Tuesday, October 06, 2009

A fair hearing for fair hearings

So, there seem to be vendors in LA County who know that I recently made the executive director of a local regional center angry with a needlessly hostile description of regional center habits vis-a-vis the termination or reduction of services without the prescribed ID team meeting or notification of fair hearing rights. Regarding the degree I exaggerated (I might have said service coordinators never follow the regulations in this situation,) I feel comfortable that I was within the statistical margin of error. Regarding the degree to which my tone was needlessly hostile amid a very strained effort to pull the community together in the best interest of all, I do repent (and did apologize.)

But, while running your mouth foolishly is a terrible pedagogical technique, I mights use the event to talk about the difference between how I, as a vendor, view the fair hearing (and aid pending) laws, which I believe is sharply different from the way regional center personnel hear vendors talk about those laws. Consider this my effort to follow the aforementioned executive director's lead and deepen the partnership between two segments of the community that often don't collaborate or communicate well in good times and have particular need of each other now.

In my experience, by far the commonest way that our services are terminated or reduced begins with a phone call from the service coordinator to the vendor agency. Friends who run agencies throughout the state assure me this is their experience, as well. The client is often left out of the process entirely, even though state be provided a team meeting in which they are to be the leader. At that meeting, if the client does not agree to service termination or reduction of reduction of services both state and federal (for Medical waiver enrollees) law require that they are to be provided notice of their right to appeal, their right to support for the appeal, and their right to continue their service as currently provided until the appeal is resolved, if they choose to appeal. I won't say again that this protocol is never followed, but I will say again that this protocol is rarely followed unless a vendor insists that it be followed.

However, the law is clear, plain and theoretically binding. When someone calls the office or an ¡Arriba! supervisor to say that "I am cutting" or "I have to cut" or "these new regulations require that I cut" services, we are all trained to remind them of the regulations which apply to that process. The result is almost always an ID team meeting at which the SC explains to the client the reason for the cut, the staff make sure the client understands what is being done and, most importantly, the client has the opportunity to review what is proposed, consider what the price will be and then the ID team can work together to look for solutions if the transition will create important problems.

The value of the hearing rights is not necessarily in the hearings themselves. More often, the value comes from the ID team everybody felt too busy to sit in on until it was required. ¡Arriba! staff are forbidden from encouraging clients to appeal, unless the client first states that they are uncomfortable with the change. I have been director of this agency for nine years and to the best of my recollection, our clients have had informal hearings maybe three or four times and formal hearings zero times. But many times, clients have had productive ID team meetings as a consequence of the threat of an appeal. While we are all looking to thoughtfully make the best solutions for our budget problems, I would argue that the ID team meetings will be crucial.

As long as the best way to get a thoughtful, collaborative meeting remains the threat of an appeal, vendors should remain vigilant about insisting on those rights. (Plus, they are, you know, rights.) While a regional center employee might receive reminders of the regulations as antagonistic, from this vendor's perspective, we insist on them for collaborative purposes.

22 comments:

paul said...

Sounds like a great topic for a Townhall Telemeeting

paul said...

In fact - has the internal operations, policies, and procedures of ANY Regional Center EVER been a TOPIC of a Townhall Telemeeting?

I know that there has been some RC guest speakers and panelist, but the topics discussed were implementaion of legislation, rate reductions...all centralized issues.

If Rio can get the olympics, well then....

paul said...

Well – since I have likely violated the Sacred Cow exception to accountability I will, in homage to Andy, provide a trilogie to make my position even more precarious.

Part Un

Doug,

I tip my hat – and I do not tip it often (which should bring me under the curmudgeon exception for accountability, but somehow it has not…).

“Accountability” is bandied about so much it is now officially cliché. To be more specific - holding Sacramento accountable is cliche, while holding others, such a Regional Centers, is as rare as hen’s teeth, especially from a provider!

There seems to be more exceptions to accountability than the application of it.

Tenure Exception
“The people you criticize the most, are the people who have taking the moral stand for longer than you have been around in this field.”

Sacred Cow Exception
“Shhhh…C’mon – its Marty”

Damocles’ Sword
[audit in progress]

Connotative Prestidigitation
“stop playing the blame game, we need to focus on the task at hand” which is ALWAYS money, DDS, money, the governor, money, legislation, money, judiciary, money, and let’s not forget funding..etc.

Nobility Exception
Curmudgeon Exception
Et Cetera..Etc…etc…

“Don’t bite the hand that feeds you”.

Californians working in developmental services have taken this metaphor to their heart of hearts and it has become

“Don’t hold accountable the hand that feeds you, benefits you, or is any closer to you than Kevin Bacon!!!”

