"Cash and Counseling: A Model for Self-Determination"
Suzanne Crisp

Consumer-Direction

"Not doing things by yourself - but being in charge of how things are done."
- Judith Heumann

! Consumer controls
--what, when, how & who




Consumer-Direction 
! Consumers are the best judge of their needs & approach

! Should be able to choose services & who provides those services

! Use flexibility to tailor solutions

! Crosses disability (types and degrees), culture, funding & age





Consumer Direction Myths
! Fraud
! Abuse
! Exploitation
! Not interested
! Lack ability
! Health will decline
! Too vulnerable
! Case managers know best
! Agency services are superior




Cash & Counseling 
! Sponsors - Robert Wood Johnson Foundation & US Health and Human Services
! Use Medicaid funding
! Large scale
! Rigorous evaluation
! Develop the national model



Why Cash and Counseling?
! Offer more choices
! Expand work force
! Tangible advancement to show disability community
! Opportunity for technical assistance
! Save $$$$




Independent Choices

The Arkansas Approach:

An opportunity to exchange Agency personal care services for a monthly cash allowance



The Cash
! Allowance
--	Based on personal assistance needs
--	Approximately $8.00 per hour
--	Average allowance is $375.00 a month
! Uses of cash
--	To meet personal care needs
--	Hire personal care assistant
--	Purchase items & services related to personal care




The Counseling
! Counseling
--	Explain program       
--	Develop expenditure plan    
--	Offer skills training
--	Monitor
--	Perform reassessments

! Fiscal support
--	Issue allowance
--	Maintain savings
--	Write checks
--	Monitor uses of cash
--	Pay taxes 
--	Report wages




Who Is Interested?

! Began December 1998

--	Over 2,000 choosers
--	73% age 65 or older
--	44% use a representative
--	76% live in rural areas
--	60% White, 30% African American
--	15% of population enrolled



Uses of the Cash

! 82% hire a personal assistant
! 85% family members
! 15% friend or neighbor
! 16% personal supplies, medicine or home modifications
! 2% save 



How's It Going?

! AR 1st in nation
! 100% satisfied
! 80% satisfied with lives
! 93% would recommend
! 98% know who they hire
! 4 -5 say lives have improved 
! Most have chronic illnesses
! 95% pleased with assistant times
! Zero say worse off




Ms. Millie 
"Hiring my daughter makes me feel independent.  I know she is always there. She knows what I like and what I don't like."



Ms. Lillie
"I understand Grandma better than anyone. When it's your own you're looking after, you pay more attention." 




The Observations

! Comfortable with self-direction & enjoy independence
! Capable of Responsibility
! Biggest benefits:
--	Choose assistant/items
--	Know when and who
--	Non-traditional times
! Allows more services at same cost 
! Matches preference with needs
! Amount of services still insufficient




The Verdict

! Consumer direction works
! Respects preferences
! Honors dignity/privacy
! Recognizes rights
! Will never replace traditional models
! Considered  in ALL program designing




More Information
www.IndependentChoices.com
Suzanne Crisp
501-682-2441


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