Book Review

Title: Developments in Direct Payments

Editors: Janet Lee & Joanna Bornat

Publishers: The Policy Press, 2006

Cloth, ISBN: 10 1 86134 654 9, 320 pages
Paper, ISBN: 13 978 1 86134 654 4

Cost: Cloth: $85.00 USD, Paper: $39.29 USD

Reviewer:  Kevin Dierks

      Developments in Direct Payments, an edited volume from Great Britain, chronicles the experiences of people with disabilities since the passage of the 1996 Community Care Direct Payments Act.  The passage of this Act is the result of the advocacy work of organizations of people with disabilities, and allows government support money to be paid directly to the intended beneficiaries, age 18-65, rather than paid directly to service providers.  Thirty-four authors contributed to this work, representing researchers, healthcare professionals, social workers, parents, and people with disabilities.  The editors attempted to balance the philosophy and policy of direct payments with the real experiences of recipients and frontline workers.  
      Direct payments are basically a simple concept--government assistance funding is allocated directly to the intended beneficiaries.  This concept becomes overwhelmingly complicated when it clashes head on with a legacy system that includes institutionalization, segregated care, and an extensive stream of workers and middlemen accustomed to answering to an employer other than the person with a disability.  Direct payments represent a dramatic paradigm shift for all parties and this book helps the reader understand this from the perspective of the people that live it.
      Direct payment users are people of all ages with a variety of disabilities and labels, and there are significant differences in enrollment and outcomes for different users.  Anyone wishing to learn more about the results of ten years of experience with these systems will enjoy this collection.  Despite a decade of implementation it is still found that “many key stakeholders do not know about or really understand direct payments.”(p.26)  This fact, combined with the advocacy driven aspect of direct payments, makes this a must read for anyone purporting to support people with disabilities.  
      For US readers there are some comparisons to similar support models on this side of the Atlantic, but there is much to be learned from the UK experiences.
	The first two sections present an overview of the historical context in which this legislation appeared and the challenges and opportunities in going from policy to practice. In spite of the different levels of support people need to be successful with a direct payment budget, the biggest barrier appears to be lack of information.  The next three sections report the experiences and wisdom of direct payment users and professionals. 
      The most compelling arguments for direct payments come from the direct users and frontline workers.  Their stories are interesting, enraging, amazing, and ordinary all at once.  A highly controversial aspect of direct payments revolves around paying existing care providers, typically family or friends, for the support they provide.  This issue is explored in Chapter 13, “Carers and direct payments”.   
      Section 5 presents the perspectives of the growing workforce of individuals employed by a person receiving direct payments.  Studies reported in this section indicate these workers have less stress and higher job satisfaction, while at the same time having lower pay and poorer working conditions.  Personal stories and quotes help shed light on this apparent contradiction.  
	The last section deals with the future of direct payments and paints an optimistic, yet realistic view.  Direct payments are currently being challenged with funding limitations and the allowable scope of personal assistance workers by existing service providers, steeped in the medical model, seeking to stop direct payment users from purchasing therapy and other services that cross the line into nursing care.  
      Direct payments are reported as a movement, a policy, a philosophy, a social model, and most definitely a work in progress.  This book provides useful information for anyone who wants to learn more about this progression.   

Kevin Dierks has been working professionally helping people for over 15 years.  He has worked assisting and supporting people with developmental disabilities for most of this time.  Through this work he has been taught many things by people with disabilities, and has developed a personal philosophy and professional approach of partnering with people to support them to find and develop their own life solutions and directions.  He currently works to support innovative approaches to helping people with disabilities at the Center on Disability Studies.