This is of course completely understandable given the nature of the political beast called Homo Sapien sapien. Lucky for me I am merely a French Ardipithecus ramidus and get the genus exception. Therefore I am absolved of any blame, accountability or participation. Yes, yes – I know that this exception does not exist in Wonderland were the general rule is that those furthest from involvment with people, and with the least abilty to make any real change are the MOST responsible, but I digress

Alliances form and they agree upon the common causes. There are plenty of instances where accountability for a person’s, or an organization’s, words, actions, inactions, or ineptitudes, should take second fiddle to a common cause or a political alliance. More true is that that plenty IS NOT EVERY!

There is a point when our inactions cast a large shadow over advocacy. That point is when our our adherence to our alliances, common causes, and exceptions to accountability do more to inhibit system reform rather than advance it in any way.

We have reached and have gone beyond that point.

The Golf game of some regional centers has been below par for some time.

It is time to include in a Telemeeting an ARCA representative that will explaining to participants the process that is due under the Lanterman Act when a Regional Center calls a provider to say that "'I am cutting' or 'I have to cut' or 'these new regulations require that I cut,'"

AND if the Law is not followed explain to participants how they may respond.

We dont have to bite the hand, but perhaps a growl by the "action network" is in order?

Part deux

Would we recognize our descent to, or beyond, a place where our advoccy does more harm than good? I doubt it.

Ardi said...

Part deux

Would we recognize our descent to a place that does more harm than good? I doubt it.

One of the many benefits of working our front line is if you hang around long-enough you can eventually become a “director” of something, being nothing more than a a warm body notwithstanding, or maybe even a CONSULTANT. In addition Many advocates have is or her life, identity, and income so completely entwined in our “Holy War” that most are ill-equipped to objectively view our advocacy efforts

Camelot goes to pieces as we praise and glorify our knights fighting the Holy Wars far, far away.

Our knights will soon return and Blogs, list-servers, electronic bulletins will grow shorter and less frequent. After all - Bills have been signed, budgets have been cyphered, and injunctions have been ordered, and there is nothing more than can be done – so we will be told, and so we will believe.

It is soon the winter of advocacy, it is the lonely time of year for our “Advocates” for they pine for February 2010, the year of the Tiger.

Our current culture believes that our ability to improve the lives of people with disabilities is nothing more than a collection of newly passed bills, prospective legislation, promulgated regulations, and the budget. It seems that California’s Lanterman dream has been unable to grow beyond the sum of these parts.

Our “advocacy” usuallly feeds this culture. Can we, will we ever, shine the light somewhere other than Sacramento?

Part Trios
What can we do?

Doug said...

Paul 1, I'd like that.

Paul 2, I think there was one years ago but I don't remember it well. It strikes me that some RC folks were indignant.

Paul 3, we don't have sacred cows here. The bull is sacred on this site. I'd note that you rightly include criticism as accountability but that there are other forms. I think we will know our advocacy is a net negative when we start a blog on the topic.

Paul/Ardi, The nice thing about becoming a consultant or executive director after doing a bunch of direct care ought to be understanding that neither legislation nor rates are the biggest parts of helping people. Unfortunately, a lot of have CRS syndrome (and I should admit I have more experience as a director than I do as a direct care person. By a lot.)

paul said...

“I should admit I have more experience as a director than I do as a direct care person. By a lot.)”

I am sorry.
At each step I took a step away from consumers I was able to see a little further beyond the horizon. That experience was not too pretty.

Part Triox

What can we do?

A lot of things – each with varying and little to no chance of success.

When things generally do not seem to be working or going well, as I would argue is the case with California’s developmental services, it is sometimes helpful to not look at what is being done, but rather what IS NOT being done.

We recently learned about a Temporary Restraining Orders and Preliminary Injunction. Hopefully soon we will learn about permanent injunctions. We have learned the name and address of our representatives, the “Who’s Who” at DDS, the Budget process, and the song, “I’m just a bill – yes I’m only a bill, and I’m sitting here on Capitol Hill”

We are encouraged to hold our representative, the governor, and DDS accountable – “Accountability WITH Action”

These are good things, and such attention is necessary.

We DO NOT know the names of the board of managers of our local regional center. We DO NOT know the names of the board of managers of our local providers unless they make the news when an unfortunate video gets posted on YouTube, or a staff person beats a consumer to death, or grow wealthy. When we do hear something other than the usual tune the music IS NOT brought to us by our “advocates” but the front page of the LA Times, or a Senate report we "coincidentally" hear nothing about.

