Affiliations: Institute for Community Inclusion Children's Hospital,
Boston, MA 02115, USA
Note: [] Institute for Community Inclusion, Children's Hospital, 300
Longwood Ave., Boston, MA 02115, USA. Tel.: +1 617 355 6506; Fax: +1 617 355
7940; E-mail: butterworth@al.tch.harvard.edu
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.
Keywords: changeover to community employment, community inclusion, rehabilitation
