Effects of person‐centred planning and practices on the health and well‐being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data

Abstract

AbstractBackgroundA person‐centred service planning and practice approach (PCP) is one that is driven by service users' individual preferences, needs and priorities. The approach has been identified as a best practice and is codified in US policies that encourage and, in some contexts, require state systems of home and community‐based services to adopt and demonstrate person‐centred practice. However, there is insufficient research on PCP's direct impact on outcomes for service users. This study aims to contribute to the evidence base in this area by investigating the association between service experiences and outcomes of adults with intellectual and developmental disabilities (IDD) receiving state‐funded services.MethodsThe data for the study come from the 2018–2019 National Core Indicators® In‐Person Survey that links survey responses with administrative records for a sample of 22 000 adults with IDD receiving services from 37 state developmental disabilities (DD) systems. Associations among service experiences and outcomes of survey participants are examined through multilevel regression techniques that include participant‐level responses and state‐level measures of PCP. The state‐level measures are constructed by combining administrative records describing participants' service plans with the priorities and goals they expressed in response to the survey.ResultsCase managers' (CM) accessibility and attentiveness to individual preferences, as reported by survey participants, are significantly associated with self‐reported outcomes such as perceived control over life decisions and sense of health and well‐being. Controlling for participants' experiences with their CMs, their reports of the person‐centred content of their service plans have net positive associations with outcomes. After accounting for experiences with the service system as reported by participants, the state system's person‐centred orientation, measured by the extent to which service plans across the state reflect participants' wishes for improving their social connections, remains a significant predictor of participants' sense of control over their daily lives.ConclusionsThis study contributes to the evidence base supporting PCP as a service model by identifying pathways that link person‐centred service planning and delivery and person‐centred orientation of state systems to positive outcomes reported by adults with IDD and by demonstrating the value of linking survey and administrative data. The key implication of the findings for policy and practice is that an overall person‐centred orientation of state DD systems as well as PCP training for people who support planning for and delivery of direct supports will substantially improve the lives of adults with IDD.