It is people CLOSEST to the issues that usually have the greatest power to make change. Drivers of automobiles can do more to reduce accidents than laws setting speed limits and traffic rules.

Direct Care staff, and there supervisors can do more to improve services than legislators passing bills mandating this and requiring that.

The Lanterman act, like most laws, relies on the honor system for compliance. Since most providers and Regional Centers are filled with the relatives of people with disabilities our lack of success is somewhat sad.

The enforcement of the Lanterman Act and services to people with disabilities was designed to be primarily enforced outside the halls of Sacramento through the planning team, regional centers, providers, and other circles of support.

It can be strongly argued that support for this formula has been lacking over the years. Even if this is the case it DOES NOT explain our almost complete departure from the architecture and formula presented in the Lanterman Act – voluntary enforcement on the front lines.

While funding and updated/revised/changes to statute and regulations may be necessary it will DO nothing to prevent a provider from KNOWINGLY or negligently violating the letter or the spirit of Lanterman at the Regional Center or provider level.

Our patchwork of “fixes” that result from the failure of systems we hear little about, and our current culture, has created an almost completely centralized system. We now seem to have all the downside to centralization without any of its benefits and all the downside to privatization without any of the benefits. How could this have occurred? Only one way.

Our system, over the last 30 years, has been molded and modified to predominately benefit everyone BUT people with disabilities.

Our paths of accountability have become blurred by our efforts, and our desire to apply accountability equitably and properly has been reduced by our “advocates” who tell us that our “proverbial mousetrap” is wonderful and all that is lacking is the political will of Sacramento. This is willful and intentional Bull Shit.

paul said...

Part Triox.1

People can spend years as managers, directors, or board members of providers and Regional Centers and seem to gain little more from it than learned helplessness.

Our consultant and advocates are NOT chosen by their ability to help people with disabilites, but the to wave the same old flag.

Do we really have “advocates” or something else?

A lobbyist is an activist, that is usually funded by an interest group to promote that groups positions to legislatures. A lobbyist can also work to change public opinion through advertising campaigns or by influencing 'opinion leaders' or pundits, thereby creating a climate for the change his or her benefactor desires. 'change' to not necessarily benefit the consumer, and sometimes benefits many others at the expense of the consumer.

When we consider the fact that almost ALL our attention is focused on Sacramento it is safe to say that we DO NOT have advocates, but lobbyists.

Our labels, “Accountability WITH Action”, “community action network”, “alliance for inclusion” do more to keep the acolytes pointed in the "right" direction, towards Sacramento, and away from equitable and balanced accountability.

We do not need to cease holding our representatives accountable!

But WE DO need to start, just a little, to hold those closest to people with disabilities accountable, those with the most power to make a difference on a daily basis.

To disuade such accountability makes one part of the problem

Doug said...

Paul, there's a lot there but one thing I want to highlight in your comment is that I have come to a similar conclusion about the centralization/distribution. The system is a hybrid of distributed, market-based mechanisms and traditional central planning. It seems to me as well that at each pass, the decisions are made to move closer to the traditional central-planning model.

I think you will agree with me that advocates for the clients and direct care staff help to push things that way, and those would normally be the people trying to widen decision-making. I'm curious and really can't explain why that would be so.

Doug said...

Oops. Cross-posted.

I'll agree somewhat with your second comment, too. I think there's a conventional wisdom in our community that we have to win on funding before we can address process. I've said for years how much I disagree with that and will again today. I really disagree with that. The system we want might well be better and cheaper than the one we have, and I doubt very much that this system will ever be funded to do things as we now do them well.

paul said...

“I'm curious and really can't explain why that would be so.”
-Doug-

Well – at the risk of playing armchair psychologist I think the answer is ironic, but not very novel. Positive Reinforcement

The reason it continues, IMO, is our complete lack of any effective checks or balances to normal human tendencies to “self-deal”

Part quatre

Why do our best solution have little to no chance of success?

There is A LOT of money to be made, and those that have focused our attention exclusively upon Sacramento, at the expense of a more rounded and complete accountability, have growing success both financially and personally.

Each success, each notoriety, gives our lobbyists, regional centers, and some providers more power to entrench themselves as a sacred cow and ensure continued success.

While the media can help provide a check, and some accountability, upon ourselves there is a fundamental problem here.

1. Most people simply do not want to hear about the plight of people with disabilities in a politically charge byzantine system, not even the relatives of those served.

2. Reports are easily spun to imply that the messenger HATES people with disabilities, supports institutionalization, or is a compassionate conservative.

When we hear about bad group homes readers scream “BIAS!” because the article didn’t include all the successes of “supported living”.

