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Self-Determination: Living With Dignity
Self-determination has been the focus of person centered planning for several years, but there is not a lot of understanding of how it can be used and how the system works. Self-determination can be very confusing because it means a lot of different things. In fact, it is different for each person, because that is what it is about. It is about living your own life and not having your life fit into a slot already determined by school or a CMH provider. Self-determination is developed from a set of principles instead of a set of human services interventions. These principles are:
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Freedom, the opportunity to choose where and with whom one lives as well as how one organizes all important aspects of one’s life with freely chosen assistance as needed;
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Authority, the ability to control some targeted amount of public dollars;
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Support, the ability to organize that support in ways that are unique to the individual;
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Responsibility, the obligation to use public dollars wisely and to contribute to one’s community.
In 2000, at the request of individuals with disabilities, The Center for Self-Determination, headquartered in Ann Arbor added
Every individual with a disability strives for a dignified life. Self-determination is a step in that direction. But, it also poses several risks that are not usually raised by traditional or typical human service systems. The use of self-determination to step out and try a new job, volunteer opportunity, or class in the community presents the risk of failure and rejection that isn’t present in the safety of a workshop. But with this risk comes hope. These risks and hopes are a common, everyday human experience, but individuals with developmental disabilities are often sheltered from both risk and hope by sheltered programs that “protect" them from the risks of community living.
Self-determination also carries the risk of responsibility. It may include becoming an employer, and taking on the obligations that an employer owes to an employee. It could include starting your own business, and facing the uncertainty that any new business owner faces. Or it could be trying a new job, outside of a sheltered workshop, with an employer who isn’t used to working with individuals with developmental disabilities. Many self-advocates embrace the risks of responsibility, failure, rejection -- and hope – because they are all necessary to live with dignity.
There are many resources you can turn to for more information about self-determination, including your caseworker and The Arc. A good website for more information is www.self-determination.com.
Self-Determination in Kent County:
How does it actually work?
To choose self-determination, your eligibility for mental health services must have been established by an assessment by a supports coordinator/caseworker (SC). The assessment establishes how many dollars are available for your services.
If you choose to receive services through a self-determination arrangement rather than traditional provider agency programs, you and your SC will determine the goals that you want to pursue. Your SC will also explain the risks you undertake with self-determination. For example, if a strong system of natural supports is not available, it may be difficult to hire enough paid supports to provide the services that you need.
Creating a successful self-determination plan is an interactive process. Everyone involved needs to work as a team to make it successful. This is a new process for most support coordinators, and they may need some help to understand their role! If you don’t feel supported by your SC, ask to contact the Self-Determination point person in their agency for assistance.
Once you set your goals, you will write a new Person Centered Plan, or write an addendum to your PCP. This can be done at any time—you don’t have to wait until a year after your last PCP!
The self-determination goals written into your PCP must promote greater integration into the community. The goals must also be for services that are authorized for payment with Medicaid dollars. For example, funding approved to support self-determination plans can pay for community living supports that increase or maintain self-sufficiency, such as training or guidance with household chores and safety skills.
Other proper uses of self-determination dollars include skill development to achieve or maintain mobility, sensory-motor, communication, socialization and relationship-building skills, and participation in leisure and community activities. Goals can also include skill-building activities such as increasing economic self-sufficiency, or assisting in meaningful activities such as school, work, and/or volunteering.
Once your goals have been set, your team will examine what supports can be obtained from family and friends and other neighborhood supports. Then, an Individual Service Budget (ISB) must be drafted. This establishes the amount of CMH funds available to pay for self-determination supports. It is based on your needs, but under current network180 policy cannot exceed the cost of the services you qualify for from a network180 provider.
The ISB Review Panel must approve the budget. Once approval is obtained, then you can go ahead and hire or contract for the supports needed to practice self-determination. There are lots of papers that must be signed by the employees that you hire, or the agency you contract with to provide the service. The Arc, or another agency that serves as the Fiscal Intermediary, will make sure that all the correct forms are signed so that you can legally hire staff that understand your rights and their role in providing supports.
Yes, it takes more work than just accepting a slot in a provider program. But, anything good in life takes work, and getting a life is worth it!
The Fiscal Intermediary Role
A key player in a self-determination arrangement is the Fiscal Intermediary. This is an organization that receives the publicly administered funds on behalf of the self-determination participant and spends the funds as directed by the participant and according to his/her approved budget.
The Fiscal Intermediary is the mechanism that gives the individual the authority to spend their support dollars, including those that come from public ally funded sources. Most of these dollars will be from state Medicaid plans. Currently, Medicaid prohibits individuals from receiving Medicaid funds directly. The Fiscal Intermediary can receive these funds on their behalf. The Fiscal Intermediary pays bills, processes a payroll and keeps a record of expenditures.
Please do not hesitate to contact us if you want additional information about our Fiscal Intermediary or other services.
Phone: 616/459-3339 Fax: 616/459-5299
E-mail: info@arckent.org
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