Thursday, May 15, 2008

Well, that was kind of sensible, mostly

As some of you might have heard through a friend of a friend, the Governor's May Revision of his budget is out. It did not live up to the Cassandaric expectations that I and others had. There is no apparent further cutting to DDS' budget, although there are further reductions due to lower caseload which can mean either (A) we have looked at the data and the trend is lower than expectations or (B) we have some evil plans so subtle that to announce them would be like putting marzipan on a gourmet gateau. It will be worth asking questions about that. 

In some ways, I have to say I'm a little disappointed. First and least, because I think the sustainability and stability of funding is more important to what we do than sufficiency, and I'm skeptical that such a large budget gap can be honestly solved without more pain (and fewer 'S's.) Secondly and more importantly, because this system is so reluctant to change, even for improvement's sake that budget crises are usually the minimum requirement to discuss reform. Thirdly, I'm pre-emptively disappointed because the various associations, providers and regional centers are generally much more vigorous in defense of Regional Center cuts, than when the cuts bypass agencies and harm clients directly as is the case in the May Revision. The eye-catching cuts are to CAL-WORKS, which many people with disabilities use, IHSS which many people with disabilities use and Medi-Cal which most people with disabilities use. 

So the question is: If we could reform the DDS system to provide more value with less money given a promise* that any savings would go to backfill IHSS, Medi-Cal and/or CALWORKS what would we, as a community, do? If the answer is nothing, we deserve much worse treatment than the administration has so far given us.

*I'm not sure it would be wise to believe that promise, although "why save money for people with disabilities to protect prison guards" is both a realistic and depressingly cynical response.

***6/5 Update: I learned a new blogging trick, by Jim.  Comments are currently closed on this topic but open on all others.  If you find this outrageous, please contact me or leave a comment in the post above.  If anyone wishes to email me and doesn't have my address, it can be obtained by clicking on my name under "Contributors" above and reading down the left hand column of my profile.

41 comments:

paul said...

"Secondly and more importantly, because this system is so reluctant to change, even for improvement's sake that budget crises are usually the minimum requirement to discuss reform."
Doug

You can Say it again brother!...unfortunately

My soul is often torn between my affinity for a "crisis" because it is, as you say, the "minimum" required for discussion, and the knowledge of what a crisis can do.

"If the answer is nothing, we deserve much worse treatment..."

It is my belief that the answer is nothing, and I think that I have 15 years of empirical evidence to prove my position.

IF ANY dramatic change to our system is coming it will come from a silent majority of outsiders. Unfortunately, they are perhaps least equipped.

No matter - perhaps we should welcome it - invite it! Breaking up the cabals, juntas, and camarillas is something that is at least worth exploring…

Doug said...

Paul, I'm remembering Nixon's silent majority right now. But I agree, the cabals, juntas and camarillas (nice vocabulary, by the way) are better called camarones. I would welcome and invite all those without a conspiracy to form a new one.

paul said...

"Paul, I'm remembering Nixon's silent majority right now."

Perhaps apropos - However, I think that any silent majority that history claims to have existed back in the early 70's can be contrasted to our own.

The 'issue' then was a war, and now it is 200,000+ individuals with what Marty Omoto has called the ‘Other California’

The reportage in the 70's was apparent. No evening went by without the evening news or newspaper referencing the issue. This is our most severe contrast.

I doubt that a random member of my local community has the slightest idea that DDS has a 4 billion dollar budget or the 21 non-profit agencies get most of that 4 billion. I highly doubt that same random person let has a clue as to how and where that money is spent.

I doubt that a random member of the community even knows the local regional center exists, or the fact that it is likely one of the largest, if not the largest, non-profit in the area.

Since the MAJORITY has no idea that our esoteric world exists, no idea how it is controlled, and no idea how much it costs they cannot opine - et viola silence, add the MAJORITY part (prob 25 Million) and et viola a silent majority.

While historians can argue about Nixon's silent majority there is little wiggle room here.

The ultimate question however is what our silent majority would say about our esoteric world should the light shine brightly into all the cracks, crevices, lairs, and dens?

And should the light shine and should it speak how would we respond?
"Compassionate conservative!” "Sofa change!” “Fighting the good fight!” “Political will1”

I wonder if this is all that we have…

No matter - perhaps just academic. I believe it would take a virtual disaster to bring out world into the light. The beating of a man with a disability that was filmed on a cell phone only got a blip, from the mainstream media, and al but NOTHING form those advocates that claim to care.

Doug said...

Light is less flattering than we're raised to believe, isn't it, Paul?

stanley said...

[paul say] see what he say above about DDS...our esoteric world

well ditto for any and all systems/departments (esoteric worlds)...separately or collectively

In 2005, Governor Schwarzenegger*s own California Performance Review Commission reported that *California*s state government is antiquated and ineffective. It simply does not mirror the innovative and visionary character of our state. Instead of serving the people, it is focused on process and procedure.

It would be great if our esoteric world would take the lead to reform the state by first reforming DDS/RCs...but;

no one is responsible...on this blog there is finger pointing...doug say it’s the legislature, paul say its advodivas...etc say its that fellow behind that tree...so until there is some leadership...light on DDS alone would be a disaster for those we desperately want to provide quality care...and;

considering the current state of the state: then $4B is indeed sofa change and there is no political will...at least not equal to that to fund the Dept Of Corrections or whatever, you pick one.

the most needy, almost voiceless, are the lowest on the needs priority list...first on cut list...and;

there is no less light on their esoteric world than on any state esoteric world...department.

Again it would be great if DDS would take the lead...but it will take DDS leadership not evident...or advodiva leadership also not evident...sigh, oh my, where are you...

stanley seigler

Andy said...

Here I am, Stanislaus! I got your leadership, right here! I'm having a little trouble finding a follower, though.

[ …Douglas asks] If we could reform the system to provide more value for less dough and knew that the savings would go to a good cause, would we sign up for the surgery?

It’s hard for me to imagine what those reforms could be. Self Directed Services? Sure. Replacing developmental centers with quality community supports? In a heart beat. Reforms resulting in a cut to my supported living rate? Uhhh, no.

