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Zhang J, Chen YC, Shi C, Wang JSH. Developing an Operationalized Framework for Comparing Consumer-Directed Care for Older Adults: Evidence from Expert Survey and Cross-National Comparison. J Aging Soc Policy 2023:1-21. [PMID: 38151708 DOI: 10.1080/08959420.2023.2297594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/24/2023] [Indexed: 12/29/2023]
Abstract
Consumer-directed care (CDC) programs for older people aim to optimize health outcomes by offering clients control and flexibility regarding service arrangements. However, policy design features may differ due to heterogenous sociostructural systems. By operationalizing a framework with three dimensions of CDC, i.e. control and direct services, variety of service options, and information and support, we analyzed how countries vary in their policy designs to achieve consumer direction. Using an expert survey (n = 20) and cross-national document analysis, we analyzed 12 CDC programs from seven selected countries: the United States, the United Kingdom, Germany, the Netherlands, China, Australia, and Spain. Among the three dimensions, CDC programs placed more emphasis on and displayed more homogenous performance of policy designs that achieve consumer direction in the dimension of control and direct services, while less emphasis was placed on and more heterogenous performance displayed in the dimensions of variety of service options and information and support. We offer a systematically operationalized framework to investigate CDC policy designs. Findings advance our understanding of CDC policy features from a cross-national perspective. Policymakers could incorporate these findings to empower older people in their respective societies.
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Affiliation(s)
- Jinbao Zhang
- Personal Social Service Research Unit, University of Kent, Canterbury, UK
| | - Yu-Chih Chen
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cheng Shi
- School of Graduate Studies, Lingnan University, Hong Kong, China
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2
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O’Brien L, Randjelovic I. Intermediary Services to Assist People With Disabilities to Implement Individualized Funding Plans: A Rapid Systematic Review. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073221130529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A systematic review was conducted to describe, and evaluate the effectiveness and cost-effectiveness of, intermediary services to support people with a disability to implement individualized funding plans. We included six records, including one subanalysis of randomized trial data, three qualitative studies, and two systematic reviews (reporting on 73 and 18 studies, respectively). No studies directly compared “consumer-directed plan plus intermediary services” to “consumer-directed plan with no/alternative intermediary,” so effectiveness of these interventions is uncertain. There is qualitative evidence from the perspective of disability planners and workers that intermediary interventions are important enablers of successful plan implementation. There is also qualitative evidence from consumer and family perspectives that external support is required to successfully navigate self-directed systems and that strong, trusting, and collaborative relationships with both paid and unpaid individuals in the person’s support network were facilitators of successful plan implementation. There was evidence of disabling practices and attitudes among some support agencies, resulting in coordinators being very risk averse in order to safeguard their clients. Suggestions for future research include carefully planned and ethically robust comparative trial designs, clear description and consistent delivery of interventions, and long-term evaluation of impact. The protocol was published on PROSPERO (CRD42020177607).
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Affiliation(s)
- Lisa O’Brien
- National Disability Insurance Agency, Melbourne, Victoria, Australia
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Ivana Randjelovic
- National Disability Insurance Agency, Melbourne, Victoria, Australia
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3
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Yuan Y, Thomas KS, Van Houtven CH, Price ME, Pizer SD, Frakt AB, Garrido MM. Fewer potentially avoidable health care events in rural veterans with self-directed care versus other personal care services. J Am Geriatr Soc 2022; 70:1418-1428. [PMID: 35026056 PMCID: PMC9106846 DOI: 10.1111/jgs.17656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/02/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural residents face more barriers to healthcare access, including challenges in receiving home- and community-based long-term services, compared to urban residents. Self-directed services provide flexibility and choice in care options and may be particularly well suited to help older adults with multiple chronic conditions and functional limitations who reside in rural areas remain independent and live in the community. METHODS We conducted a retrospective observational study to understand whether differences in health outcomes between Veteran-Directed Care (VDC), a self-directed Veterans Health Administration (VHA)-paid care program, and other VHA-paid home- and community-based personal care services vary in rural/urban location. The sample included 37,395 veterans receiving VHA-paid home- and community-based long-term care services in FY17. Our primary outcomes were changes in monthly incidence of VHA or VHA-paid community acute care admissions, nursing home admissions, and emergency department (ED) visits. We used fixed effects logistic regression models on unmatched and coarsened exact matched cohorts, stratified by rural/urban location. RESULTS Both urban and rural VDC recipients were significantly less likely to be admitted to VHA-paid nursing homes, compared to those receiving other VHA-paid personal care services (rural: incremental effect = -0.22, [-0.30, -0.14]; urban: incremental effect = -0.14, [-0.20, -0.07]). Rural, but not urban, VDC enrollees had significantly fewer VHA-paid acute care admissions and ED visits, relative to recipients of other VHA-paid personal care services (acute care, rural: incremental effect = -0.07, 95% CI = [-0.14, -0.01], urban: incremental effect = -0.01, [-0.06, 0.03]; ED, rural: incremental effect = -0.08, [-0.14, -0.02], urban: incremental effect = 0.01, [-0.03, 0.05]). CONCLUSIONS VDC recipients had fewer incidents of potentially avoidable VHA-paid health care use, compared to similar veterans receiving other VHA-paid personal care services. These differences were more pronounced among rural VDC recipients than urban VDC recipients.
