Friday, June 17, 2005

Self-Directed Services: My endorsement

I support self-directed services (SDS) because in concept, SDS programs empower people with disabilities by removing some control from service providers (including both Regional Centers and direct service-providers,) because an effective SDS program lowers the cost of quality in services and supports by involving the person best able to control costs in the negotiation for price, and because without SDS the integration and sovereignty sought by the DDS system for people with disabilities are largely absent from its workings.

The current proposal adopted by the legislature's budget conference committee certainly will implement the initials SDS and may well lead to the actual manifestation of its meaning. The ban on using SDS while a client lives in a congregated facility or uses a day program certainly limits both the choice of clients and the benefit to the system and the state. The failure to specify the role of service coordination staff in SDS, which may or may not occur in writing the regulations, leaves up in the air how much actual control will pass to people with disabilities and, therefore, whether or not this new program meets its goals or produces significant benefits.

Fears as to whether the regulations being developed will follow the normal process of public input have placed many erstwhile supporters of SDS into a skeptical state.

All of that said, this proposal is the most promising reform to come this close to implementation. So, I endorse the SDS proposal with the anticipation that legislative and regulatory corrections will be needed to implement SDS itself.

4 comments:

Anonymous said...

Hmmmm
Guess you are allowed that opinion

Doug said...

That was supposed to be a draft, I'll actually write something later.

Anonymous said...

SDS whether the Admins version or the Legislative variety ignores the already inherent and imbedded language contained in the Lanterman Act that service delivery be cost effective and cost effective in the aggregate.
Other than the SD5(5 Self Determination RCs) I have yet to see a case worker or manager attempt that feat...they do however seek to be "payer of last resort" in exhausting clients to prove beyond a reasonable doubt that someone else should pay for the needed/identified services. And then deny the service as one they are willing to pay.
Remember $3 billion of allocated clients' monies would go far if Lanterman were followed properly and clients weren't blamed for their developmental disabilities.
Self Determination in their current constructs mean absolutely nothing when the Lanterman Act is so widely "interpreted" by the NP21(21 nonprofit regional Centers).
A 22nd Self Determination Regional Center that anyone can join will be the only one that can currently begin, from new design to the new build out,
to actually delivery community benefit to all DD that qualify.
Today. Not in some abstract tomorrow.
We can do better than this.
We must do better than this.
Too much money for less than stellar results.
Read the 1995 Senate Audit Committee overview of the Regional Center System and most identified issues or corrections have not been fixed.
Running 26.5 miles in place will never make one a Marathoner.
Regional Center Executive Directors and ARCA membership....lets put CLIENTS first and last as a priority and follow Lanterman and support the 22nd Regional Center to show excellence, serve clients and lighten your load.

Doug said...

Anonymous,

You make a lot of excellent points which to a large extent I agree with. Really, SDS is just a new format for doing what the Lanterman Act says should have been done all along. But the reformatting is important because I think, and I think you'd agree, the Lanterman act really hasn't materialized.

Economists talk about "The Principal-Agent Problem." In a nutshell, the idea is that when someone is hired to attend to the interests of another, the person hired has interests of their own which compete with the ones they were hired to pursue. This leads to inefficiency in a good case and the wholesale replacement of objectives in a bad case. I would assess our system as a medium case.

Inside or outside of what you refer to as the SD5, I'd say good people work hard and smart, but just a whole bunch of interests are competing with intent of the people of California. In the end, I expected to endorse SDS because at least in theory it eliminates a significant portion of the principal-agent problem in our system when it is implemented.

I am open to but not confident in the possibility that the language adopted will do that. At the end of the day all service providers including Regional Centers and direct-care agencies have to lose significant control or else SDS will be just another phony empowerment program.

The proposal may well lead to exactly that, but once SDS exists outside the minds of its advocates the community can start to pursue changes that make it real.

And by the way, running 26 miles in place may not make you a marathoner, but you'll be in a lot better shape than I am.