I assume your question is meant to ask if we, as providers, would accept lower rates in exchange for the system’s clients receiving more effective services and supports. However, if the question can also consider less money to mean less service, it becomes, for me, an easier choice. It also makes it easier to imagine some reforms. A reduction of the hours of service we provide is something I could easily accept.

With rates, I could also accept a 10% cut to our ILS reimbursement and our day program rate. They are a small part of our business and I think they allow a few ways to reduce costs without seriously hurting anyone.

A 10% cut to our $17 an hour SLS reimbursement would have to come with a miracle, rather than a reform, to somehow provide more value. That’s what I can’t imagine . . . what possible reform could increase value or efficiency when one effect would be to lower the already low wages of our staff, or (our other option) eliminate their health benefits.

Here’s a fun fact from left field: When we opened for business fourteen years ago, our hourly SLS rate was $15.60. An increase in the late 90’s, and the pass through a few years later, launched us to $17.10 hr. (ahhhh, those were heady times). If future rate increases match this same pace, in 100 years our rate will reach $34.00 an hour . . . which might buy a liter of gas.

I think 90% of the responsibility for poor services lies with service providers . . . AND! . . . I don’t think DDS, regional centers, unions, politicians, or reforms can do much of anything about it. I’ve had problems with every suggestion I’ve heard about improving provider performance (e.g. outcome-based this or that, mo money, limiting verndorization, mandated super training, etc. etc. etc.)

I propose the possibility that there is no far-reaching answer.

More on that later . . . for now, I’d like to know, Doug, did you really have to praise Paul’s vocabulary? Do you not like this blog anymore? Are you trying kill it? Why not tell Paul that his writing would really “take off” if he sprinkled in a few more foreign words and phrases . . . class it up, a bit . . . Latin especially is good for that. Why not suggest to Stanley that he expound more on fewer topics?

Look, I know we who post here are not quite of the same caliber of your average, everyday, run-of-the-mill Ambrose Bierce buff . . . but give us another chance . . . we have nowhere else to go.

---Andy

stanley said...

[andy say] Here I am, Stanislaus! I got your leadership, right here! I'm having a little trouble finding a follower, though.

Where’s the barricade or bridge...will be interesting to see who shows up.

Doug said...

Stanley, did I say its the legislature? I usually say it's all of us, one community, reprehensible.

Andy, your vocabulary is nice too. I don't as much mean trading lower rates for better results which is pure altruism. But one of the things that troubles me is that, right or wrong, I think if the State offered a 10% rate increase to all providers that agreed to pay an 11% tax surcharge the response would be heartwarming. OK, leave your hourly rate alone. Would you accept a 10% cut in your administrative fee along with a 15% reduction in administrative workload?

Stanislaus. I'll follow Andy to the ice cream shop if you'll follow him to the bar.

paul said...

"Would you accept a 10% cut in your administrative fee along with a 15% reduction in administrative workload?" Doug

Doug – I take this to be a tag line to your general desire for a more laissez faire system (in some respects – to qualify…add more accountability and specifically outcome based accountability).

While I see the potential benefits of such an approach in a system predominately populated with Andy’s Supported Services W/ Integrated Programing Extraordinaire and Doug’s Integrated Programing Service Habilitative Individualized Training we should be cautious if we are making corrections to a system based upon the diamonds in the rough - the exceptions and not the rule... NO?

During my personal “dark ages” [my tag for my past work in this field] or as Andy loves it, Acerbus Aevum, I found that the administrative aspect of services did little to disturb the turds in the punch bowl (the rough surrounding Andy and Doug). The turds simply avoided or forged the necessary administration. If this is the norm of the majority or large portion of providers then I would submit that you are attempting to reinforce the strongest part of the dam.

It is my belief that while the “administrative” aspect of our system are annoying and perhaps counterproductive it is also the Pepto that prevents the turds in the punch bowl from fowling the entire system.

As a side note I will admit that the “paper work” aspect of our system is a tool that is rarely used by the very system that mandates it… One audit showed that a consumer at a local day program spent three entire days at Michael Jackson’s Ranch. While an investigation seemed to indicate that this report was the product of a frustrated staff person who was convinced that nobody read the entries (She was correct), there were other indications of simple rebellious behavior on the part of the staff. It was hard to tell. Her nose piercing and tongue piercing were tied together with a small chain. She was hard to understand…

Luckily, 5 other staff where also her housemates and provided some interpretation.

stanley said...

Doug said...did I say its the legislature? I usually say it's all of us, one community, reprehensible.

Yes, with a possible CYA statement that we all are resp.

[doug say] Stan, I think SDR went unimplemented because the legislature didn't give DDS authority or funding to do anything. Various proposals went into various pieces of legislation that weren't passed. DDS, the regional centers, vendors, families and clients had no authority to implement any of the changes except those that we could always do. I guess the responsible parties would be the legislature and, through them, the advocacy community. [Monday, April 14, 2008, What's not in the DDS Report, Controlling Regional Center Costs, Part I]

And when all are responsible...in effect, no one is...

stanley seigler

Doug said...

Paul, that's a funny story and a little bit tempting. Maybe I'll submit an incident report alleging fiscal abuse by Elvis. I'm not especially arguing against the value of administration or paperwork generally (my salary is paid on the contrary assumption) but I suspect an audit of administrative mandates might turn up a few ladle weights. Some mandates, accountability, etc. serve to protect clients from abuse and taxpayers from theft. Some probably exist because something terrible happened one time and someone thought it would be important to have a mechanism in place to prevent that thing from happening again. I doubt any of the assorted administrative safety measures have ever been tested for efficacy or cost. Testing regulations against what they are supposed to accomplish and what they diminish sounds like something worth doing.

I can give one example quickly, although it also costs very little. Whenever a new client comes into our agency, we explain a list of rights, as required by law and have the client sign that list. The list I am referring to includes the right not to be dressed against gender, not to receive electroshock therapy, etc. I think one of the rights on the list is potentially relevant to some of our client interactions. They are all important rights in the sense that to violate them would be terrible, but if, across the state, 1 million dollars are spent in administrative costs going over those rights, zero abuses are prevented by that process and ten individuals are scared witless by the fact that we even brought up the possibility of electrocuting them, then maybe there's 1 million dollars of pressure we can remove from the budget. Sic transit gloria mundi

Stanley, you make excellent points. I think we disagree on whether when we talk about SDR we are talking about the whole problem. My assessment of SDR was that to implement statewide would be an expensive muddle. I would say when we are responsible, in effect, no one person or party is to blame. I can live with that.

stanley said...

