Support Coordination: The Leverage Point
Support Coordination: The Leverage Point
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Research for Social Change
Leverage is everything. Having leverage and how that leverage is used makes the difference when trying to change people, things process and systems. Leverage points according to Donnella Meadows are "the places within a complex systems where small shift in one thing can produce big changes in everything. Support coordination represents the leverage point in the home and community based service system. Support Coordination plays the most significant role in the implementation and functioning of the Home and community-based waiver service system. As a conduit between the individual in need of support and the organizations and systems of support services the role of support coordinator is the leverage point at which system change can be best be achieved.
The SC Landscape
The SC Landscape
Preliminary results of a ongoing nationwide survey of supports coordination services provides a brief glimpse into the landscape of this critical component of the HCBS system.
Arizona: Ranked the number one DDD system in the country by ANCOR in 2019 the AZ HCBS system through its 1115 demonstration Project ALTCS supports approximately 48,000 people over 22 counties. Support coordination in the state of AZ is provided through the State Department of Economic Security's Division on Developmental Disabilities. Based on 2019 numbers there were 953 supports coordinators employed by DDD that covering the entire state of AZ's 114 square miles and its 22 counties which are divided into 5 districts; Central, Eastern Southern Western and Northern. Similar to the challenges faced by SC's across the nation, SC's in the grand canyon state face high rates of attrition, higher than average caseloads and challenging wages. The most common hurdle expressed by SC's is a familiar refrain; the high numbers of people and the increasing levels of paperwork make the role unsustainable.
New Jersey: New Jersey's IDD system was ranked thirty-eight by ANCOR in 2019 and Support coordination in the Garden state by contrast is provided by over 156 independent agencies that cover 21 counties over considerably less distance with NJ coming in at about nine thousand square miles. SCO's in New Jersey must support a minimum of 60 individuals or they may not continue to operate. New Jerseys HCBS system supports approximately twenty-five thousand people.
Vermont: Ranked number three by ANCOR, and similarly to Arizona Vermont has incorporated its 1915 (c) HCBS waivers into 1115 (c) Demonstration projects. SC services in Vermont are provided through the Medicaid state plan as opposed to an included service under the waiver. SC services under this model are delivered through independent agencies called Designated Agencies (DA's) or Specialized Service Agencies (SSA), that are not exclusively supports coordination providers.
Innovation
Historical Perspectives
Historical Perspectives
Early Forms
Early Forms
Service Coordination was made possible with a demonstration grant in 1985 however…
A New Frontier
A New Frontier
Building on the work of Davis (2018), Bogenschutzm, Dinora and Johnson (2019) highlight the sparse research on case management, and more importantly the absence of the voice of the support coordinator. Parallel to the findings of Davis (2018) Bogenschutz et al (2019) reached the same conclusion from their nationwide reach as Davis (2018) in his focused look on Supports Coordination in PA, both concluding that the over emphasis on regulatory compliance and inadequate wages were among the challenges prohibiting more effective supports coordination.
The Effectiveness of Scale
The Effectiveness of Scale
Columbus Organization has become one of the largest supports coordination service provider in the state of Florida and ranks among one of the largest in the country. Though data and research on support coordination organizations is scant there are a handful of multi-state agencies providing support coordination services to participants in the Home and Community based waiver program. Most SCO's are state specific organizations serving their immediate area. While growth and scalability of a proven model can be good it begs the question in this environment is being the largest provider of SC services a boon or hinderance to the industry of supports coordination itself , to the service recipients for whom it is intended and to the people doing the hard grinding work of supports coordination.
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