A good friend wrote to me with a comment on my previous post below.
The email read, in part, "ok-- i agree with your points- but trust me - sds will end up being mostly same old same old."
This is worth discussing. I invite my friends who lurk here, cross post to list servers, and/or read out of a sense of friendly obligation to discuss this in the comments section. Comments can be left anonymously but on the off-chance a conversation actually develops here, I ask for this: If you comment anonymously, please use a pseudonym or unique signature so participants can respond to your comment with some form of address.
Five reasons to think self-directed services, SDS, will be a new, more valuable and more efficient model of service delivery:
1. Program design belongs to the person or family served. A client-centered design is not guaranteed but it should be the most natural result. In the traditional model, the wisdom, insight, bias and preference of the service provider and service coordinator are the most likely guidance.
2. To the extent that accountability and oversight are transferred away from the regional center to the people served, inefficiencies in defining, assessing and assuring quality are significantly reduced. These inefficiencies in the traditional model widely deplete fiscal resources, human resources and efficacy.
3. Layers of overhead can be eliminated. Vendorization of service providers, reporting requirements, worker's compensation, mandatory reporting, employer liability, general liability are all provider costs that can be eliminated or reduced under SDS, especially where the client does not use a co-employer agency. Insurance for SDS clients is a brilliant investment for SDS dollars where staffing is involved.
4. To the extent that decision-making is located in the client's home, rather than in the broker and/or regional center, the iterative reviews of client choices that inhibit both creativity and dispatch can be reduced. For those of you who were reading during the series on Value Stream Management which began here, this represents an efficiency improvement referred to as making the value stream flow.
5. As neighbors and system civilians replace agencies in the provision of some supports, natural supports in the community can be constructed and strengthened.
Five reasons to suspect that SDS will turn into the same old corruption we're saddled with now:
1. The development of the regulations followed the same process of speculative problem-solving that many feel inhibits creativity and thins the robustness of supported living. I have argued here that regulations for the system have been overwritten, undercomplied with and often ambiguous, detracting from the very virtues of efficiency, market-driven discipline and individualism that characterized the original intent and intelligence of the Lanterman Act. These regulations are well-intended, thoughtful and smart but it is probably the nature of regulation writers to see regulations in too positive a light and, what's more, California regulators have to harmonize with the habits of federal lawgivers. There is no reason, based on available drafts of the upcoming regulations to think SDS won't be over-regulated, stiffening the flexibility we look to for a better model.
2. While brilliant people have made sincere and thoughtful cases for the exclusion of people being served in congregate settings and allowances have been made to overcome that criterion, the concern remains that the most costly, least person-centered and most confining parts of the system have been protected from the reforms involved. This also means those who can benefit the most from SDS will be excluded. This creates two risks: The first, that salutary results will be diminished, reducing enthusiasm and advocacy the program will need to survive or thrive. The second, that as the more individualized and person-centered supports grow leaner, the already expansive portion of advocacy and consultation offered by bulkier, less responsive agencies continues to grow.
3. Scoundrels are scoundrels wherever they gather. The regulations leave a lot of room for regional center input and control. There's no certainty that service brokers will function as envisioned. The same bad habits that attenuate the virtues of the current system can easily thrive in the new system.
4. While some regional centers, including the five pilot sites and San Gabriel/Pomona have shown commendable enthusiasm for the new program, it will not be difficult for regional centers leery of SDS at the management level to undermine, redefine and/or disincline the engagement of the program.
5. The spontaneous occurrence of idiocy remains a distinct possibility. By idiocy, I offer this example. Stupidity that limits the flexibility of service models intended to provide responsive, person-centered care and justified by incomprehensible paeans to quality, person-centeredness and "the principles of the New Day conference" not only occur but find limited resistance and meet little reason. If Westside and Orange County regional centers can do it to ILS, they can repeat with SDS. Two or three years out, look for regional centers to propose converting SDS into a formal congregate steeplechase and be met with a resounding "um."
Your turn. Discuss.