Wednesday, August 18, 2004

Regional Center Operations and System Reform

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.

9 comments:

Anonymous said...

Aren't you saying that DDS needs to better manage the regional centers? And how can the differences among regional centers be sustained when needed to reflect the individuality of the catchment area served?

Doug said...

First of all, thanks for commenting. What I'm saying is broader than that, that Regional Centers that need to change don't. The only sin that invokes DDS' wrath in recent history is failure to budget and the boards are self-perpetuating which is really the opposite of self-correcting. I wouldn't advocate DDS running Regional Centers, because, as you point out they should be different from one another but that should be a reflection of the community. There are Regional Centers that are rigid and/or inefficient and/or insulated from the best thinking in their communities. The processes included in our system to foster learning and improvement and flexibility and accountability for Regional Centers don't seem to be working.

If you're challenging me to make a specific proposal the first one out of my mouth would be a majority of RC board members elected by clients, conservators and guardians.

Sedonasmile said...

DDS does need to start putting the brakes on with regard to regional center practices. As you point out, regional centers are run differently and some are run in such a manner that some managers should be prosecuted not only for their corrupt acts, but also for their blatant stupidity. I have discovered that some regional centers are so self-serving that the only people being vendored are those willing hand over money to the all powerful personnel running those regional centers. Yet, no one seems to care. When the budgets are met, it seems that they fact that their is corruption that consists of bribes being paid, kickbacks for clients and grants being given to favored careproviders, blacklisting for those who speak out, etc., DDS just does the three-monkey routine and ignores the process. This may change, but only when enough of us speak out about these practices. Recently I learned that their are people in the Los Angeles are that are taking careproviders program designs and offering them to potential careproviders at the sum of $500 cash. What enterprising crooks? And they are just a few of the unethical, dispicable individuals running our regional centers. If I sound disgusted, I am. However, I also know of some regional centers (like San Gabriel/Pomona) that runs an ethical agency that will call you to come pick up even a box of candy. They intend to stay free of the bribes and are managing to set a good example. What about the rest? Can they say the same from themselves. I think no!

Sedonasmile said...

DDS does need to start putting the brakes on with regard to regional center practices. As you point out, regional centers are run differently and some are run in such a manner that some managers should be prosecuted not only for their corrupt acts, but also for their blatant stupidity. I have discovered that some regional centers are so self-serving that the only people being vendored are those willing hand over money to the all powerful personnel running those regional centers. Yet, no one seems to care. When the budgets are met, it seems that they fact that their is corruption that consists of bribes being paid, kickbacks for clients and grants being given to favored careproviders, blacklisting for those who speak out, etc., DDS just does the three-monkey routine and ignores the process. This may change, but only when enough of us speak out about these practices. Recently I learned that their are people in the Los Angeles are that are taking careproviders program designs and offering them to potential careproviders at the sum of $500 cash. What enterprising crooks? And they are just a few of the unethical, dispicable individuals running our regional centers. If I sound disgusted, I am. However, I also know of some regional centers (like San Gabriel/Pomona) that runs an ethical agency that will call you to come pick up even a box of candy. They intend to stay free of the bribes and are managing to set a good example. What about the rest? Can they say the same from themselves. I think no!

Doug said...

Hi, Sedona and welcome back. I generally try to stay away from words like bribe but I agree with you all in all. First, I'm pretty comfortable with ethics at SGPRC and at ELARC as well. The problem is you're also right. Whether with criminal or good intent, the system of accountability for Regional Centers is crummy. It's not comforting to me that ethical people choose to behave that way, because the system ought to have a mechanism to make it mandatory. I certainly have experienced, as you seem to have, the RC management as locally-worshipped deity. No taxpayer dollars should flow through a system where that's possible and no-one with disabilities should have to depend on one. I'm not familiar with the caregiver program you refer to. If you'd like to come back and add to your comment, I'd be grateful. Thanks for commenting.

Anonymous said...

A good example of how a Regional Center can go real bad is seen in San Diego Regional Center, where you have the Executive Director, Carlos Flores, married to the Assistant Chief of Case Management, Nina Garrett, and what that means for people who don't understand how a Regional Center operates, is that if a parent wants to make a complaint about how bad their services are for their child, or failed case management, you are supposed to appeal to the EXECUTIVE DIRECTOR and HE investigates. THat's a big problem when his wife is making high level decisions about services that prompt parents to have to complain. Carlos Flores and his wife Nina have not ever filed a conflict of interest. Yet, others at San Diego REgional Center are told they have to file conflict of interest statements.

Anonymous said...

jennifer gilbert-soto, married to natali medina cisneros. Jen and Nat like to write things on people's blogs and they like to talk to Regional Centers to pretend they are normal. http://almanacnews.com/print/story/2006/05/17/woodside-resident-among-drug-arrests

Anonymous said...

friend of mine is a regional center client. he gets housing through a family home agency arranged for by the regional center. the family home agency gets over 6k per month from the state for case management for each client. they pay $2500 per "consumer" to "providers" who house them, feed them, and drive them to and from medical appointments. so each year, family home agencies earn over 60k per year, providers earn 30k per year. per month. all of this $ is tax free as a stipend. they are not required to pay for clothing, shoes, give rides to buses or trains on rainy days, or give $ for meals outside the home. this violates least restrictive environment because the consumer is economically forced to take 3 meals per day inside the home. friend of mine went to college and had to use his own $ for lunch since the providers getting $2500 a month tax free would not give him $10 a day for college lunch. guess how much the disabled consumer gets? $140.00 per month. my friend was wearing shoes with holes in them because his provider, making 30k tax free per year, was not obligated or wiling to buy him shoes. i bought him some. the system is completely corrupt.

Anonymous said...

San Gabriel/Pomona Regional Center is just as corrupt as the others, if not the most CORRUPT! They play favoritism, and try to break those who stand up to their unjust rulings and decisions. Regional centers must be closed down, we are better off without them!!!