A Revolution in Human Services

By Valerie J. Bradley, Marc H. Fenton, and Kevin J. Mahoney

Subjects: Public Policy, Disabilities, Social Problems, Gerontology/aging Studies
Hardcover : 9781438483436, 254 pages, June 2021
Paperback : 9781438483429, 254 pages, June 2021

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Table of contents

List of Illustrations

1. Self-direction: What It Is and How It Works

2. The History and Policy Antecedents of Self-direction

3. The Federal Role: Less Visible, Just as Important

4. The Status of Self-direction across the Country

5. Setting Individualized Budgets to Support Self-direction

6. The Impact of Self-direction: Results for Participants

7. The Impact of Self-direction: Financial Results

8. Factors That Can Influence the Growth of Self-direction

9. The Expansion of Self-direction to Other Participants

10. International Examples of Self-direction in Human Services

11. Reflections and Recommendations


Relates how the self-direction movement was developed, the research that supports it, how the model has spread across the country and the globe, and recommendations and prospects for the future.


In the past, when people with disabilities and older adults needed help with activities of daily living and navigating their communities, they rarely had any choice about who helped them, when that support was delivered, or what the worker would or would not do. The self-direction movement changed all that by offering people the option to select their own workers and even create an individualized budget to help them live more independently. Written by experts who played a key part in the growth, evaluation, and dissemination of this revolutionary approach, Self-Direction describes the development of this movement through the authors' personal accounts. Also included are stories from actual participants in the movement who benefitted from this approach and from policymakers who saw how self-direction could help address states' problems. The book's conclusion discusses recommendations that can improve the way self-direction is delivered and how to spread its message so that all people with disabilities can have this choice.

Valerie J. Bradley is President Emerita at the Human Services Research Institute. She is the author of several books, including (coauthored with Robert L Schalock and James F. Gardner) Quality of Life: Applications for People with Intellectual and Developmental Disabilities. Marc H. Fenton is former partner at Public Consulting Group, Inc. and Founding President of Public Partnerships, LLC, the country's largest fiscal intermediary for people using self-directed budgets. Kevin J. Mahoney is Professor Emeritus at Boston College School of Social Work and Founding Director of the National Resource Center for Participant-Directed Services. His previous books include (coedited with Ellen K. Mahoney and Michelle Putnam) Self-Direction in Long Term Services and Supports: The Cash and Counseling Demonstration and Evaluation Ten Years On.


"…an accessible and thorough history and overview of self-directed supports programs. The authors share their aggregate wisdom and experience with a friendly style that walks the reader through the many programs, policies, experiments, and studies that tell the story of how self-direction has become mainstream. They provide an excellent articulation of the underlying philosophy, the history of implementation in state and federal programs, and most importantly, a summary of the benefits of self-direction in terms of public spending and participant outcomes." — Journal of Aging & Social Policy

"…a comprehensive resource for those who would benefit from understanding the promise of self-direction … I recommend this book to anyone interested in teaching the next generation of health professionals and leaders about the best ways to address the needs of the growing population of people with disability. Those who are interested in influencing, making, or implementing long-term care policies and all who are pursuing research or evaluations about long-term care also will find this a valuable resource." — Richard M. Allman, The Gerontologist