New Hampshire Project Gives the Impaired More Control Over Needed Services

Starting in December 1995, staff at the State of New Hampshire Department of Health and Human Services sought to replicate the principles of the Monadnock Self-Determination Project (ID# 023006).

The Monadnock project, piloted in southern New Hampshire as part of the Robert Wood Johnson Foundation's (RWJF) Building Health Systems for People with Chronic Illnesses national program, had generated considerable interest among the developmentally disabled and their families in the state and resulted in significant cost savings, even for the most severely impaired persons.

The goal of this project was to imbed that pilot project's principles of client choice and authority within each of the state's 12 community-based agencies providing services to the developmentally disabled.

Key Results

  • To create an infrastructure that supported self-determination, project staff developed new management structures at the state and regional level and fiscal reporting protocols and evaluation procedures for provider agencies.
  • They engaged staff and other stakeholders in each region in collaborative activities, training events and leadership development.
  • The project also worked to revise state rules and service definitions to reflect the value of client self-determination.
  • Service to 170 clients was phased in over the grant period.
  • After four years, 11 of 12 regional service agencies were changing their systems of care to foster more client prerogatives.
  • In the same time period, provider agencies within the regions were either examining or adopting the use of individual services budgets for their clients, a means of fostering greater client choice and control.