Today's topic: Things to think about when considering the Regional Center's role in our system, or, Why I have no friends in this world.
During California's lengthening budget debacle, the most common cost-containment proposals coming from vendor groups have advocated for reducing the size and scope of Regional Center operations. There are some important reasons that these proposals deserve a cautious response.
Primer paragraph: In California's community-based system of support to people with developmental disabilities, the legislature budgets funds to support the system which are allocated to the Department of Developmental Services (DDS.) DDS contracts with 21 private (more on "private" later) non-profit agencies, called Regional Centers (RCs) which have sole dominion for the provision of non-institutional services within a catchment area. The funding provided through those contracts is divided between Purchase of Service (POS) funds which must be spent on direct support through outside vendors and Operations which are intended to pay for those activities performed by Regional Center staff and which may be diverted to POS at the discretion of the Regional Center board. The primary roles of the Regional Centers are to identify eligible people, determine with the clients what supports are appropriate to the client's needs and aspirations, finding and purchasing those supports typically through vendors, and monitoring the quality of the support provided by vendors.
A few things all honest participants in this system can probably agree on:
1. All the activities Regional Centers are charged with are necessary.
2. The quality and effectiveness of Regional Center performance varies greatly between Regional Centers
3. There is probably an efficient formula for how much effort is spent on each Regional Center activity but no-one knows how to find it. Many of the formulas used are defined in statute.
4. Methods and policies employed at Regional Centers are of varying effectiveness, but there is no standard to distinguish success from failure within a frighteningly broad range. Also failure to budget accurately is the only failure likely to trigger oversight.
A few opinions I'll add with honest intent and questionable intellect and little expectation of conscensus:
1. Reasonable people may disagree as to whether all the activities Regional Centers are charged with should be done at Regional Centers, There may be economies of scale combining some activities between RCs but there are probably synergies (for example between quality assurance and service coordinators) that add value in keeping these activities together. Any proposal to change the functional makeup of Regional Centers should receive a whole lot of scrutiny.
2. The quality and effectiveness of Regional Centers' performance hardly varies at all over time. In my experience, badly run RCs stay bad and well-run ones tend to stay good. If I were going to propose Regional Center reform, I think this would be the most compelling fact.
3. The problem with any RC operations reform is that we don't track outcomes in our system. There is no basis, therefore, to improve staffing formulas. Smaller caseload ratios in service coordination could, for example, theoretically save money by reducing the purchases of chronically unsuccessful support or providing for more effective matching. It's highly likely that the right formula is different for rural RCs than it is for urban ones.
4. In my opinion, much of the proposals we've seen for reforming Regional Center operations reflect a lot of frustration with individual Regional Centers, how their responsibilities are discharged and the overwhelming difficulty (within the margin of error from impossibility) of changing Regional Center behavior.
5. I may be crazy, but the idea self-perpetuating boards overseeing public entitlements seems kind of goofy and pretty suspect.
Based on all of the above, I would be reluctant to support changes in what Regional Centers are meant to do or staffed for. Nonetheless, the frustration of clients, their families and vendors working with many Regional Centers is awfully well justified. Even the best Regional Centers are better at contract enforcement than determining program quality and its rare that they do well at informing families of options. Laws are regularly flouted at the worst regional centers. The entities charged with Regional Center oversight rarely act aggressively and appear fairly powerless.
The fact that many Regional Centers function badly doesn't call into question the value of those functions they do badly. On the contrary, the frustration throngs of us share at chronic failures proves the value of those activities. The best correction will be to amend the uncorrectability of these agencies. History found feudalism unsustainable. That duly elected officials have restored it for people with disabilities would make a cute irony if it weren't so wrong.