Power Shifts Through Self-Direction [PDF]

Notes on Self-Determination 
Anticipated Power Shifts and Conflicts of Interest

John O’Brien

June 1998

This note summarizes a discussion with people involved in Wisconsin’s Robert Wood Johnson Self-Determination Project. The group met on 10 June in Madison and included representatives from each of the three project counties as well as people from guerrilla counties and a number of state DD staff.


Project counties pursue different approaches to self-determination, but each intends to implement at least part of it’s approach through the more flexible approach to medicaid funding allowed by the proposed “Consumer Directed Supports” amendment to Wisconsin’s HCBS waiver. Counties’ different understandings of self-determination and designs for their different self-determination projects have at least one common aspiration: people with developmental disabilities will have significantly more power in their relationships with the service system.

Discussion focused on exploring changes in relationships anticipated as people with developmental disabilities exercise more power. The group first mapped current concentrations of power and the conflicts of interest that influence the present system, then mapped the power concentrations and influential conflicts of interest foreseeable if the self-determination projects succeed, and finally used the contrasts between maps to identify key issues for consideration in preparing the memoranda of understanding that will be necessary to implement Consumer Directed Supports.

Each county in the self-determination project pursues its own strategy; this discussion focused mainly on the issues common to them.