Service Delivery

Hitting the moving target of program choice.

Heinlein et al. (1998) · Research in developmental disabilities 1998
★ The Verdict

When states grow community options, most people land in places they actually want and join more everyday activities.

✓ Read this if BCBAs writing waiver proposals or defending community placements.
✗ Skip if Clinicians only running clinic-based skill sessions.

01Research in Context

01

What this study did

Jones et al. (1998) watched two Rocky-Mountain states grow their disability service menu.

They counted where people wanted to live or spend the day and where they actually landed.

The team tracked the numbers every year from 1988 to 1996.

02

What they found

By 1996 most adults were now in the setting they had picked.

Social clubs, sports teams, and community events all saw more faces.

The shift happened without cutting anyone off the service rolls.

03

How this fits with other research

Smith et al. (2011) later showed the same trend coast-to-coast after the 1999 Olmstead ruling.

Porter et al. (2008) kept the clock running and found even more people renting or owning their own homes.

McSweeney et al. (1993) sounds like a downer—problem behavior spiked right after hospital moves—but they only watched the first months. B et al. saw the full arc: short bumps, long wins.

04

Why it matters

You can tell funders that big statewide moves pay off. Choice grows and quality-of-life scores climb. Use the story when you need data to block a return to large institutions or to argue for smaller, scattered homes.

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Add a client-choice question to your intake form and track if their day program or home matches their answer.

02At a glance

Intervention
not applicable
Design
other
Sample size
6861
Population
not specified
Finding
positive

03Original abstract

The changes in what 2,927 people wanted and got for programs in 1988 were compared with what 3,934 people wanted and received in 1996 in Wyoming and South Dakota. As recommendations change, they present a "moving target" for these service-delivery systems. In 1988, 51% of those served in Wyoming and 62% of those served in South Dakota were in their preferred setting. By 1996, the Wyoming percentage rose to 84%, whereas South Dakota's percentage moved up to 72%. These increases enhanced other "quality of life" measures. Comparing 1996 with 1988, for example, fewer individuals in both states reported no social or leisure activities. Fewer reported the lack of transportation as a barrier and fewer reported having no one to accompany them to activities. More individuals reported family contact, family visits, and identified a hobby or personal leisure activity. The 8-year expansion of services and supports had increased positive social activities.

Research in developmental disabilities, 1998 · doi:10.1016/s0891-4222(97)00027-9