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Affiliation(s)
- Yingzhe Yuan
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kali S Thomas
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine and Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Megan E Price
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven D Pizer
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Austin B Frakt
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Melissa M Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
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4
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Laragy C, Vasiliadis SD. Consumer expectations of self-managing aged home care packages in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2362-2373. [PMID: 32567131 DOI: 10.1111/hsc.13057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
This study investigated the expectations of older people who chose to participate in a self-management trial of home aged care packages conducted by COTA Australia. Empowerment theory is used to interpret the findings. All Australian home aged care support packages are delivered using a consumer directed care (CDC) model, and most are managed by an aged care provider. The COTA Australia trial gave older people the opportunity to self-manage their package and have more control over spending and less constraints on its use. This study examined three questions: (a) what motivated the older person, or an informal carer acting on their behalf, to participate in the self-managing trial; (b) what outcomes they expected (c) and what was their attitude towards risk. The trial was conducted over 9 months in 2018-2019. Seven registered home aged care providers from six Australian states and territories recruited 103 consumers to the trial, with having an informal carer act on their behalf. Online questionnaires with consumers (n = 103) and informal carers (n = 66), and 18 semi-structured interviews showed that older consumers and their informal carers had high expectations that self-management would result in: increased choice and control and more flexible use of funds; lower administration fees and more money to spend on services and supports; improved relations with service providers and the opportunity to select support staff. Participants wanted clear information and guidelines and support from their provider. While wanting to have more control and be empowered, few respondents noted concerns about possible risks. This finding raises questions about consumers' awareness of risks that are documented in the literature, and it challenges providers to balance risk management with facilitating independence and autonomy.
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Affiliation(s)
- Carmel Laragy
- School of Social and Political Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Sophie D Vasiliadis
- School of Humanities and Social Sciences, Deakin University, Burwood, Vic., Australia
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5
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Kelly C, Jamal A, Aubrecht K, Grenier A. Emergent Issues in Directly-Funded Care: Canadian Perspectives. J Aging Soc Policy 2020; 33:626-646. [PMID: 32321374 DOI: 10.1080/08959420.2020.1745736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Direct Funding (DF) provides individuals with a budget to arrange their own home care instead of receiving publicly arranged services. DF programs have evolved in a number of countries since the 1970s. In Canada, while small-scale DF programs have existed since the early 1970s, the research on these programs remains limited. Responding to gaps identified by an umbrella review and using a health equity framework, this research extends the knowledge base on DF programs from a Canadian perspective through an environmental scan. The research asks: What are the features of DF programs across Canada? What are the emerging issues related to program design and policy development? The study employed a qualitative environmental scan design, gathering data through questionnaires and semi-structured interviews (n = 23). The findings include a summary table describing features of 20 programs and two interview themes: a lack of information on DF workers and concerns about the growing role of home care agencies. This study has the potential to contribute to long-term health equity monitoring research. The findings suggest that as DF expands in Canada, promoting hiring from personal networks may address inequities in rural access to home care services and improve social outcomes for linguistic, cultural, and sexual minorities. However, the findings underscore a need to monitor access to DF programs by people of lower-socioeconomic backgrounds in Canada and discourage policy design that requires independent self-management, which disadvantages people with compromised decision-making capacities.
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Affiliation(s)
- Christine Kelly
- Assistant Professor, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aliya Jamal
- Master's Student, School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Katie Aubrecht
- Canada Research Chair Tier 2 Health Equity & Social Justice and Assistant Professor, Department of Sociology, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Amanda Grenier
- Norman and Honey Schipper Chair in Gerontological Social Work and Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Hanson A, Dillahunt-Aspillaga CJ, Smith TJ. Ticket utilization and implementation: Investigating use patterns of the Ticket to Work program from the consumer’s perspective. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ardis Hanson
- University of South Florida, Shimberg Health Sciences Library, Tampa, FL, USA
| | - Christina J. Dillahunt-Aspillaga
- University of South Florida, College of Behavioral and Community Science, Rehabilitation and Mental Health Counseling Program, Tampa, FL, USA
| | - Tammy Jorgensen Smith
- University of South Florida, College of Behavioral and Community Science, Rehabilitation and Mental Health Counseling Program, Tampa, FL, USA
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7
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FitzGerald Murphy M, Kelly C. Questioning "choice": A multinational metasynthesis of research on directly funded home-care programs for older people. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e37-e56. [PMID: 30198139 DOI: 10.1111/hsc.12646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/08/2018] [Accepted: 07/18/2018] [Indexed: 05/24/2023]
Abstract
In many developed contexts, home-care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home-care assistance with the activities of daily living. Directly funded home-care programs, or "direct funding" (DF), are not value-neutral policy interventions, but complex and politicised tools for the enactment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced, in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of "choice" manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home-care delivery.
