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male narrator: For years, persons with developmental disabilities and their families faced a poverty of alternatives.

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Society almost always prescribed institutional care for these individuals, ignorant of the role its own negative attitudes and low expectations played in that prescription.

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Thought of as being less than human…

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Identified with their handicaps and not their personhood…

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Persons with developmental disabilities were typically the objects of fear, pity, or ridicule.

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Victims of a profound misunderstanding in which they were never seen to grow, develop, or change.

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The Civil Rights Movement brought a new perspective. Families of persons with developmental disabilities began to organize. Parent advocacy grew.

Court decisions specifically addressing the legal status of persons with developmental disabilities multiplied and the individual achievements of a growing number of persons with developmental disabilities shaped more mature attitudes, and with the spread of these attitudes began the movement towards smaller facilities located within the mainstream community.

In time, parents and professionals both came to question whether the mere presence of persons with developmental disabilities in a community improved their quality of life, advanced their interests or those of their families.

It was not enough to be physically in a community but not really part of it. In 1975, federal law established that children with developmental disabilities had a right to free and appropriate education in the least restrictive setting.

This gave families the option to refuse out-placement and to keep their children living at home. Those children with developmental disabilities who received appropriate public education who remained at home with their families or lived in home-like environments attained a level of achievement far beyond those who had been institutionalized with these results in hand, it became clear to more and more parents and professionals that the major problems were restrictive and sterile environments, not the disability; negative attitudes and low expectations, not the handicap.

Lack of appropriate skill in providing services, not the person. What was missing from the equation was not care but the quality of care.

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More and more professionals and families began challenging the old views. They began asking, "What would happen if persons with developmental disabilities learned how to make choices about their lives; they lived in places they could really call home; they were taught the practical skills needed for everyday situations; they enjoyed the company of friends?"

They began to suspect that the value of broad experience, varied experience, rich experience was as great for the person with developmental disabilities as it is for any human being.

Experience that afforded learning, independence, integration. These are the goals of quality case management when it comes to improving the lives of persons with developmental disabilities.

Today case management concerns itself more with what an individual is capable of achieving and less with what his or her limitations happen to be. Case management is about rising expectations, arrangements that reflect what the person with developmental disabilities thinks or feels is important, family needs, and individualizing services to help transform hopes into reality.

Case management is available to anyone with mental retardation or other developmental disabilities provided that the person, his or her family or legal representative applies for it at the county social service department, and the department establishes that person's eligibility.

Effective case management demands a close partnership among the case manager, the person with developmental disabilities, and his or her family or legal representative.

From the very beginning, it has to be a team effort. While the case manager is the team leader, decision making is participatory, and the person with developmental disabilities must be present whenever the team is making service decisions unless his or her medical condition prevents this.

Of course, other professionals may join the team whenever the need arises for more information or specialized expertise. Case management is a five-part process involving assessment, planning, monitoring, evaluation, and advocacy.

To understand what happens in each of these phases, let's explore the case management process in a little more detail. During the assessment phase, the team collects information to determine what services or arrangements the person with developmental disabilities will need in order to lead as integrated and as fulfilling a lifestyle as possible.

What we would like is your input as to what you think, you know, you wanna see for Brian in the future residentially and vocationally. What you see as Brian's strengths, that's really what we wanna build on is what Brian can do.

narrator: In the planning phase, the team reaches consensus on all the services needed and the case manager sets up the arrangements discussed in the assessment phase.

One result of this phase is an individual service plan or ISP, which reflects the assessment summary, goals, objectives, and all service expectations the team has defined for the person with developmental disabilities with as much of that person's participation in the process as possible.

Andrea, could you give us an idea of what your vocational program has to offer and how it could be fitted into Brian's life?

Well, our program has a lot to offer in the way of training one-to-one if he needs that on a large scale or a small scale since we have a large workroom and a small workroom, and, after he receives that training, he can utilize that on an enclave in the community and, perhaps later down the line, be an independent and getting to his job independently and using that independently.

narrator: Next, the case manager draws up an individual habilitation plan or IHP. This breaks down the services listed in the ISP in terms of how each will fulfill the person's goals.

This is the phase that sets the stage for the transition to a more integrated style of life, a higher quality of life for the person with developmental disabilities. In the monitoring phase, the case manager spearheads a process designed to make sure that the services specified in the ISP are working as planned…

Hi, Andrea, how are you today?

I'm fine, Candy, thank you. How are you?

Good, I thought I'd come out today and observe Brian at work.

Good, he's working on headsets right now. Just follow me, and I'll take you where he's at.

narrator: And shares this information with the person with developmental disabilities and the other members of the team.

Our meeting today is an evaluation of Brian's past year, and what we want is input from both of Brian's providers--residential and vocational.

narrator: Evaluation occurs at least once a year, more often if necessary, and concerns the progress the person with developmental disabilities is making toward achieving the stated goals.

It's just remarkable what he's accomplished, and I think a lot of it had to do with having a consistent director staff person and a lot of assistance in coordinating some training for him. I really see where he's so bright we have to make it even more challenging.

narrator: Advocacy is often ongoing. With every member of the team prepared to stand up for the best interests of the person developmental disabilities. The purpose of this phase of the case management process is to seek solutions should problems arise, fill gaps in service if they develop, or overcome whatever other obstacles may arise to prevent the person's continued process toward greater independence and integration into the community.

It's a process that demands the maximum possible participation of all team members including the person with developmental disabilities and his or her family. The entire process, from assessment through advocacy, begins when the person with developmental disabilities or the family applies for and receives case management services.

Case management is the administrative tool that paves the way to a broad range of individualized services--services designed specifically for a particular person with developmental disabilities and suited to that person's individual needs and circumstances.

Families need to know that obtaining individualized services may not be easy. Their availability depends on the creativity of the case manager, the ingenuity of the service providers, and the sensitivity of the social service agencies involved.

There's no way to know for sure how long or how complicated the process of securing individualized services will take in every instance. It may be necessary to be persistent, assertive, or even confrontive in order to accomplish this.

Despite the fact that the right to individualized services is protected by case management regulations, for many families, it can become a protracted struggle bringing them into conflict with social service authorities, elected officials, and government bureaucrats.

Often it helps to have the support of one of the growing number of volunteer groups dedicated to the cause of persons with developmental disabilities

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Is quality case management worth the effort? Ask any of these people, but we think you already know what the answer will be.

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