Support Coordination – Complexity [PDF]

Working In Complexity
Lessons For System Change From Support Coordination

John O’Brien & Patti Scott


We advocate a strong view of inclusion and self direction that disrupts most current ways that publicly funded assistance to people with ID/DD are organized and delivered. Progress in realizing these values calls for deep change.

We find the Cynefin framework a helpful way to guide the design and practice of Support Coordination.* Cynefin distinguishes ordered situations –in which best practice and good practice define good solutions– from complex situations, where adaptive solutions are discovered through purposeful action in particular situations.

Progress toward inclusion and self direction requires the capacity to work in complexity.

  • • Different understandings of inclusion and self-direction lead to significant disagreements about how to implement policies including the recent CMS Setting Requirements and Employment First policy.
  • • These disagreements can only be effectively resolved by generating social inventions that test a variety of ways to offer people with ID/DD individualized support to experience self-direction and valued roles in community life and broaden and build from what works.
  • • These social inventions must be co-created with people with ID/DD and the diverse people with whom they participate in community life. They can’t be imposed.
  • Under conditions that encourage them to work in complexity, Support Coordinators can join and encourage some people with ID/DD and their families to co-design, co-develop and direct forms of assistance that sup- port them in valued community roles.

Unfortunately administrators of public funds for assistance to people with ID/DD often act as if as if the context for Support Coordination wereordered and effective performance were a matter of implementing best practice as administrators define it. This expectation diminishes the con- tribution Support Coordinators can make to real change and consumes attention in compliance driven activity.

From assuming….to understanding…
…the work is Ordered
…the work as complex with ordered aspects

Past practice shows conditions that have allowed Support Coordination to work in complexity, with good results. Whether those conditions can be retrieved and strengthened remains to be seen. If the grip of belief in an ordered situation is too strong, people with ID/DD and their allies who choose the leading edge of inclusion and self-direction will need to create new forms of assistance to make the best of their complex environment.