Quality in Services for People with Intellectual and Developmental Disabilities

Throughout the United States, there has been a shift in the manner in which people with disabilities, service providers and accrediting bodies are defining quality.  The current National and International trends move beyond compliance to established processes to redefining quality within a context of community inclusion, rather than on programs, services and organizations.        

The Council on Quality and Leadership (CQL) has published a report entitled Weaving the Threads of  Quality.^[1]   CQL is a nationally recognized accrediting body for services for people with disabilities.  In this report, a brief summary of how quality has been defined, how it has been measured and how it was used for system improvement is provided for three periods of time, 1970 to 1990, 1990 to 2005, and 2005 to the present.  The report outlines how the definition of quality has changed from 1970 when it was focused on the performance standards established to address several national exposes of public institutions to the current focus on redefining quality within the context of community rather than programs, services or organizations.  This focus on community was the result of CQL’s shift from compliance to process standards to responsiveness to the people receiving services through an assessment of Personal Outcomes which began in 1990. 

The Commission on Accreditation of Rehabilitation Facilities (CARF) is another major accrediting body in the USA.  While it has not taken the step toward quality being defined in the context of community, it followed a similar path as CQL in its definition of Quality.  It also moved from looking at compliance with a set of performance standards to also looking at the outcomes that are achieved by people receiving the services and supports.          

Should states have a consistent definition of quality across state agency funders?

States should adopt a definition of quality for services and supports for people with Intellectual and developmental disabilities.   The following definition is presented for consideration:

Built upon a foundation that assures optimal health and safety, quality in services for people with intellectual and developmental disabilities is characterized by supports that are flexible and effective in assisting people to achieve personal outcomes in the most inclusive community settings possible.