The Apostle Stanley is stirring it up in the comments in the post below this one, comforting the afflicted and afflicting the rational. His comments have inspired some thought on my part, no mean accomplishment.
If you look through this blog over the years, those reforms I argue for most consistently: transparent and public outcome evaluations of programs and policies, self-determination and its pale cousin self-directed services and value-stream management share a common assumption: That end users of the system, given the means and opportunity to do so, will choose quality supports providing the maximum likelihood of achieving the client or families goals. It is on this basis as well, that I tend to kick against top-down, regimentary solutions such as those Stanley suggests.
I make this assumption in direct contradiction to some experiences I've had. I am often at meetings with groups of clients and/or family-members gathered for the purpose of advocacy. Often at those meetings, complaints are rife towards service providers and regional centers. The commonest answer to "have you discussed this with your agency/regional center?" seems to be "I am afraid they will retaliate." The commonest response to "Have you considered changing agencies/service coordinators?" seems to be "It's a lot of work and, anyway, the next one might be worse than the last."
I recently told a good friend after one such meeting of my suspicion that if mediocrity in a service provider cost money, excellence would abound. Likewise, I suspect that if listless service coordination made extra work, service coordinators would struggle to be responsive.
I am sure fears of retaliation aren't entirely unjustified and I certainly grant (and assert) that discovering quality supports is impractically hard. But, if end users won't seek alternatives to poor service, then Stanley is probably right, the only way this system will get any better is a top-down process that will also make it less creative, innovative and diverse.