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Ensuring Quality in Disability Services
 An interview with Valerie J. Bradley, M.A., co-author of Quality Enhancement in Developmental Disabilities: Challenges and Opportunities in a Changing World. From the November 2002 Disabilities newsletter.Q: How has quality assurance in disability services changed in recent years? A: Notions of quality in the field of developmental disabilities have changed dramatically over the past three decades. In the 1960s and 1970s, as a result of dramatic exposes and class action lawsuits aimed at the dreadful conditions in public institutions, the major thrust of quality assurance activities was aimed at basic needs, such as food, clothing, shelter, and personal comfort. Therefore, quality standards were comprised of rules governing heating and air conditioning, square footage, personal storage space, positioning, staffing ratios, and other input measures critical to individual health and safety. The next phase, which coincided with the movement of people out of institutions, spanned the late 1970s and 1980s. During this period, community services expanded exponentially, and the aim of quality assurance became the dissemination and "institutionalization" of best practice in the burgeoning residential and day system. Standards that evolved during this period were aimed at the process of delivering services. The third phase emerged during the early 1990s and is influenced by the emergence of the voices of self-advocates and a recognition that people with disabilities have aspirations and dreams similar to the rest of us. Thus, the goals of quality assurance began to expand to include an assessment of individual outcomes as determined by individuals rather than by professionals. Most recently, those concerned about quality assurance mechanisms have turned their attention to macro indicators of performance and are currently attempting to understand the regulatory ramifications of emerging self-determined models. Q: How should agencies and service providers incorporate principles of self-determination into the quality assurance process? A: There are a number of ways that agencies and providers can incorporate self-determination principles. The first step is to take very seriously the crafting of the person-centered plan and to ensure the resulting document captures both the individual's desires and the strategies to achieve these ends, and also an exploration of potential vulnerabilities and the ways in which supports and accommodations can be developed to minimize risks. The second step is to ensure that individuals and their families are significant participants in the quality assurance enterprise — both as fact finders as well as interpreters of results. Finally, agencies should ensure that there are multiple opportunities to solicit the input of people receiving services through intentional canvassing as well as through grievance and complaint mechanisms. In the end, one of the most important roles that agencies can give individuals in a quality assurance structure is that of purchaser and employer — roles that make them the ultimate arbiter of quality. Q: What are some indicators that can be used at the state level to monitor the performance of its agencies? A: There are a number of critical indicators that can be used to monitor agency performance including the following:
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