[doug say] I think we disagree on whether when we talk about SDR we are talking about the whole problem. My assessment of SDR was that to implement statewide would be an expensive muddle. I would say when we are responsible, in effect, no one person or party is to blame. I can live with that.

SDR is shorthand...it epitomizes the issue (the whole problem) of who is responsible...and the way leaders are excused for lack of results...repeating;

doug say it’s the legislature, paul say it’s the advodiva...stanley say its lack of leadership at level where dept heads are charged with the responsibility for positive results...sadly their result is a morass of bureaucratic bills that impede vice implement the delivery of quality service for those with special needs.

Think you are pulling my leg with your interpretation of the comment: when all are responsible, no one is reasonable...BUT IN CASE NOT;

someone is responsible, someone has to be accountable or there is no accountability...which is exactly what we have after decades of the attitude all (no one) is to blame.

Wish I had some new examples...but lack originality...so an old one...in the old Navy the ship’s capt was court-martialed if ship...eg, ran aground...whether or not he was on the bridge when it happened...

someone has to be accountable, the blame, TO BE responsible...if all are, no one is...which is what we have now...THE BUCK STOP WHERE?

stanley seigler

Andy said...

[ . . . from an evermore distant wilderness, Stan the Baptist sayeth] “someone is responsible, someone has to be accountable . . ."

Stanley, at great risk of lighting your fuse and reigniting your hair, I must ask you, “Responsible for what?”

Crummy services? [Answer: 11,800 service providers*]
Crummy service providers? [Answer: Mr. Lanterman and his thoughtful Act . . . as well as 11,800 service providers*]
Lives of isolation and alienation? [Answer: Post-War American Culture . . . though, for most, Pre-War wasn’t so hot either]
Ninety percent unemployment? [Answer: The Industrial Revolution and Modern Capitalism]
The stigma and devaluation of disability? [Answer: Human Nature . . . or maybe just the ‘baser angels of our nature’ ]
Inadequate health care? [Answer: Poverty, the AMA and the Medical Industrial Complex]
Poverty? [Answer: Poverty . . . and benefit programs that require it]

I suppose I could go on, but I wish and will wait for my dear friend the Baptist to better identify those issue(s) he laments . . . (and ‘happy broken camper homes’ mantras won’t cut it!)

*Based on the estimate of 12,000 service providers in California.


Andy
President/CEO/CFO/COO/UFO
Andy’s Supported Services w/ Integrated Programming Extraordinaire

Doug said...

Stanley, I think the problem is how people with disabilities can have better lives. If that's the problem then firing department directors when the system sucks is only a very small solution. I don't think Andy or Jeff or I will do much better for fear that Theresa Delgadillo will get canned if we don't. Also, what basis does Kim Belshe have for even knowing if the system is working? The complaints of stakeholders? It's hard to hold anyone from the Governor down accountable when nothing is measured and nothing is counted. I don't think its possible to hold DDS truly accountable for what happens to 200,000 people until I am held responsible for what happens to 110.

STAKEHOLDER, n. A complainant with a professional audience.

Andy, I think you're being a little generous to service providers.

stanley said...

[andy say] Responsible for what?

sad you have to ask...reminds one of : If you have to ask what jazz is, you'll never know....OTOH I could be more specific...but we were talking about the delivery system (aka DDS) and who is resp for the DDS functions...

so the ans to Responsible for what...is: responsible for the implementation of the Lanterman act...and who is resp...weel;

The Court explained that the Lanterman Act is: A comprehensive statutory scheme to provide a pattern of facilities and services sufficiently complete to meet the needs of each person with developmental disabilities, regardless of age or degree of [disability], and at each stage of life...The Lanterman Act tells DDS to contract with regional centers to provide services to you and other persons with developmental disabilities. DDS remains responsible for monitoring the regional centers and ensuring implementation of the Lanterman Act...http://groups.yahoo.com/group/DDRIGHTS/message/3653?threaded=1&l=1

Seems the question should be: why hasnt DDS ensured compliance...why havent advocates demand compliance with Lanterman...surely it is not believed there is compliance.

[andy say] and happy broken camper homes mantras won’t cut it!

Why not... happy broken camper homes are not implementated as mandated by Lanterman...

[doug say] firing department directors when the system sucks is only a very small solution...what basis does Kim Belshe have for even knowing if the system is working...It's hard to hold anyone from the Governor down accountable when nothing is measured and nothing is counted. I don't think its possible to hold DDS truly accountable for what happens to 200,000 people until I am held responsible for what happens to 110

and who is resp for measuring (monitering) the system?

excuses...the beat goes on and on and on and on...as said: when all are resp...no one is, ie, Noman Leadership!

stanley seigler

stanley said...

PS

[doug] I don't think Andy or Jeff or I will do much better for fear that Theresa Delgadillo will get canned if we don't...

if Delgadillo were to can you; andy/jeff may do better...or if Delgadillo (thu RC) were to shut fred chappa down...ie, get rid of the bad apples...stop providers and RCs from gaming the system...then you three and some others might do better

[doug] what basis does Kim Belshe have for even knowing if the system is working

directors should have a basis...don’t you...don’t CEOs (in general) do...or better have a basis.

[doug] until I am held responsible for what happens to 110

DDS should can you if you are not providing quality programs.

Caveat: have no doubt, doug, jeff and andy provide the best they can, within the limits of either closing or living with the system...OTOH;

DDS/RCs have done nothing to eliminate the bad apples...and;

Sadly many of the bad apples are accepted by parents (whoever) as great...eg, Devereux (sp?), Valley Village (not to mention JRC)...and of course they provide a service better than snake pits...weel maybe in long term not.

stanley seigler

paul said...

"...why havent advocates demand compliance with Lanterman..."
-Stanley

Stanley,

What do you think the answer is to this question? Is it as simple as, “they just don’t care”, Alice-wonderland-rabbit hole, Potemkin, campers..etc

I think that this question probably has several viable answers, and all of them are perhaps more illuminating than the question.

If there is an answer can we then use that answer as a tool to change the reality – how?