When we hear that a staff beats to death a young girl we hear yells of BIAS because the story did not also include all the young girls that WERE NOT beaten to death. [insert IM “confused” face here]

Nobody – ESPECIALLY family members want to made to appear to not care. It is MUCH easier to keep our focus, criticism, and accountability focused on a the “task at hand” a city far, far away and towards those impersonal that are all but non-existent, and so very, very EVIL.

All this will continue with ease because we we lack effective checks on ourselves or balances. Checks or balances do not have to be formal, but affirmative action is needed to ensure they exist. Where we do have alleged checks and balances we often find only vestigial systems that provide only a facade of a check and/or balance. In the words of Peter Drucker, most of our boards have been reduced to an “impotent ceremonial and legal fiction”.

The fact that we may have many impotent and ceremonial boards of managers running our regional centers and providers is not our downfall or the driving force behind our culture of impotence and inertia. It is HARD to form and maintain such systems!! It is said that one thing that all boards have in common is that they do not function.

In our case, it is not our dysfunctional boards that is the real problem, but the complete lack of the recognition of how difficult, yet how important, it can be to have a group people that have a real ownership interest in the ORGANIZATION (this is something beyond their child's participation in that organization) and desire to effectively govern that organization through it rights and obligations.

We cannot plan a trip around the world if we do not first recognize that it is round.

Doug said...

It's round? I'm woozy.

So, a question, meant interrogatively: Would it help if some of us denounced others of us?

paul said...

"Would it help if some of us denounced others of us?"
Doug

My thoughts:

Generally: NO

Against egregious violators (intentional lying, intentional subterfuge, reckless disregard): Tempting, but probably not

As a tool of last resort: Cant hurt, probably wont help, will definitely feel good.

We are already do so towards Sacramento and the “positive reinforcemet” [feel good – stand well in they neighbors eye (e.g. I shriek therefore I care..) will likely increase such denouncement in the future.

We have not yet made any attempt to alter our cultural slide towards arbitrary accountability. Ironically, we have used the word “accountability” to gain less of it!

From the hip:

Accountability need not be adversarial or laced with blame. It certainly need not contain denouncements. Accountability can take the form of a simple question requesting clarification. If someone even TRIES to clarify they may discover that they cannot justify or explain a position or comment and change direction – likely to a more positive direction.

Sometimes Accountability can be simple to ask “why” for often it is more important to understand why we believe what we believe that what it is we believe.

Asking WHY should not cause such a kerfuffle, or cause anyone to spit the dummy. When our Sacred Cows start to deify themselves so much that they are not only above ANY reproach, but even above being asked “WHY” we are almost beyond repair.

Everybody has a lousy day and even someone as charming as myself or Stanley can be a bit gruff at times. Its going to happen, but when that happens there often is, should be, a simple frown.

While someone can be burned in effigy for simple asking “why” our blue bloods can lie, cheat, and steal with little response.

I think that we should learn to “frown” a bit, in a different directions, before we begin to “denounce” people

Doug said...

OK. I'm a pretty fair frowner.

paul said...

"OK. I'm a pretty fair frowner."

But doug - would you agree that being a fair frowner is the easy part?

Is it not more important to fairly frown at those that deserve a fair frown for what they did/do/or are planning to do, NOT who they ARE?

Doug said...

Paul, I have no children, but my view of child-raising is that kids should be punished when they do nothing wrong so that they will understand at a visceral level what will happen when they do something wrong. Likewise, I think people should be frowned at for being within frowning distance.

stanley said...

Difficult for a low functioning (possible on some spectrum) parent to determine the issue in the so far enjoyable 15 comments...butbutt, to cut to the proverbial chase, if/and;

It’s aboot local v Sacramento accountability...ie/re, paul say: holding Sacramento accountable is cliche, while holding others, such a Regional Centers, is as rare as hen’s teeth...then;

...some insight/recommendations how one lo functioning parent can hold 21 RCs and untold providers accountable vice holding sacremento (DDS) accountable...is very much appreciated.

an ad nauseam repeat: 4434b say: The department [DDS] shall take ALL necessary actions to support regional centers to successfully achieve compliance with this section and provide high quality services and supports to consumers and their families. http://groups.yahoo.com/group/DDRIGHTS/message/4664

seems holing DDS accountable to enforce Lanterman is the most direct approach.

BTW this lo function parent did hold RC (NLACRC) accountable for daughter’s 1:1 support in a fair hearing...which would probably have been lost if not for a call to DDS.

stanley seigler

paul said...

"It’s aboot local v Sacramento accountability"

NO - it is not. I think this dilemma is a false one...

stanley said...

