## Wednesday, April 30, 2014

### Formal Learning: Data, Big Data and Statistics.

The first challenge we can call an input problem.  Developmental disabilities are defined statistically for the most part.  In statistics

This will start what I hope will be a series on formal learning in individualized services.  Because I sometimes read, and all the writing these days is about big data (100.5%.)  There are corners of the system (almost vacant of service providers and probably of families) that hope that collecting outcomes data will lead to better services.  I think that hope should live on, but that people understand that the benefit will be much less direct than in other sections of the economy.

To give a quick overview of "big data" and its benefits, now that so much of what we interact with generates information and the capacity to store and analyze it so much vaster than it had been, that humans have grown much much abler to discern patterns that had escaped us in the past.  The opportunity to make change comes when we are able to see those patterns in context.  Using statistics, we can find what factors affect the patterns we are concerned with the most.  The term of art for the factor most relatable to changing a pattern is "the big coefficient."  Terms of art in statistics are still pretty arcane and prosaic.

From my spot on the spectrum, individualized services ought to include the search for, identification and exploitation of patterns along with respect, protection and kindness.  And math, particularly statistics, are the handiest tools we have with which to do that.  And the rest of this series, if and when it emerges, will be about why I think professional caregivers should do math.  But there are reasons to question whether big data can have the same impact in this field that it already has in medicine, marketing, science, politics or engineering.

One reason why big data will have trouble helping us help the people we serve might be called an input problem.  Just to clarify nomenclature, to the left is what is called a "normal distribution."  Of any given naturally occurring trait, there is a central tendency where any random individual is most likely to fall.  That is called the mean and can be pictured as a line through the highest part of the curve.  Where the curve flattens out to the left and right is called "the tails."  I bring this up just because the word "tails" can give either the sense of disparaging or adorable and I wouldn't want to be thought to mean either.

But most disabilities are defined at least in part by a trait being found in an individual to occur in the tail of the distribution.  You can imagine a stone dropped in still water.  Where the stone strikes, you get the most information and further along in the eddy you get less.  Not only are the people we serve rare, but it is easier using statistics to learn about commoner individuals than about rarer ones.  Which is just to say that coca-cola will still know more about refreshment-seekers than DDS will about people with developmental disabilities even after the latter starts really trying.

The other problem we can call an output problem.  When KFC wants people to eat more chicken, it is easy to find factors that correlate with the sought behavior.  If the state wants fewer people to be poor, it is relatively easy to use large data sets to figure out which factors have the profoundest impact (largest coefficient) on poverty and proliferate them.  But the Lanterman Act and those of us who serve it, wants people to live the lives they choose, not to behave according to a standard.  And that makes it much harder to find the large coefficient independent variables.

So now I hope to write upcoming posts about why measurement and math belong in the complex of tools states and their agents use in pursuit of our mission.  But I hope this post set some boundaries on how much we can hope to accomplish this way.

## Tuesday, April 22, 2014

### Why a "cost-based funding model" required a team of smarties to promote.

It should be an axiom of policy discussion that any words joining "model" in a phrase are euphemistic.  The Lanterman Coalition put forward an 8-or-so point platform together which is sadly circulating.  Of the points on their platform, in all likelihood, restoration of Early Start was the most meritorious and the most inevitable.

In part I turn my attention to the plank advocating a "cost-based funding model" to partly offset the shrugs and nods likely to greet the proposal but more because I think that proposal is emblematic of the worst habits of advocates.  It is the south pole of advocacy, the place from which every direction is up.

To translate "cost-based funding model" into English, the policy proposed is that the correct cost of services is determined by what the service provider spends.  Greybeards like me will recall this policy as the predominant one in 2002 at the dawn of a dozen catastrophic years.  Advocates like me and many of my friends on the Lanterman Coalition spent a great deal of time in Sacramento arguing that the model was unsustainable without an enormous increase in state funding.  Those of us who are eager to try the case that a \$5 billion system needs to be a \$12 billion system, which is to say, those of us eager to revisit 2002-2013 have their agenda and a coalition of statewide agencies for partners.

Another problem with the cost-plus model, other than that it quickly becomes a cost-minus model, is that true costs are hard to discover.  Translating the specific term "cost-based" from the original euphemism is "spending-based," a quantity that is not dependably related to necessary or constructive expenditures.

I will post soon about some reasonable alternatives, but the point I would get across in this post, is that anyone ready and willing to learn from experience, after the last dozen years and with the next dozen in prospect, should include sustainability as a principle of any system for which we would or should advocate.  I agree with my friends that the system is underfunded to do what it is meant to do the way it currently does it.  At least some of our advocacy needs to focus on sources of waste, potential sources of formal intelligence and engineering resilience into the system.

It isn't clear that a fully funded status quo would sensibly improve lives for people with developmental disabilities, but taxpayers surely would notice.

## Wednesday, March 19, 2014

### A New Beginning, CQI edition

Hello, old friends;

New purpose on this blog: To discuss 30,000 foot, big picture issues as Executive Director of Imagine SLS with our community of clients, staff, families, colleagues and, of course, my old friends from this blog if you return.  The main difference will be: more focus on things as Imagine experiences them and less focus on controversial political issues.  A secondary difference will be more aggressive deleting of comments which seem antagonistic.  A little less beerhall and more tea salon.