Doug said...

Stanley, this is why there isn't (yet) a Department of Jazz. Excuses versus complaints is not a battle to bring victory to people with disabilities. The question is open, though, if DDS and the Regional Centers are the best people to separate the wheat from the chaff in this system. As you point out, clients and families also don't punish bad programs, which is a kind of endorsement.

Paul, why don't you share what you think some of the answers are. I think most questions are exactly as illuminating as their answers.

Andy said...

I think I got it now, Stan. DDS is responsible for the implementation of the Lanterman Act. And death to the director if it is not implemented to the extent that every camper is indeed happy and every home unbroken. A simple solution, it seems. Like so many other simple solutions though, reality, which is seldom simple, F’s it all up.

Lanterman created 21 regional centers. It mandates that they be located around the state and that they be locally controlled by 21 nonprofit boards of directors. It assumes that the diverse needs of diverse communities are better met by the diverse (local) implementation of the legislation. (Damnit! It’s already starting to get unsimple!)

In the land of Stan and Nod, DDS would be the Politburo and regional centers the loyal and obedient apparatchiks spread across the territory awaiting orders from the Central Committee. Unfortunately, as such, DDS would be failing to implement the Lanterman Act . . . and heads must roll!

While we’re at it, shall we not fire the Vicar of Rome for failing to implement the Bible?

Lanterman is full of these little difficulties and contradictions (i.e. “as the budget allows”), making it rather unsuitable for a rebirth in simplistically stringent commie utopias.

Doug’s right when he points out that a bumper crop from the guillotine would do nothing to help. I think his assessment is actually too mild however. Given the line of first-rate directors we’ve had at DDS, their pointless executions would do far greater harm than good. But don’t take my word for it, Uncle Joe, (as if you ever do!) we have precedent to draw from (or, “from which to draw”. . . for those unable to abide a dangling preposition).

(I am sorry to keep on harping on inconvenient realities . . . this time within a historical context . . . but but but I find more comfort in reality)

Denny Amundson was the DDS director under Governor Grey Eminence. DDS was unhappy with the slow rate of placement from the DC’s to the community. Many of those darn regional centers, locally controlled and semi-autonomous (as required by an honest implementation of Lanterman Act), weren’t very keen on bringing their homeys home. Others simply weren’t very good at it. DDS provided more resources, incentives, technical assistance, and new service options (SLS) to try to speed things up. Finally, to the delight of Mr. Amundson and others in the Department, DDS got sued . . . and, to the delight of the plaintiffs, quickly settled. The Cofelt settlement gave the Department the judicial juice and additional resources to “compel” regional centers to free over two thousand men and women over the course of a few years.

To me, this was good, effective, welcome, and long-overdue implementation of the Lanterman Act . . . to others, mainly DC families, it was a betrayal and cruel bureaucratic railroading. (Both opinions can find support in the Lanterman Act).

A relatively small number of those who saw it as a betrayal teamed with a relatively large number of unions (typically, employees of a DC are represented by nearly two dozen different unions) baited their hooks with a few horror stories and a rather questionable morbidity study and fished around for bites from any major media. In 1997, hacks at the San Francisco Chronicle took the bait and ran.

CAUTION: A bit of newspaper history ahead!

(The Chronicle was the dominant newspaper in the Bay Area for many years, outselling every other daily in the area combined. In the late eighties the San Jose Mercury began challenging the Chronicle’s dominance. With Silicon Valley starting to boom, the Merc spent a lot of money on prying top-notch reporters and editors from other papers. Its quality and scope improved dramatically and it began taking a large chunk out of the Chron’s market share. The Merc won a Pulitzer Prize in 1990 and came close to another in 1996. There’s nothing quite like a Pulitzer Prize to impart gravitas to a newspaper . . . and in the Pulitzer pecking order, investigative journalism is at the very top.)

The Chronicle’s series of “investigative” stories was a horribly biased account of a lethal community service system awaiting its victims from sunlit cathedrals of care and compassion, known as developmental centers. (You don’t win Pulitzers for investigative reporting by writing about good things . . . death, squalor and injustice wins prizes. The Chronicle submitted this series for consideration by the Pulitzer Committee—surprise, surprise—but didn’t win.)

As a result of the series, Stan’s solution was meted out and Mr. Amundson’s head bounced down the steps of the Capital. In Stanland, the result of this execution would have been a swift and certain improvement in services. In reality, things got worse for those locked up and virtually no one was freed from a DC for several years afterwards.

The DDS budget has been in the crosshairs of the Department of Finance every year for decades. DDS directors and staff have done amazing work protecting it from DOF’s ever present axe. If ever there was a year to lop off a hefty percentage DDS’s budget, it is this year.

Somehow, contrary to the opinions of absolute certainty of every expert observer, Ms. Delgdillo, with, I’m sure, the help and support of Ms. Belshe, protected DDS funding for services from any cuts. But wait, Stanton, it gets worse. It is my understanding that DDS was able to secure additional funding meant to supplement services impacting people with developmental disabilities likely to be cut elsewhere in the budget (Medi-Cal, IHSS, etc.).

Obviously, Terri Delgadillo needs to be fired . . .right away! . . . her picture hung prominently on the Wall of Shame next to the other apathetic, do-nothing bureaucrats like Amundson.

Stanley, I think it’s time for you to come inside . . . or, at least, play on the porch where we can see you.

As always, with loving concern for your well-being,
Andy

stanley said...

[andy] I think I got it now

don’t think so...so much hype and you seem to miss the point: if all are resp, no one is...and the result is a system that sucks to quote doug re system.

[andy] I think it’s time for you to come inside...

Oh gawd, oh my, sigh...my hero provider has feet of clay...he wants the Baptist (perhaps any Baptist) to be a team player (come inside)...join the praises of the leaders who have produced a system that sucks...join in the mantra: “heck of a job brownie.”

Could do a point counter point (eg, re the SFChron articles)...but what's the use...if my last hope is a team player...a team that has produced the current system...butbutt;

To give credit where due...the current system is better than snake pits (heck of a job brownie)...

good enough for the retards...and so what if no one is responsible for providing the quality of life they deserve.

[andy] As always, with loving concern for your well-being

Ditto

stanley seigler

stanley said...

