Friday, December 03, 2004

Best practice?

As I have mentioned many times before now, California's system of services to people with developmental diagnoses seems to teeter between the highly individualized, market-based, community-centered system envisioned in the authorizing legislation and the bureaucratic, standardized one that naturally evolved in the state-funded environment. Doubly ironic, but also a singular opportunity to explore the future of social services.

One place near the joining of this system's two natures is the so-called "best-practice." Best Practice is a concept widespread in the helping professions. Those of us who work in those professions (technically, I'm an administrator and therefore no help to anyone, but still...) prefer our jargon to be inclusive, which is the opposite of defined. To the extent the phrase means anything (and the first word absolutely never does,) it means methods that someone thinks ought to be common. Best practices might be methods that seem to work, and/or are ideologically derived, got written down by someone, or at least seem methodical.

In the world of Regional Center-funded agencies, "Best Practices" usually means forms that you fill out to prove that you did or said or tried to do something that the regional center thinks should be done or said or tried with everyone. This makes best practices an interesting part of our system because they either represent an expansion of the accountability that the system runs so short of; or an intrusion of standardization into a system in which both quality and efficiency derive from an individual framework.

Over ¡Arriba!'s five-year focus on becoming more client-centered and, therefore, less standardized, indicators are that the clients have grown safer and more stable in their independent lives. Our caseload is too small for this to qualify as statistics, but we clearly have gotten better at prevention and intervention and response by eliminating our internal best practices. From that standpoint, I always meet the laudable goals of most "Best Practice" conversations by feeling the goals will be better served without a new standard.

On the other hand, I'm also convinced that accountability is sorely lacking in this system. I have argued strenuously on this page and elsewhere for an outcomes- or results-based system of accountability. The process-based system of accountability that barely exists is a sorry substitute and "Best Practices" clearly extend that. I suppose if you accept that this system isn't even getting ready to start to develop a useful system of accountability, then the "Best Practice" model makes enough sense to weigh against the protection of person-centered services.

What this entire argument does present, however, is that increasing standardization is the cost of failing to provide true accountability for the results provided. As long as we don't measure and track outcomes against ambitions, and publish the results we should expect the system to grow more standardized, less innovative, less efficient and less individualized.

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