Diamonds and dirt are forever.

If you want to level an accusation against regional center vendors generally and be confident you can make it stick, this vendor recommends "They suffer fools far too gladly." Westside Regional is in its, approximately, fourth attempt to convert Independent Living Services (currently service code 520, for those keeping score in your programs) into a standardized supported living-like program funded at a flat rate.

There are many astonishing aspects to this: the durability of demonstrated bad thinking, the ascendency of paperwork over people in the proposal, that the initial public conversation about each attempt always begins with a plan rather than a request for insight, the ivory-tower thinking of a community-based non-academic institution, the failure to account for client rights or the passive acceptance by vendors of a plan contrary to their own interests, hypothetical values and the needs of the people they serve. It's a little hard to pick out the worst aspect of this iteration and probably not worth the effort.

A little history, to be read as though it were in the oral tradition because I don't have time to fact check. Some time, in or around 2001, it was explained to me that Westside had conducted a pilot test of flat-rate ILS but that in the evaluation it was discovered that vendors did, in fact and strangely enough, respond to incentives and underserved their clients. Clearly, flat-rate ILS was an experiment that failed.

Nonetheless, the proposal returned from the grave twice more before now with the added twist of requiring the ILS vendors to become SLS vendors without changing their scope of service, except perhaps, to add 24-hour emergency response to replace the Regional Center's. On the first of these occasions, DDS was made aware by vendors of the proposal and a message was sent through vendors that the proposal did not appeal to the Department and could not be supported under the regulations. The second time, a letter was sent by DDS with the same message. Part of what makes this proposal so mystifying is that it seems to have no consituency beyond the Regional Center bureaucrats. If it were a tolerable cost-reduction scheme, DDS, at least should have liked it.

And here we are again. I was not present at the vendor meeting where the latest draft was announced, but as it was reported to me the Westside vendors offered no resistance. Maybe they see something I'm missing, but based on my reading of the proposal I can only imagine that either the vendors agreeing haven't thought the proposal through or they already know they'll cheat.

The plan calls for a minimum weekly activity with a flat rate covering that effort or more, plus a significant amount of paperwork beyond what is called for in regulations. On an hourly basis, the rate equates to $35.71 per hour, as a long term average, is higher than many ILS agencies receive but less than what others receive. However in long months, that rate will fall to $30 which, while higher than ¡Arriba!'s rate, is lower than most. There is no compensation for the extra paperwork and no allowance made for even small spikes in service, need or planning requirements (A medical appointment, court date or an SSI appeal can not be accomplished in increments of one hour.) If an agency provides even a small number of hours beyond the minimum, the effective rate is likely to fall 30% or more from their state-set rates. Furthermore, by requiring the activity to be weekly, the proposal would prohibit agencies from concentrating sparse hours to reduce the cost of paid travel between clients. This is why I am certain that agreeable vendors must either be fooled or frauds.

There are massive problems afflicting the proposal with regard to the rights of clients. To eliminate vendor code 520, and implement the new reporting requirements, the regional center would need to a) not inform clients of available alternatives, b) cancel services categorically, c) cancel existing services without ID team meetings and due process. All of these steps are necessary to implement this proposal and none of them compliant with existing statute, relevant regulations and/or federal law (in the case of Medicaid waiver clients.)

To summarize, this proposal has a long history of failure, is illegal, hypocritical, unhelpful and impractical.

And yet, there is value in this proposal: It is a perfect example of why innovation fails in this system. While there is no explicit goal for this proposal, beginning the conversation with a purpose and developing, in collaboration with vendors and clients, might have led to a solution with the possibility of a positive outcome. You can almost hear the voices within the regional center saying "we have to make our plan internally and then announce it as a done deal or else the vendors will just put up obstacles." By making that choice, they've left us with no alternative.

It may be worth noting that the Executive Director of this regional center delivered a scathing criticism of vendors for not providing attentive, responsive and individualized support at the New Day conference in 2005. Hopefully, the irony that he is overseeing a persistent effort to standardize the individualized services Westside can offer is amusing to someone.

Train Campaign

What is clear to almost everyone I know who is involved in this system is that training follows only good people in importance when it comes to quality of care. What seems to be clear to a lot of people other than me is that large amounts of formal training in a standardized statewide mandate will help a whole lot.

Recently I have been made aware of campaigns or suggestions by The ARC of California, the California Rehab Association and the Consumer Directed Services Network (CDSN, an ideological fellow-traveler with the Service Employees Internation Union (SEIU) all of which have proposed funding access to curricula from The College of Direct Support (CoDS.) One proposals would mandate the training for everyone, one requests funding, and one would implement a pilot project through an Assembly Bill, AB 1427 which offers a rate enhancement for agencies whose employees, among other requirements, complete 200 hours of online training. I can be supportive, generally, of access to the CoDS curricula for staff but am generally dour regarding both the prospect of a statewide mandate and the amount 200 hours.

The most peristaltic reaction I had is to the idea of the mandated training. Anyone who is in the professional or receiving end of client-centered support learns quickly that almost no knowledge is universally applicable. Some small number of techniques for more quickly and usefully establishing communication between staff and clients, such as Essential Lifestyle Planning may be of universal application but almost nothing else is. So one obvious drawback to a statewide curriculum is efficiency. In one-on-one, person-centered support the majority of formal training will be useless between a given staff person and a given receiver of services. Less so, but also, this will be the case in congregate services, however standardized. Spread requirements for training across a system serving over 200,000 individuals and the waste must be in the millions of dollars at least. The current system clearly doesn't want for waste or wasteful suggestions which are both in great supply and substantial demand.

