. At the individual level, it is necessary to define and assess self-determined behavior and develop instructional and other interventions to increase self-determined behavior. At the political or systemic level, change is required to reform agency control over dollars and tending streams in order to enable individuals to implement their decisions and support individual control. Several specific reforms have been proposed to operationalize these concepts. One important focus concerns developing new personal planning structures that give individuals with disabilities increased opportunities to develop expansive personal goals and aspirations. Traditional service planning has been criticized for remaining heavily dominated by professional interests (Cooney, 2002; Menchetti & Garcia, 2003), restricting plans to currently available agency services (Thoma, Rogan & Baker, 2001), and for often viewing self-determined choices as a privilege to be earned through compliance with programming (Cook & Jonikas, 2002). Person-centered planning has emerged as a promising tool for facilitating increased levels of self-determined choice (Wehmeyer, 2002). Person-centered planning is a facilitative approach used to guide individuals through a series of structured planning sessions designed to help clarify desired outcomes, discover capacities and possibilities for natural supports, and identify reasonable and progressive actions needed to achieve identified goals (Mount, 1992; Pearpoint, O'Brien & Forest, 1993). Person-centered planning has been useful in assisting individuals with disabilities to experience more control of the planning process and in achieving career outcomes more consistent with their preferences (Menchetti & Garcia, 2003). As an inductive, qualitative process, person-centered planning explores subjective interpretations and personal meanings in a way that helps establish the individual as the owner of his or her plan (Okocha, 1998). In addition, the use of significant others as supports for brainstorming and plan development that is one of the key components of person-centered planning has been associated with enhancing informed choice for individuals who require assistance with decision-making (Hagen-Foley, Rosenthal, & Thomas, 2005). Person-centered planning is also a flexible process that can be used for ongoing planning as circumstances and interests change. A demonstration of an choice model in a rehabilitation agency (Wolf-Brannigan, Daeschlein, Cardinal & Twiss, 2000) reported high levels of consumer satisfaction with person-centered planning. Another key component in shifting the focus of planning from agencies and systems to the individual is a reconceptualization of the role of the service coordinator or case manager. Coffey (2003) and Williams and Swartz (1998) noted that the multiple and complex roles of traditional frequently introduce dynamics of case manager power and control over individuals. Turnbull and Turnbull (2001) and Blumberg, Ferguson and Ferguson (2000) recommended that case management be replaced by a role they call service brokerage with no organizational or systems allegiances. Demonstrations of independent service brokerage, primarily in relation to individuals with developmental disabilities, have to date been sporadic and informal (Smith, 2003). Wolf-Brannigan, Daeschlein, Cardinal and Twiss (2000) designed a choice demonstration project that featured employment advisors who were directly employed by consumers. …

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