An illustrious and heuristic new year to us all

So, an anonymous friend or stranger, commenting in the post below, reminded me that I started this blog to be an undisciplined but thoughtful problem-solving forum.  A cruel reality that I think needs to be held up before I return to my original purpose is this:  This year's "reform" discussion is doomed to stupidity because no credible and systemwide effort to measure, identify, examine or rationalize what actually happens in this system has been performed and the pressures against the cost of the system are too urgent.  I expect smart and well-intended people using all the information tools available to put forth ideas for gently reducing the funding our system.  Those people, if they believe they know how the system works now and where the problems are have over-rated their guesses and gossip. 

But, maybe in the midst of the coming catastrophe, there will be opportunities to talk about accountability, transparency and adding features to the system that will make it smarter.  Here's my new year's list of topics I hope will be seriously discussed.

1.  Those of us with client-level perspectives know that the regulations guiding this system are routinely not followed.  In the end, we need to decide if we believe that a client-centered system is truly more valuable and more cost-effective.  If we do, we need spare and judicious regulations routinely followed with consequences for those who ignore the rights of clients to guide their program plans.  

2.  Efficiency, the economic concept, unlike the political euphemism, "efficiency," is the heart of justice.  In an efficient system, some of us would lose our jobs but those most vulnerable in the system including clients, direct-care workers and families would be likelier to benefit from the money and effort spent.   The honest definition of efficiency is the value added for the cost expended.  Skilled and management workers need to understand that a more efficient system might need some of us less, but moral individuals should be ready to be counted in that number.  I can still fix old cars and might get my roping back with practice.

3.  The system needs to get much, much smarter.  We don't measure and track outcomes.  At the policy level there is no hopeful way to direct resources where they will help the most.  At the client level, there is no reliable way to choose the most helpful support among alternatives. The cost of neglecting the intelligence of our delivery model will be tragic this year.  If vendors, regional centers, unions or other stakeholders seek to delay or deter transparent evaluation and easy access to information about quality, they deserve to be ignored or over-run.  It is a very late hour to start this conversation in earnest.  

4.  There is real magic available in self-directed services.  The regulations are too many and the funding too sparse for some people to benefit but for those who can make it work, significantly lower costs and better quality of life will likely be the rule rather than the exception.  The silver line around the gathering squall is that SDS will appeal to many who have been leery of it.  First chance we get, though, those eligibility criteria should be revisited and relaxed.

5.  Be kind to the grouchy, negative, critical and portly.

Best wishes to all of you in the new year.

The end is nigh, eat at Joe's

The $10 Billion deficit the State is facing is likely to deepen rather shallow and most of the tricks we've been using for the last five years are no longer available.  Cuts to the Department of Developmental Service's budget can be anticipated.  It may be a short period of anticipation, too, relieved by midyear changes to the budget, although expecting the legislature to move too slowly is not unreasonable.

Whatever the cuts will be, they won't be smart.  If we kept data on outcomes and the value added by programs and models to the lives of people with disabilities, the cuts could focus on the least helpful programs to preserve the most critical, helpful or useful.  Since the only outcome metrics currently employed are the self-righteousness of the providers, clients and families, all indications are that every program and agency appears crucial and excellent, I am pleased to report.

If there were reasonable transparency, we could anticipate that those agencies that provide the most cost-effective care might be favored for referrals and some of the deficits made up by suggestions that those people with choices to make be encouraged to consider the cost.  Since the referral process is not transparent, nor the evaluation process and the cost data is fairly meaningless, our only hope for absorbing cuts through information is the assumption that IPPs will be more thoroughly considered in the lean times.  The good news is they won't be less thoroughly considered by and large.

So, the cuts are fairly doomed to folly.  Another question, though, is will they save the state money?  That is questionable.  Lacking information on what works and what saves and what costs (a recent spreadsheet handed out at Assemblymember Buell's hearing in San Jose estimated savings to taxpayers from people with disabilities working but did not include estimates of taxpayer costs to find, create and support the jobs,) it is likely that this year's "cuts" will be of the normal sort, meaning services and supports that lower cost will be targetted equally with those that are relatively expensive and if rates are reduced it is likely to be by an even percentage, putting the low cost providers at disproportionate risk as compared to the high cost providers.  In the end, without drastic moves against the Lanterman Act and its entitlement itself, the system will probably suffer a deficiency that, by a second year, may be greater than "cuts" written into the budget.

There would be a better way if outcomes were measured and information made usefully available to people with disabilities, their families, regional centers and providers.  There would be a better way if there were a reliable means of accountability.  Instead, the legislative and executive branches will do their level best without any useful information.  My frustration will continue to be how little effort gets put into getting smarter.

For those of us who really want to see Self-Directed Services grow and prosper, though, there is a silver lining: The nags, scolds, sanctimonious pencil heads and vampires among us may accidentally wind up temporarily on the side of the angels.