Anatomy of a Service System

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Anatomy of a Service System Powered By Docstoc
					          Defining The Role of
          The Service Broker
  A presentation made by BRIAN SALISBURY at the
First International Conference on Self-Determination
       & Individualized Funding held in Seattle,
            Washington, July 29-31, 2000
                     Contact Details:

              22014 – 88th Avenue, Langley,
            British Columbia, Canada, V3A 3S8.

                 Phone / Fax: 604-888-1856
                   bsalisbury@home.com
          http://members.home.net/directfunding
           http://members.home.net/bsalisbury
        Anatomy of a System
GOVERNMENTS DEVELOP & CARRY OUT POLICY USING A

       MINISTRY /                   COMMUNITY
      DEPARTMENT
                          or      GOVERNANCE BODY

These entities usually control financial resources & decision
    making associated with 2 major system functions

        SERVICE           SYSTEM/INDIVIDUAL
         FUNDING                PLANNING

             This represents a conflict of
               interest & can result in:

  Lack of self-determination          Inflexible services
   Case Management Is
      Supposed To:
identify the full range of services needed;
identify the range of resources available, inclusive of
individual natural support resources and public community
resources;
coordinate the activities of all services and resources;
refer individuals to all needed resources;
monitor and follow up to determine if services are received;
monitor and follow along to prevent or identify problems in
service provision through ongoing contacts, all services
utilized and the natural support resources;
assess and evaluate the effectiveness of all services and
resources utilized.
                              Carragone (1984)
 Planning Supports Are Needed
That Are Flexible, Responsive and
  Controlled by the Individual

        The
       Service
       Broker
 An emerging role . . . but
one in need of clarification
            Service Brokerage
. . . is a system function & process in which
advice, information and technical assistance is
made available to individuals who request
support to:
     identify & access needed community
     services & supports
     negotiate for & use individualized funding

Brokers can act as a critical link between the
individual, network members, providers,
professionals, community and the funding body.
BROKERAGE IN A DEMAND DRIVEN SYSTEM
GOVERNMENT                                               BROKERAGE
•    Public Policy
•    Fiscal Allocations                     PLAN                     BROKERS
•    Accountability                      INDIVIDUAL                    provide
                                                                       advice,
                                            Choosing
       ADDITIONAL                                                   information,
                                            Deciding
         SYSTEM                                                      & technical
      COMPONENTS                           Controlling              assistance to
    Income Programs
    Licensing
                                                   NETWORK          develop, cost,
                                                                     negotiate &
    Monitoring                                                      implement
    Advocacy                                                        PLANS “as
    Support Groups
                                                                     requested”
    Ombudsperson
                             FISCAL
                          INTERMEDIARY



     Funded Services                Purchased Services      Generic Services
          The Role of Brokerage

    Independent                      INDIVIDUA
                                         L
     Brokerage                        Choosing
                                                    NETWORK

                                                   Friendship,
                                      Deciding      Decision
                                     Controlling     Making
                                                   Monitoring &
                                                    Advocacy
   BROKERS:                           PLAN
Information, Advice
& Technical Support
 prepare & cost support
  plans
 assist funding negotiations
 arrange / implement plans
 monitor & evaluate services   Community Services
  based on user satisfaction
 mediate & solve problems         & Supports
Working As Natalie’s Broker
            Provided advice and information
            Assisted in reviewing and
             clarifying her needs/expectations
            Developed personal plans
            Negotiated individualized funding
            Located, arranged, monitored
             and evaluated community
             services & resources
            Resolved & mediated problems
            Stimulated the development of
             new services and helped modify
             existing ones
         A Simple Value Base
Each person is unique, with intrinsic worth,
with a fundamental right to . . .
  Live a life of dignity.
  Be self-determining.
  Be fully included in all aspects of
  community life.
  Access the supports needed to be
  fully included.
  Choose, and be supported by, a
  network of family members & friends.
   Brokerage Principles

No decision-making

Autonomy

Zero rejection

Access at the individual's discretion

Continuity

Status for personal networks in support &
decision-making
        The Brokerage Process
 Visionary & creative
 Based on an understanding of needs & support
  requirements from the person’s perspective
 Relevant information is sought from family members,
  friends, professionals & potential providers
 Facilitates ongoing network involvement
 Involves researching & drafting a plan, identifying
  services, obtaining cost estimates, & final plan
  endorsement – ALL at the direction of the person
 Develops strategies for success by examining
  different options, knowing the advantages &
  disadvantages of these options, & making
  recommendations or suggesting alternatives
      The Brokerage Process
 Assists with funding negotiation if requested
 Prepares service contracts specifying rights,
  obligations & responsibilities of all parties
 Finalizes service contracts & implements the
  person's plan
 Planning supports are available on an ongoing
  basis, especially as this relates to:

    liaising with the individual, network, providers,
     funding body and the community and
    service monitoring/adjustment, including
     modifying current services, accessing
     alternative services, or stimulating the
     development of entirely new ones
   Advantages of Brokerage
Broker acts on the person’s instructions.
Personal networks can provide support in
decision making, advocacy & monitoring.
Planning is tailored to individual needs.
Broker can cross all system & organizational
boundaries.
Citizenship & valued social roles are the primary
focus.
Process is culturally sensitive & can be used
widely within health & human services.
 Locating & Paying for Brokerage
 To be responsive & accountable to INDIVIDUALS, brokerage
must operate without a “conflict of interest”. Brokers should not
   work for bodies that fulfill multiple & competing mandates
because they simply can’t serve two masters at the same time.
  How brokerage is paid for therefore becomes a critical issue.


 Government/               INDIVIDIUAL              Service
  Community                   PLAN                Brokerage
  Governance                                       Function


                             Service
                            Providers
    Issues in Paying for Brokerage
               BROKERAGE MODEL
    SUPPLY SIDE                        DEMAND SIDE
Independent, Not for Profit   Independent, Fee For Service
 Community-Based Planning     Brokers or Private For Profit
         Agencies                 Brokerage Companies
              PERSONAL CONTROL
       MINIMUM                         MAXIMUM
        $$$$$                          $$$$$
  fund community-based            are paid directly to
agencies that both hire &       the person who decides
supervise brokers to assist     who to hire as his / her
  people with a disability          personal broker
        A Mixed Brokerage Model?
                                                             ADVANTAGES
    SUPPLY SIDE                  DEMAND SIDE
                                                            Brokerage body
    Not for Profit              Private for Profit           provides regulatory
Community agencies hire       Companies/Independent          oversight
  & supervise brokers         brokers are hired directly
                                                            Reduced risk of
 Planning quality & access    Maximum choice but free      brokerage
     more likely . . . but      market creates risks for     becoming
      choice & control             planning quality          bureaucratic
        are reduced                  & autonomy
                                                            Choice is maximized
                   MIXED MODEL
                                                             while flexibility &
         CONSUMER CONTROLLED                                 responsiveness of
                                                             brokerage are
        Database/& core brokerage staff                     increased
         Capacity to respond to initial                    Well informed
                  consumer needs                             consumers
         Provision of training supports                    Brokerage body is
      Maintains list of approved community                  better able to
          “fee for service” brokers with                     address agency
                                                             training &
              whom people contract                           community
                       directly                              development needs
Brokers go beyond their mandate
      when they act as . . .


       Advocates

       Fund Holders

       Case Managers

				
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posted:4/12/2011
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