Because a new post is sorely needed

I apologize to the few but loyal readers that not much has come to mind to write about here. There's big news about Lanterman Developmental Center, of course, a topic on which I don't feel qualified to opine about.

But, in the post below, Godwin's Law seems to have reproven itself and the phrase "dead white male philosophers" has also appeared and I feel ready to propose my own Doug's First Law of Internet Discourse: To wit, no subject is so arcane that common platitudes won't dominate the discussion once the topic has been exhausted.

So, lacking anything else to mind, I'll open the thread to you all with three questions:

First, if anyone out there has interacted with the Delatorre audit, I'd be interested in hearing about the tone and rigor of the inquiry. Can anyone tell how well-informed the study has been or whether it appears vindictive or exploratory?

Second, if self-determination/directed-services is no longer an available option for streamlining and improving the system, what would you all suggest as a conceptual frame for intentional systemic reform?

Third, an anonymous guest suggested something I absolutely agree with (and have agreed with in previous posts,) that more funding won't fix a broken system. Anonymous suggests Stanley's answer to the question, but I am curious for two sentence answers: Do you all think the system is primarily underfunded or primarily broken?

Some etiquette: Let's start by answering one of the three questions (as opposed to two, all or none) per comment, begin by identifying which question you are answering and, if at all possible, consider the poor blogger who feels compelled to read all the comments and try to begin with two- or three-sentence replies.

I'll try to come up with a new post before anyone begins comparing department directors to war criminals.

Looking forward to 2010

Well, heck. The new year will bring new cuts. We all have known that for a while and none of us have any excuse for not being ready for them. I just updated my resumé, for example. I do hope people understand that the next round of cuts proposed might eliminate entire programs and, perhaps, state departments. But for my optimistic year's end post, I'd like to suggest criteria for guessing whether DDS thought through the cuts it is about to propose:

If the cuts proposed have been (tragic but) thoughtful:

1. Rates will compress toward the low end, not fall by a fixed percentage.
2. In explaining the cuts, resistance by large lobbying organizations won't be mentioned.
3. Those will be least affected who are most urgently in need.
4. The package will contain not only clear descriptions of what regional centers are to do differently, but enforcement mechanisms for reining in inventive interpretations or, at least, an expressed and manifest willingness to publicly side with other stakeholders some of the time.
5. Andy Pereira will need to think a short while before ranting.
6. Some non-residential agencies may actually close.
7. Contrary to the "furthest from the client" meme, the scope of support will narrow more than oversight fades.
8. Many members of the cost-cutting stakeholder group will complain that they weren't listened to and mean it this time.
9. The interdisciplinary team (IDT) approach, Individual Program Plan (IPP) primacy and fair hearing rights will be strengthened.
10. The limits on the IDT and IPP will be clarified, in terms of requiring a clinical and practical rationale for support.

To expand on my thinking (apart from my comment about Andy- you just gotta know Andy,) ideology will not produce a budget solution nor a human solution. To get both, consideration must be applied to efficiently shrinking the system, maximizing cuts realized (rather than scored) and minimizing disruption acknowledged (rather than ignored.)

The first challenge is that we have spent years in denial that any change to the system is necessary and one result of that is that the map of the system isn't much more detailed than it was 9 years ago when I got here (and when the map showed "Here be dragons" across the state.) So there is no real possibility that the changes to be proposed will be wise or wholesome.

That said, some common sense can be applied. It is clearly better to retain a decreased number of low-cost support agents than to continue trying to keep all the state's executive directors employed. This is why a downward compression of rates is wiser than a fixed reduction and why it is better to restore the clinical and practical requirements to the scope of a client's service than to list categories of service to be discontinued.

Because we can't describe our current reality (without lying, exaggerating or generalizing beyond the scope of surrealism,) it is important to retain whatever intelligence the system does feature. This is why both quality assurance and the ID teams remain an important feature. There's also some hope to be had that if the system shrinks more than its smarter features, the system itself can grow a little less mystical in process and product.

