Individualised funding interventions to improve health and social care outcomes for people with a disability: a mixed-methods systematic review

The World Health Organisation estimates that 15% of the world’s population live with a disability and that this number will continue to grow into the future, but with the attendant challenge of increasing unmet need due to poor access to health and social care (WHO, 2013). Historically, the types of supports available to people with a disability were based on medical needs only. More recently, however, the importance of social care needs, such as keeping active and socialising, has been recognised (Malley et al., 2012). There is now an international policy imperative for people with a disability to live autonomous, self-determined lives whereby they are empowered and as independent as possible, choosing their supports and self-directing their lives (Perreault & Vallerand, 2007; Saebu, Sørensen, & Halvari, 2013). One way to achieve self-determination is by means of a personal budget (United Nations, 2006). Personal budgets are just one example of many terms used to describe individualised funding – a mechanism to provide personalised and self-directed supports for people with a disability, which places them at the centre of decision-making around how and when they are supported (Carr, 2010). Individualised funding – which is rooted in the Independent Living Movement (Jon Glasby & Littlechild, 2009) - has evolved to take many forms. These include, for example, directpayments, whereby funds are given directly to the person with a disability who then self-manages this money to meet their individual needs, capabilities, life circumstances and aspirations (Áiseanna Tacaíochta, 2014a). Alternatively, a microboard, brokerage model, or ‘managed’ personal budget provide a similar amount of freedom for the person with a disability, but an intermediary service assumes responsibility for administrative tasks, while sometimes also providing support, guidance and information to enable the person to successfully plan, arrange and manage their supports or care plans (Carr, 2010). Other types of models also exist, largely guided by country-specific contexts, such as social benefits systems