Frontline Initiative Choice, Direction, and Control

A Culture of Coordinated Support


Jonathan Martinis is the Senior Director for Law and Policy of The Burton Blatt Institute at Syracuse University. Jonathan has over twenty years’ experience representing people with disabilities to protect their legal and human rights, including precedent-setting cases securing access to critical community based services and Supported Decision Making.

Jessalyn Gustin is the Program Director at Upper Valley Services in Bradford, Vermont. Jessalyn has been providing disability services in Vermont for over ten years, and has been recognized as champion for collaborative change initiatives. Her values and vision for communities that embrace and celebrate diversity has led to the development of innovative, person-centered service delivery systems, resulting in improved lives for Vermonter’s with and without disabilities.

Jonathan and Jessalyn are partners in Something Else Solutions, LLC. Together, they have presented to and trained thousands of people, professionals, agencies, and organizations about ways to support the dreams and goals of people with disabilities. Please feel free to email any questions or comments to SomethingElseJM@Gmail.Com

People with disabilities achieve better life outcomes when they work with their service providers to develop a Culture of Coordinated Support (CCS). Coordinated support teams use shared vision and values to develop goals and objectives based on the person’s dreams, strengths, and preferences. Unfortunately, current, complex service systems may limit information and resources. When this happens, people spend too much time searching for who can provide services. As a result, they miss out on opportunities to develop and use appropriate, individualized supports.

In a CCS, people and providers develop a unified, person-centered vision and plan. The team adopts shared values, goals, objectives, and supports directed by the person. This is its “operating culture.” Direct Support Professionals (DSPs) should play a crucial role in this process. DSPs can ensure that the person remains at the center of the culture. They can make sure that the team’s plans reflect and respond to the person’s life, abilities, and preferences. They can also help providers coordinate their efforts. They can help eliminate the redundancies. They can eliminate “turf battles” that decrease effectiveness and waste resources. These efforts ensure that supports are more person-centered and effective. They empower the person to lead a more meaningful, independent life.

Because DSPs engage team members in varying environments, they can provide feedback to ensure that people’s supports and services adhere to their dreams, goals, and values. For example, schools, vocational rehabilitation agencies, Medicaid Waiver providers, and Centers for Independent Living all must provide education, employment, and independent living supports. DSPs interface with these providers regularly. Therefore, they can encourage people and providers to work together to create a CCS where —

  • People identify and communicate their personal dreams and goals to their family, friends, and service providers.
  • People and providers develop a common set of values and vision for the person’s supports based on the person’s dreams and goals.
  • People and providers create consistent, joint, cross-agency support plans, goals, and objectives that reflect the person’s dreams and goals.
  • Support plans identify the specific services each party will provide and how they will track progress and identify and implement change initiatives.

We have consulted on CCS models in several states, including Vermont, which has convened the first task force designed to “transform practices in a way that brings a culture of collaboration” throughout state systems.3 The states, agencies, and organizations that embrace CCS show a commitment to shared vision, coordinated efforts, and appropriate support planning and provision.

Great outcomes do not require more resources. People with support to share can help teams develop common vision and responsibility for service planning and provision in a way that maximizes effectiveness and minimizes costs. By encouraging and enabling a CCS, DSPs can help people and providers create truly person-centered plans and supports empowering full, independent, and meaningful lives.