[stanley] Could do a point counter point (eg, re the SFChron articles)...but what's the use...

not sure the point...but there are two many straight lines...cant resist p/cp thing.

[andy] I think I got it now, Stan. DDS is responsible for the implementation of the Lanterman Act. And *death to the director if it is not implemented to the extent that every camper is indeed happy and every home unbroken*. A simple solution, it seems. Like so many other simple solutions though, reality, which is seldom simple, F’s it all up.

Facetious hype does not make simple solutions a failure...holding DDS resp for positive outcomes does not mean lynching the director...it could be as simple as asking tough questions and demanding honest answers...like, why weren’t SDR suggestions implemented...or is that too SIMPLE.

[andy] Lanterman created 21 regional centers. It mandates that they be located around the state and that they be locally controlled by 21 nonprofit boards of directors. It assumes that the diverse needs of diverse communities are better met by the diverse (local) implementation of the legislation. (Damnit! It's already starting to get unsimple!)

There is nothing in the simple solution of implementing Lanterman that excludes diversity...in fact if implemented diversity would rule...(w/o POS standards as suggested by DDS)...Lanterman say individual needs shall be determined by an interdisciplinary team (IDT)...sounds diverse to me...sadly;

many IPPs are just paperwork...goals and plans are never (well almost never in many cases) implemented...guess simply implementing (DDS insuring as reqd by law) legitimate IPPs is too simple and would just screw up the model system reality...so rather than asking DDS why IPPs are not implemented...we just say “heck of a job brownie.”

(Wonder if this has anything to do with currying favor...probably not...that would not be really real reality...or would it?)

[andy] In the land of Stan and Nod, DDS would be the Politburo and regional centers the loyal and obedient apparatchiks spread across the territory awaiting orders from the Central Committee. Unfortunately, as such, DDS would be failing to implement the Lanterman Act . . . and heads must roll!

In funnyandrewland...KISS not reality...instead facetious hype rules and rolls glibly off the comic's tongue...sadly none addresses implementation of Lanterman...which simply (guess too simply) says: 1)IDT determines needs; 2) RCs find programs to meet needs; 3) DDS remains responsible for monitoring the regional centers and ensuring implementation of the Lanterman (ensuring needs are met)...dammit again guess this is jut too damn simple.

no politburo required, just standard accepted good business practices required...eg, monitoring outcomes and taking corrective action if not met...oh my gawd again too simple.

a simple question for DDS: how does it monitor RCs...how does it evaluate needs are met...i think doug say there is no measuring (aka monitoring)...so the question becomes why not...or the alternate as some just say “ heck of a job brownie.”

[andy] While we’re at it, shall we not fire the Vicar of Rome for failing to implement the Bible?

the andyman cancan...why not...funny andyman, you should take your show on the road paved (by noman) with good intentions...

[andy]Lanterman is full of these little difficulties and contradictions (i.e. “as the budget allows”), making it rather unsuitable for a rebirth in simplistically stringent commie utopias...I am sorry to keep on harping on inconvenient realities... this time within a historical context...but but but I find more comfort in reality

comfort in reality of a system that sucks and budget that does not reflect the needs of those with special needs...surely you jest, Jack Benny...BTW any system resemblance to the intent of Lanterman is an illusion...sad to some advocates their reality is it's a model system other states aspire to.

http://groups.yahoo.com/group/DDRIGHTS/message/2661
The Broken Homes series views our system of care with a sinister eye, making it sound like a failure when, in fact, it is a model program to which other states aspire

Since budget mentioned...the budget reality: [SCDD say] Regional center budgets are not built upon the collective needs of their consumers, but on a 1970's funding methodology based on historical expenditures and caseload growth. This budgetary formula creates a difficult balance between stewardship of the regional center's annual appropriation and development of comprehensive assessments of each consumer's service and support needs. [2002-06 Plan] http://www.scdd.ca.gov/our_plan/Online_2002_Plan.htm#Complexity

why hasn’t DDS submitted a budget based on collective needs...why hasn’t DDS required RCs and providers to submit budgets based on collective needs...why hasn’t DDS insisted on comprehensive assessments of each consumer's needs.

BTW DDS say programs are fully funded. “Heck of a job brownie”...is this the reality that comforts andyman...

http://groups.yahoo.com/group/DDRIGHTS/message/2968
During these fiscally challenging times the Administration has continued its commitment to the Lanterman Developmental Disabilities Act by fully funding services and supports for persons with developmental disabilities

(full of these little difficulties...no one said it would be easy.)

[andy] Denny Amundson the DDS director...DDS provided more resources, incentives, technical assistance, and new service options (SLS) to try to speed things up...to “compel” regional centers to free over two thousand men and women over the course of a few years. To me, this was good, effective, welcome, and long-overdue implementation of the Lanterman Act

Agree and due credit given...now the ax...where was/is the implementation to free the thousands from Broken Homes, gundecked IPPs, budgets not built upon the collective needs of consumers, RCs and providers who game the system...providers and DCs that abuse, murder consumers...ie, a system that sucks.

[andy] A relatively small number of those who saw it [guess Amundson actions] as a betrayal teamed with a relatively large number of unions (typically, employees of a DC are represented by nearly two dozen different unions) baited their hooks with a few horror stories and a rather questionable morbidity study and fished around for bites from any major media. In 1997, hacks at the San Francisco Chronicle took the bait and ran.

not sure what this has to do with DDS’ resp to monitor and implement Lanterman...but interesting and review of history may prevent its repeat...probably not...see advocate response above to Broken Home articles...they say it's a model system.

Granted hacks should have reported the DC horror stories as well...but actually the hacks (for the most part) accurately portrayed the dark side (horror stories) of the community as did the HCFA report of 1997/98...and;

about bait: sadly the community advocates took the bait, hook line and sinker...denied the deplorable conditions existed...and made it a pot/kettle...my horror story is better than (worse than) yours debate...when the issue should have been p-poor quality in the community and the DCs...the advocates should have used the articles to show the dire need for improved funding and system reform.

The Agnews closing cost ($85M) and the annual per capita former residents community cost ($248,000) somewhat supports the opine the articles should have been used to justify reform and better funding of the community. http://groups.yahoo.com/group/DDRIGHTS/message/3883

[andy] As a result of the series, Stan’s solution was meted out and Mr. Amundson’s head bounced down the steps of the Capital. In Stanland, the result of this execution would have been a swift and certain improvement in services. In reality, things got worse for those locked up and virtually no one was freed from a DC for several years afterwards.

