Nationwide, the trend in services for people with disabilities was, by the 1980s, away from services in large, impersonal settings, such as state schools, and toward services administered in local communities. New Hampshire, lagging behind initially, had some catching up to do.

The Institute on Disability was supposed to help with that, as well as educate UNH students majoring in related fields and conduct research programs. Its mission also included working with professionals and people with disabilities and their families, organizing demonstration projects, running joint programs with other institutes and colleges, and publishing information on the Web or in low-cost booklets.

How to pay for all this? "We were expected to apply for grants," Nisbet says. From an initial budget of $120,000 and a staff of three, the institute has grown to a staff of 44 full- and part-time employees, paid for by 36 grants and $5.5 million in external funding. "The institute has become a grants machine," says Shumway. "It's brought a huge amount of resources into the state."

If the first step to improve disability services in New Hampshire was to offer those services in local communities, the next step was to put decision-making in the hands of people with disabilities and their families. "If someone with a disability wanted help getting a job, for example, they would have to get career services from a vendor," says Nisbet. "The state gave the money for those services to the vendor, and if they didn't like the services offered, well, too bad." The new approach is like vouchers, she says, "a consumer-directed service, with a new range of opportunities." The institute has done model demonstrations of this concept in several projects, including the national Home of Your Own Alliance, Project LEAD and the National Program Office on Self-Determination. For a profession used to telling people with disabilities what they want and how it's going to be provided, it was a revolutionary idea.

"The state was focused on protection from harm," says Shumway. "We were prepared to shelter people. We weren't prepared to support them in living with dignity and making their own choices. There was an underestimation of the capacity of people with disabilities to work and live and experience the joy and pain of life." Shumway says the institute has had an enormous impact in this area. "The clinics, training, demonstration projects -- they've all had a huge creative-change value and, ultimately, a cost-saving value as well," he notes.

From its initial grant, which funded a demonstration project on classroom inclusion for children with disabilities and a leadership training program for their parents, the institute has branched out like a well-tended plant into issues as diverse as welfare reform, managed care for people with disabilities, technology assistance, Social Security and career planning. And by 1998, the institute had in place several programs that could help people like Rosie Mack and her family.

At a conference in New Orleans in 1996, Ann Dillon happened to attend a one-hour workshop on autism. An occupational therapist and the parent of a child with a disability, Dillon had begun working at the institute in 1992, later earning a master's in special education from UNH in 1998 with an emphasis on autism. The workshop Dillon attended was about a pilot project at the University of Southern Florida. The theory behind this project was that very early, intensive and individualized intervention for children with autism could be much more effective than a one-size-fits-all approach. Dillon returned to New Hampshire eager to give it a try, and with institute approval helped write a proposal to several state agencies. In 1998, a two-year pilot project called "Jumpstart: Early Success with Autism" was funded with $99,000. Dillon took a training course and began looking for a family to take part in the pilot project. The Mack family, reeling from the demands of Rosie's disorder, said yes.