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Approximately 3,000 people in California with intellectual and developmental disabilities (I/DD) have complex needs that necessitate intensive behavioral support. These adolescents and adults, many of whom have a co-occurring mental illness, experience chronic instability and are at high risk of institutionalization and incarceration. The specialized group homes where some of them live are a critical part of the state’s safety net.

According to a from Stanford Law School (SLS) and the nonprofit Disability Rights California, reforming certain aspects of these group homes’ operations, and creating additional community-based residences where some individuals with I/DD and complex needs can receive wrap-around care, would stabilize and strengthen the system as a whole.

Alison Morantz, the James and Nancy Kelso Professor of Law at Stanford Law School and a senior fellow at the Stanford Institute for Economic Policy Research (69�þ�Ʒ), and her coauthors prepared the report in response to the rapid proliferation of specialized group homes serving this population and widespread reports of continuing high levels of unmet need. Morantz is also the founder and director of the Stanford Intellectual and Developmental Disabilities Law and Policy Project (SIDDLAPP), an interdisciplinary program at SLS that focuses on the rights and welfare of individuals with I/DD.

“California policy makers are currently grappling with how to best support individuals in community-based, therapeutic settings that are economically viable and consistent with principles of individual autonomy, equity and community integration,” Morantz said. “Our report is designed to inform the state’s long-range planning to expand opportunities and improve quality of life for individuals with I/DD who require intensive behavioral support.”

In 1969, California became the first state to grant individuals with intellectual and developmental disabilities the right to the services and support they need to live more independent and normal lives, Morantz said. “California remains the only state in which the right of these individuals to be supported in the least restrictive environment is construed as a civil right and an individual entitlement.”

Following interviews with group home administrators and residents, site visits, and analysis of information available in the public domain, Morantz and her co-authors identify in their report a variety of ways that California can improve the quality of care provided by Enhanced Behavioral Support Homes (which offer long-term care) and Community Crisis Homes (which provide short-term care).

The researchers found that almost 70 percent of these homes have had at least one complaint filed against them and about 40 percent have been the subject of a substantiated complaint. “Despite copious regulations, the monitoring of EBS and CC homes is falling short,” they write in the report, titled, Individualizing the Safety Net: Rethinking the Residential Continuum of Care for People with I/DD and Complex Support Needs.

Other key recommendations include:

-       Revising home placement processes to be more person-centered;

-       Mitigating the adverse effects of labor shortages by loosening eligibility and credentialing requirements for direct-care staff;

-       Collecting better data on the adequacy of safety net services and important industry trends;

-       Expanding settings, such as Enhanced Supported Living Services, in which a single adult can receive wraparound care in their own home;

-       And creating supported single child residences (SSCRs) in which a single child can receive wraparound support instead of being hospitalized, institutionalized, or transferred out of state.

Carly Frieders, a Stanford law student who served as a report editor, said she appreciated the opportunity to further her interest in disability law while informing California policymakers. “It was great to work on a project, while still in law school, that proposes concrete ideas to help people get services in the most supportive and integrated environment possible,” she said.

A version of this story was May 23, 2024 by Stanford Law School.