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Boston College School of Social Work
Center for Social Innovation

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Boston College has been designated a Changemaker Campus by Ashoka U for being a leader in social innovation education.


Innovation at the School of Social Work

A Conversation with Kevin Mahoney, Director, National Resource Center for Participant-Directed Services

Sometimes the most brilliant ideas can in hindsight also seem to be the most simple ones. Mahoney’s success is exemplary of the kind of transformative innovation that inspired the establishment of the Boston College Center for Social Innovation.

Developing the Model for Participant-Directed Services

Issue: During President Clinton’s push for comprehensive health care legislation in the 1990s, Mahoney saw an opportunity in the public debate over how to control the costs of long-term care. “It was in response to those concerns that the Cash & Counseling program was developed,” he says.

Solution: Mahoney believed that elderly and disabled Medicaid recipients should have the flexibility to decide how to meet their personal care needs rather than be limited by the traditional, agency-run system of services. Cash & Counseling tested his idea: Would giving people more control over their funding make their lives better without costing the government more?

Controlled experiments in three states showed that Mahoney’s instincts were correct.

Results: Since care workers were being hired by the participants rather than an agency, they were more respectful, showed up on time, and were more efficient. Health outcomes improved. There were fewer bed sores, falls, or other events that might require hospitalization. There was less physical, financial, and psychological stress for participants and their families. Though the changes did not, in themselves, save the states money, there were profound savings in other areas—an 18 percent reduction in nursing home use in one state, for example.

Outcomes: On the strength of these and subsequent findings in other states, millions of dollars in foundation and government funding have flowed to Mahoney’s project, enabling its continued expansion across the country and, most recently, a collaboration with the Veterans Administration to reach more than 100,000 veterans needing long-term care.

In the span of a little over a decade, Mahoney’s simple and innovative idea has taken on a life of its own.