Assistance with Integrity: The Search for Accountability and the Lives of People with Developmental Disabilities

This report discusses basic issues in the provision of residential services for people with developmental disabilities. Main points of the discussion include: (1) the service system for this population is in a crisis of accountability as meeting safety and quality requirements threatens to become counterproductive; (2) the current system is well defended against efforts to rethink and fundamentally reorganize it; (3) the perspectives of effective interdependence and systems thinking can assist in system redesign; (4) effective police power is needed to protect people with developmental disabilities from abuse and neglect; and (5) multiple, various, small scale, self-organizing systems of assistance in a field organized by principled negotiation and shared learning are needed. Other topics discussed are barriers to thinking deeply about accountability, integrity as a central virtue in effective interdependence, threats to integrity from the dominant pattern of quality assurance, dealing more effectively with failures of integrity, the potential contribution of Total Quality Management, and integrity as a guide to policy. (Contains references as footnotes.) (DB)