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International advances in self-direction: themes from a disability leadership exchange

Valerie Bradley (Human Services Research Institute, Cambridge, Massachusetts, USA)
Miso Kwak (Human Services Research Institute, Cambridge, Massachusetts, USA)
Highsmith Rich (Applied Self Direction, Boston, Massachusetts, USA)
Bevin Croft (Human Services Research Institute, Cambridge, Massachusetts, USA)

Journal of Integrated Care

ISSN: 1476-9018

Article publication date: 2 March 2021

Issue publication date: 19 July 2021




Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries’ successful strategies, unresolved questions and recommendations to enhance self-direction globally.


The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand.


In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction.

Practical implications

The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction.


This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators.



Bradley, V., Kwak, M., Rich, H. and Croft, B. (2021), "International advances in self-direction: themes from a disability leadership exchange", Journal of Integrated Care, Vol. 29 No. 3, pp. 295-305.



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