1. Transition to Participant Direction: Making Agency Culture Change Work Casey Sanders NRCPDS February 24, 2010

2. What Is Participant Direction? “Not doing things by yourself – but being in charge of how things are done.” Judith Heumann Participant Controls What When Who How Participant controls 2

3. 3 Traditional versus Participant-Directed Services Participant Workers recruited and report to agency Program and agency set tasks Agency specifies salary and benefits Normal work hour schedule Worker training required by agency Case managers determine needs & services Participant Recruits and manages workers Sets tasks Specifies salary and benefits Assigns flexible work hour schedule Trains/ arranges worker training Makes decisions about needs and services Traditional Services Participant-Directed Services

4. 4 Participant Needs are assessed Asked questions Informed of resources Given an option of agencies Assigned hours of services Provides feedback to the agency Shift in Participant Responsibilities Traditional Services Participant Makes decisions based on budget Hires, manages, dismisses workers Trains, or arranges for training of, workers Evaluates workers Assigns hours of service Determines goods and services purchased Participant-Directed Services

5. 5 Medical Model Determines needs and service plan Oversees provision of services May seek participant input Establishes goals and outcomes Program parameters and standards limit flexibility Solves problems Assesses quality of services and supports The Traditional System Case Manager Social Model Works with participant to determine needs and service plan Assists participant with overseeing provision of services Participant involvement is critical Participant is responsible for goals and outcomes High flexibility of services and supports Advises participant on problem solving strategies Participant assesses quality of services and supports The Participant- Directed Services Counselor Shift in Support System