Self-Directed Services for the Long-Term Supports of Adults with Intellectual and Developmental Disabilities: A Propensity Score Matching Analysis

Abstract

Through the civil rights movement, people with intellectual and developmental disabilities (IDD) gained rights that are often taken for granted by non-disabled individuals, including the right to live immersed in the larger community instead of institutional facilities. Self-directed services (SDS) are an option intended to promote the autonomy of people with disabilities to make their own decisions regarding services. It provides service management authority to the service participants, including budget authority. Ever since its implementation in 1993, however, little attention has been paid to the quantitative evaluation of the impact of this service, even though SDS has become a statewide community care option. Indeed, every state in the U.S. has one or more SDS programs. This cross-sectional, observational study evaluated the effectiveness of SDS for people with IDD by comparing the quality of life and service satisfaction of participants and non-participants. Propensity score matching and multivariate regressions were applied to the 2018-19 National Core Indicators data (n=18,827) answered by 37 states’ service users. All analyses were adjusted for gender, race/ethnicity, care type (home, facility, other), metro status, income, age, and disability severity. Findings were mixed with respect to the quality of life indicators, and no difference in service satisfaction was found between participants and non-participants. Overall, this study does not support the notion that SDS is superior to traditional agency-based services. The implication of this study is that SDS deserves a higher level of scrutiny than it has thus far received. Its superiority over more traditional services should not be taken for granted. There are, however, two critical limitations of this study. First, the assignment to groups was not randomized. The second is that the survey was not explicitly designed to track the effectiveness of SDS. The use of randomized designs and survey instruments more closely tailored to SDS would either validate the findings more conclusively or contradict them with more robust methods.