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Affiliation(s)
| | - Christine Kelly
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Bogenschutz MD, DeCarlo M, Hall-Lande J, Hewitt A. Fiscal Stewardship, Choice, and Control: The Context of Self-Directed Services for People With Intellectual and Developmental Disabilities (IDD) in the United States. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:158-171. [PMID: 30920908 DOI: 10.1352/1934-9556-57.2.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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.
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Affiliation(s)
- Matthew D Bogenschutz
- Matthew D. Bogenschutz, Virginia Commonwealth University, School of Social Work; Matthew DeCarlo, Radford University, School of Social Work; Jennifer Hall-Lande and Amy Hewitt, University of Minnesota, Institute on Community Integration
| | - Matthew DeCarlo
- Matthew D. Bogenschutz, Virginia Commonwealth University, School of Social Work; Matthew DeCarlo, Radford University, School of Social Work; Jennifer Hall-Lande and Amy Hewitt, University of Minnesota, Institute on Community Integration
| | - Jennifer Hall-Lande
- Matthew D. Bogenschutz, Virginia Commonwealth University, School of Social Work; Matthew DeCarlo, Radford University, School of Social Work; Jennifer Hall-Lande and Amy Hewitt, University of Minnesota, Institute on Community Integration
| | - Amy Hewitt
- Matthew D. Bogenschutz, Virginia Commonwealth University, School of Social Work; Matthew DeCarlo, Radford University, School of Social Work; Jennifer Hall-Lande and Amy Hewitt, University of Minnesota, Institute on Community Integration
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9
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Mahoney E, Oh G, Morano C, Mahoney K, DeVellis A. The Tasks and Characteristics of Supportive Support Brokers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:216-235. [PMID: 30614409 DOI: 10.1080/01634372.2018.1561585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
In the United States, under the Cash and Counseling or budget authority model of self-directed personal assistance where the participant manages his or her own services and supports, the Support Broker role was established to assist and coach the participant. The support broker role grew out of a person-centered planning process where focus groups and surveys helped ascertain what potential participants wanted to help them establish a self-directed alternative. But, despite this role being described in policy guidance from the Center for Medicare and Medicaid, little research has been conducted examining the functions, activities and usefulness of this position. This study draws on 76 ethnographic case studies with early Cash and Counseling participants, examines what participants and their caregivers actually saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and family caregivers saw support broker duties as falling into four areas: Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these duties. Key aspects of quality included: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowledge and Cultural Friendliness. These findings can provide the basis for establishing quality indicators for self-direction.
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Affiliation(s)
- Ellen Mahoney
- a William F. Connell School of Nursing , Boston College , USA
| | - Grace Oh
- a William F. Connell School of Nursing , Boston College , USA
| | - Carmen Morano
- b School of Social Welfare , University at Albany , Albany , NY , USA
| | - Kevin Mahoney
- c University at Albany, School of Social Welfare , Boston College , Boston , USA
| | - Andrew DeVellis
- d School of Social Work , Wayside Youth and Family Support Network , Boston , MA , USA
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10
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DeCarlo MP, Bogenschutz MD, Hall-Lande JA, Hewitt AS. Implementation of Self-Directed Supports for People With Intellectual and Developmental Disabilities in the United States. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207318790061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-direction is an approach to human service delivery within long-term services and supports that aims to provide greater control for individuals with disabilities and their closest supporters. The purpose of this study was to understand the implementation of self-directed supports for individuals with intellectual and developmental disabilities. Researchers interviewed state developmental disabilities administrators in 34 of 42 states that currently operate self-directed service options and used qualitative analysis to arrive at a thematic map of the strengths and challenges currently experienced by state administrators. Common strengths identified by state administrators were increased opportunities for participant self-determination and improved relationships with support staff. Common challenges included restructuring case management relationships, as well as rulemaking and enforcement. Administrators’ suggestions for the future of self-direction focused on increasing program size and streamlining services using technology.