Not sure articles caused head bouncing...but if DDS had pushed for system reform and budgets based on needs then DCs might not exist today...again the Agnews closing cost and community reforms/improvements seem to support this opine...funding and reforms closed Agnews.

[andy] The DDS budget has been in the crosshairs of the Department of Finance every year for decades. DDS directors and staff have done amazing work protecting it from DOF’s ever present axe. If ever there was a year to lop off a hefty percentage DDS’s budget, it is this year.

agree, amazing work protecting the status quo...see above comments re Regional center budgets not built upon the collective needs of their consumers...

Andy, you are a true team player...would have never thunk it...heck of a job brownie, defending a system that sucks...or;

maybe it doesn't...as said it is better than snake pits...and no one is to blame in wonderland.

BTW love “your” suggested mantra: “death to the director if it not implemented to the extent that every camper is indeed happy and every home unbroken”...Do you hear the people sing...Singing a song of angry men...weel;

At least love it compared to alternate, “heck of a job brownie” suck up crap...fortunately there is the golden mean...hope we find it.

[andy] As always, with loving concern for your well-being

again ditto

stanley seigler

Doug said...

Andy, those who do not speak Latin are doomed to repeat it. Two quotations from Iuvenal pertinent to your comment: "Quis custodiet ipsos custodes?" and "Difficile est saturam non scribere." Translated: "Who will watch the watchers?" and "It isn't hard to write satire." Clearly, I don't speak Latin.

Stanley, I agree that accountability is important but I don't think there's any efficiency in holding one person responsible for perfecting half a million. I get that if all are responsible, no one is, but I still don't think that's the problem in this system. See new post.

I appreciate your second comment. I agree that publicly asking hard questions and making sure to get them answered ought to be part of the community's relationship with DDS. I disagree about using best practices, though. The underused virtue of the Lanterman Act is the innovation and creativity it allows and might reward if we could distinguish between success and failure. If you remember John Moise (he used to run DDS' information systems) he once quoted (Peter Drucker?) someone as saying that if you don't measure outcomes, you end up managing process. The author of this blog is fond of saying "They (you) worry about what we're doing because they (you) don't know how we're doing." I think nothing is more dangerous to the Lanterman Act than the temptation to regulate and control. In my thinking, the over-regulation of things like SLS and vendors generally is largely responsible for the fact that $3Billion isn't enough.

Also, I absolutely agree with you and the State Council that the budget is not composed of the collective needs of the consumers. In fact, the budgets are almost uncorrelated with actual needs which doesn't mean they are insufficient.

Andy said...

Latin Schmatin (or is it Schmatus?) . . .bad satire is even easier to write.

[Stan say] . . . he wants (me) to be a team player (come inside) . . .

No I don’t! No way! Never ever!

“Inside” was meant as no more than a reference to reality. I think it would be nice for your audience (Doug and Paul and me) to know what realistic ideas and suggestions you may have. I realize that constructive, practical, proactive thought is not easily suited to your writing style---a style I still enjoy, by the way---but a helpful contribution would be well worth the artistic sacrifice . . . in addition to being quite mind-blowing.

Crying out to the heavens, “Lanterman, O Lanterman, why hast thou forsaken thy campers?” you, Mr. S., howl and wail, weep and whimper and roar, over and over, about the dearth of effective, compassionate leadership. Yet we dare not ask the same of you in terms of the ideas and suggestions you provide this discussion.

Parents and families have always had great influence on our service system. Their vision and leadership stirred Frank Lanterman to act. I can think of no other social service in which families have had such great effect or continue to play such a pivotal role.

Your experience as a parent, Mr. S., has given you some real understanding and insight, albeit painful, into our system. And your writings have gained you some notoriety and a certain level of fame; but, because of the protagonist you’ve created in your work, (remember, I’ve met the sweet, kindly, soft-spoken gentleman who uses your name when you’re not at home) it has gained you a reputation but, sadly, no influence. If your desire is the significant improvement of services for people with disabilities, your effectiveness towards this aim has been no different than your depictions of the impact of those “leaders” you so frequently reproach (i.e. draw and quarter).

I hope you can now plainly see that you have, like all, some responsibility and that canning your ass would do nothing to help . . . (caning it might, though). When all are responsible, then . . . all are responsible! And all must do something to help.

Now. . . how does defending Terri Delgadillo turn me instantly into a lover of sh*t services? I heard your beloved Marty O say last month that Touchdown Terri was the best director DDS has ever had. Does he get a hall pass for that? Or is he too suddenly marching in lock step with the sh*t service storm troopers like me?

And another thing . . . [Stanley say] . . . so much hype and you seem to miss the point. Wow! Talk about Pot v. Kettle . . I think they call that “projection” . . . the likes of which hasn’t been seen since Linda Blair stopped for soup in Solvang!

And one last thing . . . once again . . .what good came from firing Amundson? I await your measured, thoughtful reply.

As always, always helping because I, as a helping professional, can’t help it,

---Andy

Doug said...

We pause for the following editorial intercession: I know and enjoy sarcasm more than the next guy but want to make sure this space isn't turning into a flameboard. Some of the language here can be mellifluously patronizing and personal which I'm happy to continue if Stanley says he doesn't mind how he's being talked to and Andy says the same for himself. We all happy little bunnies here?

Andy said...

I have absolutely no issue with Stanley's characterizations of me (though sometimes I object to what he may write of others). We've done this dance before (hence, the "axe/kiss" references that I think only three of us are familiar with). . . But perhaps we should save it for off line or other forums (leaving burning bags of "stuff" on each others door steps, ringing the bell and running away) Or we could restrict the cage match to this one topic heading.

Stan, sorry I posted the above before I saw your last post. How very prescient of you . . . next time though, please try to wipe your feet before coming inside.

As always, (there is an "A" in team!)

--Andy

stanley said...

[andy] I have absolutely no issue with Stanley's characterizations of me...

