Can Case Management Contribute to Effective Use of Small Self-Directed Support Packages for People with Disabilities?

Abstract

While self-directed support for people with disabilities and their families represents a welcome shift toward self-determination and increasing control, the risk of managing with insufficient funds remains. This article examines whether different types of case management can mitigate that risk by providing support when people have only a small direct funding package. It applies the question to an evaluated program of self-directed support in Queensland, Australia that allocated A$4000 with one of two approaches to case management: program-focused or organizationally oriented. Case management contributed to the effective use of limited budgets and addressing goals when it promoted choice and control, built relationships, and enabled flexible fund use. Program-focused case management seemed to be less constrained in enhancing social participation than organizationally oriented case management, which tended to restrict some participatory opportunities. These findings are consistent with earlier research, which indicated that case management can interfere with participation. Even in the context of a small funding allocation, a case management approach that promotes flexibility and person-centered planning, control over funding, and capacity building can improve the effectiveness of self-directed support; however it does not overcome the inherent limitations of insufficient funds for adequate support, or the cost of case management itself.