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Self-determination incorporates a set of concepts and values which underscore a core belief that people who require support from the public mental health system as a result of a disability should be able to define what they need in terms of the life they seek, should have access to meaningful choices, and control over their lives. Michigan's Self-Determination Initiative is aiming for major system change which will assure that services and supports for people are not only person-centered, but person-defined and person-controlled. Self-determination is based on four principles. These are:
- FREEDOM: The ability for individuals, with chosen family and/or friends, to plan a life with necessary supports, rather than purchase a program;
- AUTHORITY: The ability for a person with a disability to control a certain sum of dollars in order to purchase these supports, with the backing of a social network or circle of friends, if needed;
- SUPPORT: The arranging of resources and personnel -- both formal and informal -- so to assist a person with a disability to live a life in the community, rich in community associations and contributions, and;
- RESPONSIBILITY: The acceptance of a valued role in a person's community through employment, affiliations, spiritual development, and general caring for others, as well as accountability for spending public dollars in ways that are life-enhancing.
A hallmark of self-determination is giving people the opportunity to control a fixed sum of dollars, using these resources to determine which services and supports they will purchase from whom and under what circumstances.
Michigan's Initiative to promote self-determination for persons with developmental disabilities is part of a national project funded by the Robert Wood Johnson Foundation. Michigan is one of 18 states participating, having been awarded $397,000 in 1996 to support the project over a three-year period. The initiative is being implemented at four local project sites: Washtenaw Community Mental Health Services Provider (CMHSP); Midland-Gladwin CMHSP; Detroit-Wayne CMH Agency through Wayne Community Living Services, Inc.; and a partnership between the Allegan and Van Buren CMHSPs. Each of these local sites has been developing its approach to self-determination for almost 18 months. People with developmental disabilities are designing agreements with these community mental health agencies, whereby they have access to an individual budget. This budget is developed based upon their individual plan of services and supports. Using their individual budget, participants may choose to purchase some, all or none of the services/supports which they previously received. For example, a person may choose to hire a provider agency to provide in-home supports, or, they may choose to use the services of a fiscal intermediary to handle funds and then be the employer of the people hired to provide personal assistance. They may choose to use the usual means of transportation arranged by their mental health agency, or they may use funding allotted within their individual budget to purchase transportation from some other individual or organization.
Self-determination is about choice and control. It is about giving over decision-making authority to people with disabilities, with support of their family and friends. It is about freedom. Self-determination asserts that a person should not have to lose their freedom because they require support from the public sector.
Michigan's managed care plan for services/supports for persons with developmental disabilities requires each local CMHSP to make consumer-managed and directed services and supports available. Self-determination is at the core of consumer-managed services and supports. Self-determination in Michigan is central to the transition to a managed care service system for persons with developmental disabilities.
Michigan is expanding the Self-Determination Initiative in 1998 to include four additional "affiliate" sites as local projects. These are: Pathways (Alger, Luce, Marquette and Escanaba counties); Kalamazoo CMHSP; Monroe CMH Authority, and Oakland CMHSP.
Contact: Michael J. Head