Almost ditto

I have absolutely no issue with Andy’s characterizations of me and will raise him one...I have no objection to what he may write of others...know of none other I would rather dance with (know of no one with who [or is it whom] I would rather dance)...disagree with...look forward to his facetious hype (aka good and bad satire and humor)...have missed the insights.

We've done this dance before. But perhaps we should save it for off line or other forums...don’t want to bore or stop anyone from contributing...doug’s call.

stanley seigler

Doug said...

Thanks guys, proceed. I'm fine with conversing smart-alecky-like and just wanted to make sure this wasn't turning into a flame fest. Stanley, to answer the "no problem with how you talk about other people" my own preference is this: I prefer "The Director of DDS should..." to "Terri Delgadillo should" but will not delete comments unless they seem overly personal. "John Doe is a murderous dog-raping thief" is a no-no. For future reference, I suggested some ground rules for another blog I helped set-up that might make for good manners.

Andy said...

Doug,

Any problem with "Touchdown Terri?"

Thanks for the okay to continue the dance . . . we seem to be the only ones taking each other's tickets. I wonder why that is . . .

Now, as I was saying:

Stanley, you ignorant slut!

Etc. etc. etc. . .

stanley said...

[Andy] Doug, Any problem with "Touchdown Terri?" Thanks for the okay to continue the dance...we seem to be the only ones taking each other's tickets. I wonder why that is...Now, as I was saying: Stanley, you ignorant slut! Etc. etc. etc.

this ignorant slut has no problem with TT...get the feeling, at some point, she may be able to handle tough questions and provide honest answers vice the rationalizations...will be interesting to see what changes she makes...know she would have the support of the likes of andy, doug and jeff...

are any of you in a position to have discussions with her similar those on this blog...eg, can any of you tell her the system sucks...and ask what she proposes to ensure: every camper is indeed happy and every home unbroken...or specifically;

ask if she will require RCs to submit budgets based on needs...and will DDS submit budgets based on needs...

BTW at a marty telemeeting there were only soft balls and heck of a job questions...and basically a non response to fully funded question by an ignorant slut, PNG parent.

moving to blog etiquette: if John Doe is a murderous dog-raping thief is a no-no...is andrew is a murderous dog-raping thief OK...

stanley seigler

Doug said...

Andy, I see no problem with Touchdown Terri as long as it isn't sexist or sportsist.

Stanley, I think as long as it's well documented, it isn't slander.

Doug said...

Oh, and Stanley, if your question is as to whether I have any relationship with Director Delgadillo that would allow me extra access you don't have, the answer's no. I was introduced to her very briefly when she was new (as a blogger, actually) but otherwise haven't talked to her. If you showed her my picture and Andy's and asked which obvious reprobate is Doug Pascover, I'd give her a 50/50 chance of picking right.

Andy said...

There are no pictures of me still in existence of which I am aware.

If you happen to hear of any such pictures, please let me know who claims to possess them and other pertinent details (e.g. phone, address, what route they take to work each day, etc.).

(Sorry Doug . . . I'll move on to the next topic now.)

paul said...

“And when all are responsible...in effect, no one is...”
-Stanley-

This is a good point, and often this reality occurs after we paint with too broad a brush or address too broad a subject. (see SDR discussion)

I believe that when discussing the ENTIRE system in its collective form we are ALL responsible. However, we are not collectively responsible for every aspect, nuance, and crevice of our system.

If a direct support “professional” physically abuses a consumer and nobody is the wiser then he or she alone is responsible. If a supervisor new, or had reason to know (perhaps failed to do a background check that would have revealed a problem, or ignores the writing on the wall), and did not act then the staff and supervisor are collectively responsible. If the Regional center knew, or had reason to know, and did nothing then the RC and provider are collectively responsible in their own distinct manner. If anyone along this chain failed to report as required by law and no consequences occur then those responsible for the potential consequences of a ‘failure to report’ are responsible for creating an environment the can be argued to foment abuse, or at least not create an environment that fights against abuse.…etc.

So sure - “when all are responsible [for EVERYTHING]...in effect, no one is...”, but that is NOT the case in developmental services or perhaps any reality [Aside from maybe in the Potemkin village or Wonderland I suppose]. So I disagree.

“When all are responsible, then . . . all are responsible! And all must do something to help”… when he or she has the authority, knowledge, and ability to help. Start in the backyard.

At times, the consumer themselves can be partially or completely responsible. Even John/Jane Q. citizen (not a mandated reporter), IMO, has a duty to intervene when he or she sees abusive behavior.



Stanley,

ARC v. DDS also sez, “Under the statutory scheme it is the regional centers, not DDS, that provide services to developmentally disabled persons and determine (sic) the manner in which those services are to be rendered.”

What that means is that the director’s authority, as a DDS director, to “shut [a provider] down...ie, get rid of the bad apples...stop providers” is limited by the Lanterman Act, the Act that your mantra sez, "just follow"

If this is true then introducting the director to your beloved Red Queen will not result in a replacement with any more authority, or increased chances of intervention. The DDS director is but one person and is limited by lanterman. On the other hand we have 21 Regional Centers, even more providers, even more supervisors, and even more “professionals”. Why do we provide disproportionatley little accountability here? It makes so little sense that there MUST be a reason. Why do we not have a CDCAN that focuses on the internal workings of the Regional Center, or Town Hall Meetings” that ask the question, “How is the RC monitoring your provider, and keeping you safe.”, or “why does your RC use different eligibilty standards than the one next door,” or “why do the internal policies of my RC differ from what Lanterman seems to say”…etc.

The lack of attention focused by the advocrates, advodivas, and parents upon this aspect of our system is strong evidence for an axiom

AXIOM: There are always a few people that benefit, even greatly, from a disfunctional system.

Corallary: Those that benefit from a corrupt or disfuntional system are the ruling class within that disfunctional system.

While we should hold DDS accountable when we can, and where the department is empowered, disproportional focus towards Sacramento only helps to support the Axiom above by displacing the attention that needs to be focused upon that aspect of our system that IS empowered, and is not stepping to the plate.

stanley said...

[paul] If a direct support “professional” physically abuses a consumer and nobody is the wiser then he or she alone is responsible.