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11
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Simon-Rusinowitz L, Schwartz AJ, Loughlin D, Sciegaj M, Mahoney KJ, Donkoh Y. Where are they now? Cash and Counseling successes and challenges over time. ACTA ACUST UNITED AC 2018; 15:104-110. [PMID: 25750590 DOI: 10.1891/1521-0987.15.3.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The positive results of the Cash & Counseling Demonstration and Evaluation (CCDE) led to the funding of a replication project that included 12 more states in 2008. Since then, the political and economic environments have changed. The authors sought to investigate how well the three original and 12 replication CCDE programs are coping with current challenges, and how their experiences may inform the growth and sustainability of emerging participant-directed programs. Semistructured telephone interviews were conducted with the 15 Cash & Counseling state program administrators. Key topics addressed included: successful aspects of state programs, biggest challenges for each program, and information program administrators would like to learn from state colleagues. Themes related to budget issues (e.g., staff shortages and program funding cuts) and non-budget related issues (e.g., understanding of program operations) emerged from the interviews. State program administrators also discussed program successes. To promote the sustainability and growth of participant-directed programs, existing participant-directed programs should be tied to national policy trends as well as review whether or not the programs address participant-directed principles. The development of new participant-directed programs should be based on other states' experiences as discussed in this paper.
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Affiliation(s)
| | - Abby J Schwartz
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Dawn Loughlin
- University of Maryland Center on Aging, College Park
| | - Mark Sciegaj
- The Pennsylvania State University, University Park
| | - Kevin J Mahoney
- Boston College Graduate School of Social Work, Chestnut Hill, MA
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12
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Gill L, McCaffrey N, Cameron ID, Ratcliffe J, Kaambwa B, Corlis M, Fiebig J, Gresham M. Consumer Directed Care in Australia: early perceptions and experiences of staff, clients and carers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:478-491. [PMID: 26934865 DOI: 10.1111/hsc.12328] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
The study aimed to identify the shared issues and challenges being experienced by staff, their clients and informal carers, with the introduction of Consumer Directed Care (CDC). Secondary analysis was undertaken of data that had been initially collected, via semi-structured in-depth interviews, to inform the development of a discrete choice experiment. The raw staff and client/carer data were re-examined using an iterative inductive process. The analysis focused on locating the shared themes and differences between the participant groups based on their CDC experience. The data were also assessed for difficulties or barriers that impacted on the service. Four broad shared themes were derived: culture, role change, operational systems and resourcing, but with a range of diverse and sometimes conflicting sub-themes between the different participant groups. Differences can be linked to participant role in the service chain, with discordance emerging between what has been traditionally offered and what might be possible. This investigation occurred during the period in which services were transitioning from a traditional aged care service model to a new model of service provision requiring considerable industry change. We conclude that existing industry regulation, culture and practice supports an established service model in Australia that arguably makes translation of the objectives of CDC difficult.
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Affiliation(s)
- Liz Gill
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Australia
| | - Nikki McCaffrey
- Flinders Health Economics Group (FHEG), School of Medicine, Flinders University, Daws Road, Daw Park, South Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group (FHEG), School of Medicine, Flinders University, Daws Road, Daw Park, South Australia
| | - Billingsley Kaambwa
- Flinders Health Economics Group (FHEG), School of Medicine, Flinders University, Daws Road, Daw Park, South Australia
| | - Megan Corlis
- Director Research & Development, Helping Hand Aged Care, North Adelaide, South Australia
| | - Jeff Fiebig
- General Manager, Major Initiatives, ACH Group, 22 Henley Beach Road, Mile End, South Australia
| | - Meredith Gresham
- Research and Design, Hammond Care, 447 Kent Street, Sydney, New South Wales, Australia
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Croft B, Parish S. Participants' Assessment of the Impact of Behavioral Health Self-Direction on Recovery. Community Ment Health J 2016; 52:781-92. [PMID: 26911369 PMCID: PMC4996770 DOI: 10.1007/s10597-016-9999-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
Self-direction involves managing a flexible budget, selecting and purchasing services and supports to meet individual needs and preferences. An emerging practice in the behavioral health field, self-direction is part of a systemic shift toward person-centered approaches to service provision. To understand the relationship between recovery and self-direction, the authors conducted a content analysis of 30 in-depth interviews with individuals from two self-direction programs in one state. A positive relationship between self-direction and recovery was established. Meeting basic needs for food, clothing, and shelter are important first steps in the recovery process for self-directing participants. Recovery domains were dynamic and interrelated, with gains in independence, self-esteem, and self-confidence facilitating achievement of goals in other domains. To maximize the benefits of self-direction, program administrators may need to develop clearer program implementation standards and address poverty and limited access to appropriate behavioral health services and supports.
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Affiliation(s)
- Bevin Croft
- Human Services Research Institute, 2336 Massachusetts Avenue, Cambridge, MA 02140, Phone: 617-335-0738, Fax: 617-492-7401, and The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454
| | - Susan Parish
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454,
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14
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Thomas KS, Applebaum R. Long-term Services and Supports (LTSS): A Growing Challenge for an Aging America. ACTA ACUST UNITED AC 2015. [DOI: 10.1093/ppar/prv003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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