That said, the purpose of this blog will be to explain what passes through what passes for a mind in the Executive Director of imagine and to solicit input.  No individual client issues will be discussed, obviously, nor matters with individual staff and in that sense the focus will be what it has been: How Imagine and other agencies can better perform for the people we serve and the communities those people share.

The first series will be about some of the thinking behind our all-staff training in May.  Interested staff can walk into that meeting with extra awareness of the substance of the training and having helped to shape it.

## Thursday, May 30, 2013

### Masonite

The typical non-profit board is composed of wealthy people, connected people and interested people. In California's DD system, I wonder how many people working at similar agencies sit on boards.  Granted, there's a conflict of interest inherent in the idea and it might be a terrible idea and all but here is a way this would help: Few trustees/directors of non-profit agencies serving individuals within the regional center system have a good idea how to do what the agency is meant to do.

That could be leaving gaps in how well boards hear and understand the budgets and proposals that come before them.  On the other hand, I might just be grouchy while I wait to hear about my budget.

## Friday, May 24, 2013

### Episode IV: A New Beginning

Hello, friends;

A project that I am working on with a good friend, colleague and fellow villain/service provider will rely on skills that I've allowed to lapse or never learned and one of those is writing for the web.  So I've decided to revive this here blog.

A few things have changed since last I posted here, thick-haired and hopeful.  I no longer run a small agency but am a mid-level manager at a larger one.  For that reason, I feel a duty to be a little more careful and a little less breezy about causing offense.  Some of the alleged "stridency" that was a feature here will be intentionally curtailed.  But I think there are still thoughts, big ideas and revolutionary manifestos to discuss as well as sarcasm to levy.

I hope my companions of yore will come back and join me.  Anybody still out there?  Or are you all wasting your lives on social networks instead of living richly on blogger?

## Thursday, September 01, 2011

### Policy, Choice and the Lanterman Act

A friend sent me this link. The concern (in the blog post linked) is that with a new state policy promoting integrated employment as a goal for every adult, that the individualization will be lost.  In response, I feel torn between two cynicisms.  On the one hand, state policy has little enough to do with actual practice that I would gladly accept a state policy stating the purpose of the regional center system as "for the enablement of the deaths-by-torture of vendor managers" for a small rate increase or the right to taze service coordinators who fail to convene ID teams.  If we are honest, there is no catastrophe here.  The most I expect the policy change to cause is a few bad meetings and series of sanctimonious speeches.  Who'll notice?

On the other hand, I can share the writer's annoyance this far:  Policy statements less substantial than a dentist's breath are a bad habit that promotes other bad habits.  That we can safely divorce such statements from outcomes has made it all too easy to also divorce outcomes from our thinking.  In turn, that makes ridiculous policy positions much more acceptable (c.f. the opening paragraph.)  Does anyone doubt that the widening divergence of policy and practice hinders system reform for cost's sake or for quality's?

So, pretending for a moment that I take this seriously, here are some concerns:
• We have a very hard time at consistently distinguishing between aspirations, moral imperatives and greedy shenanigans.  It may not be clear, for example, whether it is better to be unemployed in the competitive labor market or productive at a site-based program.  Were the policy implemented at all, it would undoubtedly be implemented inconsistently and in many cases counter-productively.
• If we really want to streamline the system, it is never, in my experience, less efficient than when we try to help people do what they don't want to, and nothing is easier to sabotage than employment.  How many hours of needed ILS, SLS, respite and vocational development would be cut or reallocated to support heroic efforts to find jobs for people who don't want them or aren't comfortable in an integrated setting, all in an environment where people who do want jobs can't find them?
All of this said, I agree with the state that every adult served by the system who is not employed in a competitive, integrated, profitable position ought to be a sign that something should be improved.

## Wednesday, July 06, 2011

### Did DDS cut something correctly?

When I hear from worried vendors concerned about cuts, much or most of the dyspepsia is over the limitation to 15% administration in negotiated rates. There certainly can be a case against that cut. People who live on their own and can't use the commonest forms of communication are highly vulnerable and for those of us who serve such people, their best protection is not the regional center, or the area board or in many cases families but oversight from the administration of their service provider. Furthermore, to the extent that we are careful and detailed as a system, there will be many cases when service designs will have to be revised to bring down overhead and those revisions may not have a smooth path to follow.

However, my instinct tells me that the greatest flaws in the budget-cutting regime over the last years has been the combination of rigidity with uncertainty. Consider my personal black beast, the new audit requirements. The cost of that requirement, it seems safe to predict, will reach the tens of millions of dollars per year systemwide in purely administrative costs. Those costs are real, certain, specific, mandatory and tangible. But the mechanism by which that requirement will save the state money is hypothetical. To be kinder, I suppose we could say hopeful.

By comparison, the 15% cap can be at least anecdotally supported as a way of saving money and the combination of vendor, client and regional center have a fair degree of flexibility to decide what features of the support should be sacrificed to reach a clear threshold. Of course, the same combination is also empowered to launder their way out of savings via reclassification of effort, but still. To the extent that it works, the cut can be tailored to protect the needs of the consumer, the competency of the provider and the preference of the regional center.

Apart from Stanley, anybody out there want to give DDS credit for this? Or are there other cuts that seem smart to you?