Likewise, for the system to grow smarter it is absolutely mandatory that regional centers grow less glib, for clients to have clear understanding of new limitations and for some agencies to close. But the most important factor is that stewardship of this system and its resources for the benefit of the people served has to improve for the remnants to matter. Which is why such proposals as an x% rate cut across the board or the evacuation of regional centers will prove a lack of good thinking by the administration.

Of course, this budget is bad enough that we just have all non-residential care proposed for elimination. In which case, dangit.

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.

Mr. Manners and five budget cutting taboos

The following is my first ever attempt to opine on good manners but, clearly, we need a new post up and this is what I got.

Brother Doug's Behavioral Tip for DDS:

When Regional Centers are wrong, be strong. In the past, Regional Centers have acted variously with regard to the need to cut costs. Some have been consultative and careful. Others have behaved as stupidly, precipitously and imperiously as a rabid whippet in a fox' den. On those occasions, DDS (as well as Disability Rights California) have been worse than useful so far as I can tell. I can only assume DDS allows regional centers their heads (wooden and otherwise) based on the idea that nobody comes willingly to cuts and other stakeholders will be fractious and unwilling in any case. I think this is a mistake.

When Westside Regional Center came out with their (dismal) expenditure plan years ago, many of the elements were clearly in violation of trailer bill language. Nonetheless, DDS was publicly supportive and despite that support, the community was fractious and rebellious and it took months for any POS behavior to change. As a counter-example, San Gabriel/Pomona Regional Center got upstream of some cuts by making them collaboratively in a forward looking way. Of course there are some yet to make, but I would wager that by working with the community, some spending reductions are already realizing savings and have done so since May without much rebellion and, so far as I am aware, any needless loss of life and welfare (as I was sorry to witness when FDLRC made it's expenditure plan without resistance.) Any strength DDS shows in preventing regional centers from too much expedition is likely to be rewarded with client welfare and more savings.

Dom Douglas's Tips for Regional Centers: Get in the habit of respecting the rights of clients and what wisdom there is in vendors and family members. As above (and in the post below) the imperious, expeditious management style is likely to be expensive, inefficient and produce needlessly sorrowful outcomes. I know most if not all of you think that all clients and vendors do with cuts is complain and resist. As a vendor and a family member, I would that we're only bumptious when laws that don't exist are given as reasons for things we hope to avoid. Generally, the community understands why there are cuts but we want them implemented as thoughtfully as possible. Most regional centers have never tested experimentally what would happen if a collaborative, person-centered approach were taken. Most other stakeholders have an evidence basis to doubt that pushy regional centers will do much well or right. Now is a good time to learn collaboration together.

Cousin Doug's epistle to other regional center vendors: To the degree that Regional Centers will work with us, the clients will listen to us and the DDS will defend, act also in good faith. It is not our place to provoke clients and antagonize service coordinators who have reached a mutually successful agreement. Those clients who need our help defending needed supports continue to have the right to a fair hearing. We will make much better advocates for those clients that need defending if we don't try to create clients who want defending. It will be harder for our detractors to accuse us of refusing to give up units of service if we show discretion and good taste. This year will stink financially for direct care providers and their bosses more than anyone else in the system, but the system doesn't owe us a living, either.

Ole' Doug's advice to clients and their families: Understand that everyone supporting you is under stress. This doesn't require apology, gratitude or certainly not the stifling of grievances (we need grievances expressed now more than ever.) But remember that however foolish, selfish, useless, youthful, greedy, controlling or impenetrable the professionals around you might be by nature, there are forces pressing us to be worse. If our behavior were personal, it would be much better.

To my friends in the chamber of commerce: Ironically, the most expensive ways we do things tend to be the least integrative of people into the community. The best ways we can implement our budget cuts for fiscal purposes and/or to preserve the value of the system will be for you all to see more of us. Take this opportunity to make new friends, employees and customers.