Tuesday, August 10, 2004

Accountability and Reform

We all like accountability, in principle and for other people. Someone reading past entrys in this blog to this point might think I'm trying to suggest that accountability is the most important reform for this system, more than funding, more than restructuring. That's about right.

The value of accountability, or the cost of its absence, is at the heart of the system's inefficiency in my opinion. I'll explain:
The system was designed to be more efficient than existing systems because of it's flexibility. Clients would receive those services that help, and not receive assistance that doesn't. Clients and their service coordinators would select those supports best suited to the client's challenges and aspirations or try to devise something better. Local communities, through the Regional Centers would guide the evolution of the services available to fit with local conditions. All of which works perfectly as long as there's a sound basis for the choices made.

The system, as designed is efficient because it allows enough flexibility to move people into less restrictive environments which are generally far less costly and because the individualization can prevent the expense of unnecessary, unhelpful or inappropriate support.

The lack of evaluation (which isn't getting better) and oversight (which still has a long way to go) has two effects which probably inflate the cost of the system without helping the clients:

First- There's a general lack of reliable information about what works and doesn't, which programs are effective and how some agencies might make a good match for a given client. As a consequence, it is nearly impossible for a client or family to select wisely or proactively. There's insufficient basis for a service coordinator to have confidence in a recommendation. Although nearly all agencies strive for excellence, only our own brochures indicate to us whether changes we make are going in the right or wrong direction.

Second- Theories aren't tested. Especially at the policy level (Regional Centers or the State,) there's no means to discern between policies that bring positive change and those that damage the ability of the community to support individuals with developmental disabilities. Several Regional Centers and DDS are run by layers of smart, mission-centered managers with smart, critical boards. Several are run by charlatans a long way down with complacent or self-serving boards. Regardless, the best intended ideas of smart people can be wrong as can the conspiracies of scoundrels. With no witness to the outcomes, either through their measurement or independent consideration, policies may serve the opposite of their intent for years without reversal. In this system the failure to recognize failed policies costs our clients and our state in the currencies of wellbeing and general fund dollars.

So, this blog will go on to discuss other proposed reforms. Now it has been said, my central conviction is that the best first reform for the sake of people with disabilities and the state budget would be the creation of real systemwide accountability.

This is why my office is in a brick building. Harder to blow down.

No comments: