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Charleston, WV 25387

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Why This Topic is Important

     Service coordination has evolved into a very important part of the service system. In the past, people with disabilities and their families had to manage the system on their own. It was up to them to figure out what they needed, who might provide it, if they qualified, and so on. Once they became a client of a particular agency, they might get help coordinating what happened to them. In many cases, however, they simply became a case to be managed. 

     The intent of service coordination has always been relatively straightforward – help people identify what they need, help them get it, coordinate the activities of the services and resources they get, and make sure everyone does what they are supposed to do. The intent was not to manage people as cases, but to help them manage the system so it worked on their behalf. The newer term, service coordination, better reflects that intent.

     Partners should compare the concept of service coordination to what happens locally. Think about what is being provided. Think about how well it's being done. Decide what to do to make it BETTER!

     Good service coordination services are the hub of service provision. It is essential that service coordinators be very knowledgeable about their role and about the needs of the people they are to serve. It is essential that training for service coordinators be on-going. It is essential that service coordinators have the authority to secure needed services. It is very important that the number of people service coordinators support is small enough so they can know each person well and be a rock-solid advocate for each person.


     Service coordination is the formal link between the individual with a disability and the service system. When an individual, and that group of people who are committed to the individual, develop a plan for the future, the service coordinator may well play an active role in getting the service system to respond. In more regulated and formal systems, the person's own plan may be more like a piece of information that the system takes into account, but does not take the place of the forms and processes required by law.

     The goal of service coordination should be to improve the individual's quality of life, ensure that his or her needs are met, and foster the individual's autonomy. To accomplish this goal, service coordinators are responsible for four types of activities – assessment, planning, implementation, and evaluation. Each activity informs the next, so that the cycle is ongoing. The cycle of service coordination activities includes:

  • Assure the ASSESSMENT of consumer needs and of the things they would like to learn to do.
  • Coordinate PLANNING of services to meet consumer needs, wants, preferences, and learning objectives.
  • Assure the IMPLEMENTATION of the service plan and individual objectives.
  • EVALUATE the adequacy of supports and services to meeting individual goals and objectives.

Service Coordination should:6

  • Identify the full range of services needed.
  • Identify the range of resources available, including each individual's natural support resources and the public resources available.
  • Coordinate the activities of all services and resources.
  • Refer individuals to all needed resources.
  • Monitor and follow-up to see if services are received.
  • Monitor and follow-along to prevent problems or to identify problems in service provision through ongoing contacts with all services utilized, and with the natural support resources (i.e., family and friends).
  • Assess and evaluate the effectiveness of all services or resources used.
  • Continually advocate with and on behalf of each individual to maximize his or her quality of life.

6Section adapted from Shaping Case Management in Minnesota..., 1991.

Service coordinators should base their services on these values:7

  • Every individual has worth.
  • Long-term relationships enhance self worth.
  • This is an interdependent world where we all share the responsibility to assure the health, education, and welfare of all citizens.
  • Learning is an essential and important part of human existence.

7From Caragonne, 1994.

Service coordinators should ensure that the support people with developmental disabilities receive is consistent with the following principles:

  • Non-intrusive.
  • Easily accessible.
  • Efficient.
  • Growth-enhancing.
  • Promotes inclusion into the community.
  • Involves the opinions, wants, needs and preferences of the person(s) receiving supports.
  • Age appropriate.
  • Enhances dignity.
  • Encourages connectedness and friendships.
  • Promotes a positive social role.
  • Protects the individual's rights.
  • Cost effective.
  • Produces positive changes in people's lives.
  • Fosters full citizenship for each individual.

The life and learning experiences encouraged by service coordinators should:

  • Support and maximize growth.
  • Emphasize the whole person.
  • Maintain or increase the person's sense of community.
  • Make personal decision making fundamental.
  • Enhance the relationship building capacity of the individual and of those who are important to him or her.
  • Occur in a variety of settings.
  • Include the provision of supports and adaptations.
  • Include real experiences and their consequences.

If you are a consumer, you have a right to expect your service coordinator to:

  • Talk with you.
  • Ask for your opinion.
  • Help you with the things you need to learn.
  • Do what they say they will do.
  • Treat you with respect.
  • Listen to you.
  • Talk with you about your concerns or problems.
  • Ask you about your likes and dislikes.
  • Ask you about what you would like to do or learn.
  • Be reasonably available when needed.
  • Help you to get the services you may need.
  • Talk with your family or friends when it's helpful unless you object.
  • Give you the opportunity to make or to be involved with making decisions about things that affect your life.
  • Encourage you to be involved with community activities, whether recreational, work or school related, religious, or social.
  • Protect your rights.
  • Assure that you have opportunities to experience new things.
  • Coordinate the annual team meeting and arrange for support and services based on your needs and preferences.
  • Be concerned with your whole life.
  • Help you to enjoy living in the community and become more independent.

If you are a consumer, your service coordinator should work with you and for you. Your service coordinator should talk with you about your needs, wants, concerns, aspirations, feelings, likes and dislikes regarding:

  • Dental services,
  • Housing,
  • Medical services,
  • School,
  • Work,
  • Family involvement,
  • Friends,
  • Community outings and activities,
  • Transportation,
  • Religious affiliation,
  • Future plans,
  • Social groups,
  • Protecting rights,
  • Promoting growth and opportunities,
  • Roles and images that support consumer choice.