Because it was the right thing to do: Changeover from facility based services to community employment

Abstract

This manuscript presents findings from a qualitative study of six community rehabilitation providers that successfully closed a facility-based program. Potential organizations were selected using a national nominations process and results from a 1991 national survey of community rehabilitation providers. Following a screening process, participating organizations were selected to provide diversity in location and size. Primary data collection took place during a two-day site visit with each program. The six organizations that participated in this study established an explicit goal to redirect resources from facility-based services to community employment, and each succeeded in closing a sheltered workshop or other facility-based program. Catalysts for the change were almost exclusively internal to the organization. The change in each organization was based on a change in organizational values and goals, but was often supported by other factors including financial concerns or other pressures. While leadership and the approach used to implement the change process varied, there was striking consistency across seven themes or characteristics of the organization that suggest organizational and systems strategies for approaching change. These themes included an openness to risk taking, shared values that drive service delivery, an ongoing process of self evaluation, linkages to external resources, a holistic focus on consumer needs, direct staff roles in organizational goals and decision-making, and an emphasis on continuous improvement. Strategies for state systems, community rehabilitation providers, and advocates are reviewed.