The Effects of Funding Packages on the Outcomes of Integration and Independence of Adults with Developmental Disabilities in Two Rural States

This study presents a method for measuring outcomes, and for making comparisons between funding packages and between states about the effectiveness of programs in encouraging integration and independence, while controlling for potentially confounding factors. Adults with developmental disabilities, (N = 3,291), were served in two very rural Western states, and in a medium-sized Midwestern city. Information about the individuals served was taken from the Inventory for Client and Agency Planning (ICAP); fiscal information about the types and amounts of funding, provider and geographic information factors were used to explain the outcomes. Analyzing the combined data with analyses of covariance to control for possibly confounding factors, it was found that federally-funded people are more likely to be involved in the more restrictive living and day settings than people supported by state general funds. Residential independence was highest for people with state funding, intermediate for those paid by Home and Community Based (HCBS) waivers, and lowest for those living in Intermediate Care Facilities for the Mentally Retarded (ICFs/MR). Significant differences in independence between HCBS and ICF/MR were not substantiated for daytime settings, however. The disability level of the individual served was the best predictor of independence. Factors used in the study explained 85% of all of the variance in residential independence and 52% for daytime independence. The methodology shows value in establishing clear outcome-based quality measures, and doing so economically since it uses existing databases.