Based on paul say: holding Sacramento accountable is cliche, while holding others, such a Regional Centers, is as rare as hen’s teeth...

stanley assumed there was concern advocates tended to hold DDS accountable while letting RC-etal off the hook (It’s aboot local v Sacramento accountability)...butbut

Paul say: “NO - it is not. I think this dilemma is a false one”...

so will reread in hopes of finding the issue

stanley seigler

Doug said...

Stanley, I'd say Paul is mostly talking about holding advocates accountable. In general, I'm fer it.

stanley said...

[doug say] I'd say Paul is mostly talking about holding advocates accountable. In general, I'm fer it.

Me too...also agree it’s as [paul say] Accountability can be simple to ask “why” for often it is more important to understand why we believe what we believe that what it is we believe.

Advocates need to make it a hard ball “why”...NOT the “heck of a job brownie” but “why”...,eg;

what's his name on his promotion (why promoted) was given a “heck of job brownie” for, at best, maintaing the status quo on his watch as DDS director...compare beginning and end of his watch: 1998 SF Chron and then HCFA reports and the 2006 Broken Homes articles... andand;

what's her name is praised for continuing the status quo and recommending cuts to DDS programs and leading legs to believe the cuts were stakeholders’ idea (see ARC alert)

and/oh, there is no status quo, systems either progress or regress...

the issue gets/is confusing...my “why” relates to holding DDS responsible, the cliché mentioned...

so back to need for: some insight/recommendations how one lo functioning parent can hold 21 RCs and untold providers accountable vice holding Sacramento (DDS) system accountable...

goes w/o saying daily “why” asked by stakeholder of RC/providers...eg, why is my daughter dressed like that, why weren't her teeth brushed, why isn't she smiling, etc...but;

for system changes seems focus should/has to be on the cliche, DDS...ie, and repeating: how does an advocate ask 21 RC and untold providers “why” the system does not function as intended by Lanterman...eg;

I ask andy/doug, NLACRC director “why” and what does it get the system...

sincerely looking for approaches, not arguments...who should ask who “why” and who “we white man”

stanley seigler

Doug said...

Honestly, Stan, I'm not sure I would ask DDS, 21 RCs, 8000 providers or 250,000 clients why. It seems to me, the system function as it does because of how it was set up. There's a web of entitlements, accounts, policies, boards, providers, media, clients and families that taken together make this system work this way.

Listen to the advocates from anywhere, including the legislature, and ask yourself what they are asking. Mostly I hear we need more money.

It seems to me that if we want to drain the swamp, we need to look at the swamp, not the crawdads.

stanley said...

[doug say Listen to the advocates from anywhere, including the legislature, and ask yourself what they are asking. Mostly I hear we need more money.

if we are to believe paul we hear much about accountability as well. [paul say] “Accountability” is bandied about so much it is now officially cliche. To be more specific - holding Sacramento accountable is cliche, while holding others, such a Regional Centers, is as rare as hen’s teeth, especially from a provider!

[doug say] I'm not sure I would ask DDS, 21 RCs, 8000 providers or 250,000 clients why. It seems to me, the system function as it does because of how it was set up. There's a web of entitlements, accounts, policies, boards, providers, media, clients and families that taken together make this system work this way.

“why” is shorthand for questioning the status quo and solutions searches...attempting to determine why no one is held accountable...why is accountability only a cliche...

with this in mind, feel sure you would/do ask DDS, RCs, providers, clients: WHY. Why is there “a web of entitlements, accounts, policies, boards, providers, media, clients and families that taken together make this system work this way”...make the system dysfunctional.

Making the system more functional (and back to original subject)...

[doug say] While we are all looking to thoughtfully make the best solutions for our budget problems, I would argue that the ID team meetings will be crucial.

The ID team is most crucial to many (not just budget) problems/issues...WHY isn't it used as intended by Lanterman...the ID team is the key to making the system functional...WHY hasn't DDS insured the ID team functions as intended...why don't providers, clients demand it be used as intended...

WHY do RC bad habits re the ID team exist...ie;

[doug say] regional center habits vis-a-vis the termination or reduction of services without the prescribed ID team meeting or notification of fair hearing rights. Regarding the degree I exaggerated (I might have said service coordinators never follow the regulations in this situation,) I feel comfortable that I was within the statistical margin of error

the ID team can/should be used in determing quality of life...not just in termination or reduction services issues.

Providers dont stress ID team/IPP value...weel at least one, (valley village), who kicked my daughter out of their program without ID team involvement, made the ID team a provider organization...it should be understood by all that the ID team is a client organization.

stanley seigler