Defining The Role of The Service Broker Contact Details: – 88 th Avenue, Langley, British Columbia, Canada, V3A 3S8. Phone / Fax: A presentation made by BRIAN SALISBURY at the First International Conference on Self-Determination & Individualized Funding held in Seattle, Washington, July 29-31, 2000

Anatomy of a System GOVERNMENTS DEVELOP & CARRY OUT POLICY USING A These entities usually control financial resources & decision making associated with 2 major system functions MINISTRY / DEPARTMENT COMMUNITY GOVERNANCE BODY This represents a conflict of interest & can result in:  Inflexible services  Lack of self-determination  SERVICE FUNDING  SYSTEM/INDIVIDUAL PLANNING or

Case Management Is Supposed To: identify the full range of services needed; identify the range of resources available, inclusive of individual natural support resources and public community resources; coordinate the activities of all services and resources; refer individuals to all needed resources; monitor and follow up to determine if services are received; monitor and follow along to prevent or identify problems in service provision through ongoing contacts, all services utilized and the natural support resources; assess and evaluate the effectiveness of all services and resources utilized. Carragone (1984)

Planning Supports Are Needed That Are Flexible, Responsive and Controlled by the Individual The Service Broker An emerging role... but one in need of clarification

Service Brokerage... is a system function & process in which advice, information and technical assistance is made available to individuals who request support to: Brokers can act as a critical link between the individual, network members, providers, professionals, community and the funding body. identify & access needed community services & supports negotiate for & use individualized funding

NETWORK GOVERNMENT Public Policy Fiscal Allocations Accountability INDIVIDUAL Choosing Deciding Controlling FISCAL INTERMEDIARY BROKERS provide advice, information, & technical assistance to develop, cost, negotiate & implement PLANS “as requested” Purchased Services Generic Services Funded Services PLAN BROKERAGE IN A DEMAND DRIVEN SYSTEM BROKERAGE ADDITIONAL SYSTEM COMPONENTS  Income Programs  Licensing  Monitoring  Advocacy  Support Groups  Ombudsperson

NETWORK Friendship, Decision Making Monitoring & Advocacy BROKERS: Information, Advice & Technical Support The Role of Brokerage Independent Brokerage Independent Brokerage  prepare & cost support plans  assist funding negotiations  arrange / implement plans  monitor & evaluate services based on user satisfaction  mediate & solve problems INDIVIDUA L Choosing Deciding Controlling PLAN Community Services & Supports

Working As Natalie’s Broker  Provided advice and information  Assisted in reviewing and clarifying her needs/expectations  Developed personal plans  Negotiated individualized funding  Located, arranged, monitored and evaluated community services & resources  Resolved & mediated problems  Stimulated the development of new services and helped modify existing ones

A Simple Value Base Live a life of dignity. Be self-determining. Be fully included in all aspects of community life. Access the supports needed to be fully included. Choose, and be supported by, a network of family members & friends. Each person is unique, with intrinsic worth, with a fundamental right to...

Brokerage Principles No decision-making Autonomy Zero rejection Access at the individual's discretion Continuity Status for personal networks in support & decision-making

The Brokerage Process  Visionary & creative  Based on an understanding of needs & support requirements from the person’s perspective  Relevant information is sought from family members, friends, professionals & potential providers  Facilitates ongoing network involvement  Involves researching & drafting a plan, identifying services, obtaining cost estimates, & final plan endorsement – ALL at the direction of the person  Develops strategies for success by examining different options, knowing the advantages & disadvantages of these options, & making recommendations or suggesting alternatives

The Brokerage Process  Assists with funding negotiation if requested  Prepares service contracts specifying rights, obligations & responsibilities of all parties  Finalizes service contracts & implements the person's plan  Planning supports are available on an ongoing basis, especially as this relates to:  liaising with the individual, network, providers, funding body and the community and  service monitoring/adjustment, including modifying current services, accessing alternative services, or stimulating the development of entirely new ones

Advantages of Brokerage Broker acts on the person’s instructions. Personal networks can provide support in decision making, advocacy & monitoring. Planning is tailored to individual needs. Broker can cross all system & organizational boundaries. Citizenship & valued social roles are the primary focus. Process is culturally sensitive & can be used widely within health & human services.

Locating & Paying for Brokerage To be responsive & accountable to INDIVIDUALS, brokerage must operate without a “conflict of interest”. Brokers should not work for bodies that fulfill multiple & competing mandates because they simply can’t serve two masters at the same time. How brokerage is paid for therefore becomes a critical issue. Service Providers Service Brokerage Function Government/ Community Governance INDIVIDIUAL PLAN

Issues in Paying for Brokerage BROKERAGE MODEL SUPPLY SIDE DEMAND SIDE Independent, Not for Profit Community-Based Planning Agencies Independent, Fee For Service Brokers or Private For Profit Brokerage Companies PERSONAL CONTROL MINIMUM MAXIMUM $$$$$ fund community-based agencies that both hire & supervise brokers to assist people with a disability $$$$$ are paid directly to the person who decides who to hire as his / her personal broker

A Mixed Brokerage Model? SUPPLY SIDE DEMAND SIDE CONSUMER CONTROLLED  Database/& core brokerage staff  Capacity to respond to initial consumer needs  Provision of training supports  Maintains list of approved community “fee for service” brokers with whom people contract directly MIXED MODEL Private for Profit Companies/Independent brokers are hired directly Not for Profit Community agencies hire & supervise brokers ADVANTAGES  Maximum choice but free market creates risks for planning quality & autonomy  Planning quality & access more likely... but choice & control are reduced  Brokerage body provides regulatory oversight  Reduced risk of brokerage becoming bureaucratic  Choice is maximized while flexibility & responsiveness of brokerage are increased  Well informed consumers  Brokerage body is better able to address agency training & community development needs

Brokers go beyond their mandate when they act as...  Advocates  Fund Holders  Case Managers