Of course we all have individual responsibilities...eg, the above DSP: a DDS director cannot be fired if the DSP murders a consumer...or to use dougs example a DDS director cannot be fired if a user fails to seek a better program...OTOH

The murdering DSP and a user who fails to seek a better program cannot not be resp for the implementation of Lanterman...the law sez DDS is...neither can a collection of DSP and all stakeholders be resp for the implementation of Lanterman...and as long as we continue to excuse the lack of results with the “we are all resp” go along crap...we are doomed to the status quo...a system that sucks...that works maybe for the rich folks and those with strong advocates...or;

If you (anyone) believe the collection can be held resp...please explain how...and try to keep the "how" to implementation of Lanterman

if my daughter is abused how do I hold the collection resp...who is in charge of the collections fair hearing

Probably not a good analogy...but an analogy: Ike was given the resp for D-Day invasion...if D-Day had been a disaster...the multitude of soldiers involved could not be held resp...think Ike had written a letter accepting resp for the failure...in case it failed.

stanley seigler

Doug said...

Paul, your axiom and corollary are interesting. I imagine that you'd also agree that the ruling class within a system is often composed of people other than the titular rulers.

Stanley, that's a pretty good analogy but the Lanterman Act kind of says that the objective is not the beach but the French. I don't think Ike would have taken responsibility for the French any more than De Gaulle.

stanley said...

[doug] a pretty good analogy but the Lanterman Act kind of says that the objective is not the beach but the French. I don't think Ike would have taken responsibility for the French any more than De Gaulle.

Nitpicker...Ike was resp for the D-Day invasion...DDS is resp for Lanterman implementation...as asked paul (anyone)...if my daughter is refused a program where is the collections (all us) fair hearing...BTW;

there was a murder (Marky, 2002/03?) in Lanterman DC...no one was resp...neither the DSPs, the DC, the RC...this is an example of justice when all are resp...

DDS should have taken action to ensure those resp were, at a minumum, never allowed to work in the system again...

DDS promised a report...anyone seen it...

stanley seigler

paul said...

“there was a murder (Marky, 2002/03?) in Lanterman DC...no one was resp...neither the DSPs, the DC, the RC...this is an example of justice when all are resp...

DDS should have taken action to ensure those resp were, at a minumum, never allowed to work in the system again...”


Stanley,

You and I have discussed this before so I will cut to the chase.

As I recall there was insufficient evidence, according to the D.A., to press charges. Presuming that there was not sufficient evidence to “ensure those resp were, at a minumum, never allowed to work in the system again...”, (if you have evidence to the contrary please share) then WHAT do you suggest?

Rolling a die?
Rochambeau?
Eeny, meeny, miny, moe – your guilty.

As I recall, it was at least equally likely that it was another consumer was resonsible, yet you state, “at a minumum, never allowed to work in the system again...”

Work? Sounds like Brer Stanely has no need for Rochambeau, or Eeny, meeny, miny, moe. You are able to play judge, jury, and executioner - how efficient.

Is this Southern Justice?

”DDS promised a report...anyone seen it...”

“anyone seen it”? I guess this is another way of implying that someone else is responsible for finding it for you?

Is there a booger I can pick for you?

paul said...

"I imagine that you'd also agree that the ruling class within a system is often composed of people other than the titular rulers."

Absotively

stanley said...

[paul] As I recall there was insufficient evidence, according to the D.A., to press charges. Presuming that there was not sufficient evidence to “ensure those resp were, at a minimum, never allowed to work in the system again...”, (if you have evidence to the contrary please share) then WHAT do you suggest?

perhaps (I don’t believe it) insufficient evidence to pursue criminal charges when little retards are involved...certainly not insufficient evidence for DDS to take administrative action...ie;

the lawsuit against Goodwin was dismissed. The state settled their part for almost 1 million. It was shown that Lanterman management was negligent...The residence manager ignored repeated pleas by Goodwin and other staff to give Marky his own bedroom, due to his aggressive nature.
In his previous bedroom, he and his one roomate were sustaining injuries, and were even witnessed in an altercation with Marky as the aggressor. What was the solution according to management?...To put Marky in a bedroom not by himself, but with 3 other guys, much more capable of defending themselves! What happened to Marky was truly tragic, and we all feel for his family for their loss.
http://groups.yahoo.com/group/DDRIGHTS/message/3954


[stanley]”DDS promised a report...anyone seen it...” [paul]“anyone seen it”? I guess this is another way of implying that someone else is responsible for finding it for you?

Implying the promised report doesnt exist...implying no action taken against those resp for creating/allowing the conditions that led to the marky's murder...implying cover up.

implying this is justice...injustice...when all are resp, noman is resp.

stanley seigler

Anonymous said...

"the lawsuit against Goodwin was dismissed. The state settled their part for almost 1 million. It was shown that Lanterman management was negligent...

Stanely,

THese are the words of an anonymous email that you got from zyzzx911@. You post them here as fact.

Perhaps it is accurate, but when a case is "settled" there is no conclusion of law, and therefore a case cannot be settled and also "show[] that Lanterman management was negligent.."

Are you sure that report does not exist?

Doug said...

Oh, boy. The Hitler comparisons are going to start pretty soon, aren't they?

Andy, sorry I missed your comment before. I have polaroids.

Stanley, I suspect people needed firing and someone needed charging in that case, but I don't know anything. Two big arguments against holding DDS primarily responsible for the implementation of the Lanterman Act: 1) We, in the community-based system, don't want to use the DC model and 2) The DC model, as you point out, doesn't even assign blame well, much less responsibility.

Paul, I'm probably with Stanley on this one, although with the caveat that the information I have is not reliable, beyond the initial news report which I recall being about 4 paragraphs: If someone died from violence in a supervised, congregated setting that can't not be a colossal failure of leadership. Whether or not the DA found enough evidence to charge a perpetrator is the DA's problem. I have trouble seeing how nobody loses their job. And unlike ¡Arriba! or other community-based providers, DDS owns Lanterman.

I'll grant this, though, if I fire someone for negligent supervision, neither you nor Stanley are likely to know about it due to a bunch of rights various people have, so I'm not sure no one was held responsible.

Stanley, let's check the thesaurus. "Retards" isn't in mine.

Anonymous, impressive citation. I must miss a lot by not participating in listservs, although, less and less.

OK, everybody, up to the new topic. Godwin's Law is hanging like Damocles' sword over this one.