Shifting to a Person-Centered System: Moving Toward Capabilities and Support

Support Development Associates (SDA): 

Move Away From:
Identify and Fix What is Wrong
Move Toward:
Build on Existing and Future Capabilities
Underlying Assumption
  • System is the expert;
  • People who are aging or who have a disability are dependent on the system.
  • The person, family and loved ones are the experts.
  • Enhance/endorse the capacity of the family and the community to support people with disabilities and promote interdependence.
  • Identify a comprehensive list of deficits in physical, functional and intellectual performance to determine eligibility;
  • Complex and inconsistent process may take months to complete, no requirements for timeliness.
  • Identify the person's capabilities and interests, emphasize what they can do, and identify areas where support is necessary.
  • Transparent process completed within a defined timeframe; people know what to expect
  • System must be informed of and involved in all aspects of the person's life;
  • Comprehensive list of needs identified;
  • System takes responsibility for meeting all needs.
  • System only goes where it is invited, does not "barge in" to all aspects of the person's life;
  • Customized list of areas of desired support are identified;
  • Families, friends and natural associations are first source of meeting needs.
  • Only health and safety matter;
  • Priority is to assure health, minimize risk and ameliorate deficits (not satisfaction)
  • Goals identified by the experts based on skills needed to be independent.
  • Interests, comfort, satisfaction AND health and safety each matter equally; balanced approach.
  • Intentional planning designed to build on a person's interests in order for the balance to exist.
  • Personal outcomes desired are used to identify the supports delivered.
  • Verify service delivery is focus, regardless of impact;
  • Compliance with minimum standards is the goal;
  • Blame and corrective action plans are the norm creating an us vs. them culture
  • Accountability and continuous opportunities for improvement are the basis for learning;
  • Continuous review of effectiveness of supports in reaching person's desired outcomes;
  • Collaborative relationships across agencies focus on improving process collectively and assure action is taken.
Financial Structure
  • Slots funded, vacancies funded for unlimited time;
  • Guaranteed amount of funding for a program, regardless of outcomes for the people who attend.
  • Resources allocated to a person move with them as their service delivery changes;
  • Outcomes are identified for people, and payments made based on performance compared to outcomes
Quality Management
  • Licensure /certification is designed to identify what an agency has done wrong (non-compliance);
  • Paper "proves" quality;
  • Compliance with minimum standards is the priority.
  • Licensure and certification focus on problems.
  • Results oriented licensure/certification process;
  • Quality management processes are informed through direct engagement with a focus on the relationships across stakeholder groups;
  • Continuously seeking opportunities for improvement and ways to satisfy people supported and their families
  • Licensure and monitoring roles are seen as technical assistants and verifiers