The second concern, related to the first is the general one I carp about regularly. An effective system of delivering value to individuals must allow that individual to define the value. Statewide training mandates are one more large intrusion into the time, funding, and attention of those who offer and receive services driven, devised and defined by strangers.

A final concern, and this one takes in the AB1427 proposal in its current form is the matter of whether formal training not required by the task is good, bad or neutral. They say if you have a hammer in your hand, everything looks like a nail. My concern is that providing tools by training will influence the suggestions staff and managers will make, what problems they see to solve and how they approach those problems. At some point, the standardized curricula may detract from quality of care as easily and often as they help.

Training is important but only helpful when helpful. Standardized curricula can be harmful and are far less likely to be helpful than either informal training or formal training prompted by the needs and situation of the service user.

My suggestion is that more appropriate training is the change worth seeking, measurably better training a laudable goal and more training shady in the typical way.

Inclined to agree

When meeting the obligations of the community-based system is projected to cost more than the budget allocated, the Department of Developmental Service (DDS) is required to file a "deficiency request" with the legislature to request an appropriate additional amount. In January, DDS submitted such a request for the current year.

Senator Dennis Hollingsworth, a member of the Senate subcommittee to which DDS' request was presented sent a letter to the rest of the subcommittee stating his opposition to roughly two thirds of the request because it was not accompanied by any attempt at reform.

I don't know if Senator Hollingsworth and I would agree on what reform means, but I agree with him that this system has proven we will not spend our way to excellence. That war is lost whether we continue to have battles or not. If the community won't fight for reform with the same vigor that we've fought for money, the "reform" will be a familiar, unconstructive, unproductive, inefficient, damaging, depressing and/or diabolical one like the Purchase of Service Sandards of the past which will damage the lives of indivuals without saving money. Better to ask for a leaner, more person-centered support system focused on adding value to the lives of people with disabilities with less regard for the institutions involved.

We can win that war, if we'll fight it, because excellence, unlike the current system, is sustainable.

Peer Pressure

I have already been reminded that those who are friendly towards me expect a more biting review of the conference than the one below. Please forgive me, friend, for forgetting my place. There's no better metric for the failure of the conference than that.

To be more biting means to be a little repetitive, because the weakness I found were those I predicted in this space, but to recap.

Wrong format and content: It is pure vanity for anyone to believe the substance or particulars of that conference are change agents or that the conference itself is a change agent. The truth beyond the fiction presented is this: No one working in this field needed this conference to learn the words "dignity," "meaningful," "individualized" or "appropriate." No one there needed models presented to provide dignified, meaningful, individualized and appropiate support. None of us missed the transformation from doing to to doing for to working with to working for people with disabilities. What we needed, need and don't have is a system in which the right, effective and most valuable support prospers and the deadening one is entombed rather than the person served.

What exists now exists as it does because the supports now offered are adaptive to the environment. Like gum chewing in a lecture hall. If we want change, and I think we're sincere about that, we have to change the environment and I don't believe we are sincere about changing the environment. We want to watch from under the sea as our issue prosper on land.

Look at the conference. Dignitaries, experts and other charlatans speaking from a lectern about listening. The conference was a site-based, segregated day-program using generations-old prompts to modify behaviors.

The topic is not what to do differently but how the system needs to change so that we can all get what we claim to want. When a system changes, every element within it changes in form, function or both. Regional Centers have to change. Providers have to change. Clients and families and DDS has to change. First change? Learn to use question marks. If the Devil were a question mark, it would have been the cherubs that fell.

Wrong Message: The message continues from last year. That the failure of the system is a failure of imagination. Or a failure of willingness. This is not true. All over the state are clients who know what support they want, unmatched to the many providers ready, willing and able to provide that support. It's not even a failure of will. The failure is to ask why the system doesn't tolerate the services we all imagine and how intolerance can become encouragement.

Glossary:
ADAPTIVE, adj. Expedient. Ethical.
APPROPRIATE, adj. Traditional.
COURAGEOUS, adj. Selectively submissive.
DIGNITY, n. A shimmering blanket draped over the head of the pitiful to reflect the beauty of the beholder.
INDIVIDUALIZED, adj. Filled to taste, as a glass from a vat.
MALADAPTIVE, adj. Inconvenient.
MEANINGFUL, adj. Fully funded.

The Second Semi-Annual New Day, Summary

On the whole, the conference was as I expected, although the session entitled "What do I do now that I'm out of High School?" was constructive. It covered a project working within colleges to integrate people with developmental disabilities. It's not clear how truly integrative the project has been but the outcomes they tracked demonstrate that the project seems beneficial. If the consortium working on that project presses, improves and changes, integration might grow within it.

For those who asked why I listed Limericist as my title, I answer:

When you preach to the choir from the dais
Always make sure what you say is
What they want to hear
Or at least as near
As you can so you don't end up payless.

Newish Day, Day 1 in the Garden

I feel pretty good about my prediction for this month. Report from today: Imagine 5400 fingernails on blackboards. The problem with a Regional Center-organized conference is that conferences, by nature, tend to built on the assumption that the speaker's have the authority of pioneers and regional centers, by nature, tend to use pioneer era thinking. I've spent the last six hours, with the exception of Kim Belshé's presentation of the Governor's health plan, being encouraged to boldly imagine the world I live in already and be fearful for nothing. I don't drink, but I wish I did and may yet tonight.

The second semi-annual new day

The New Day California is a brand new, efficiently aged institution. The purpose is to urge other people to do what they ought without discussing why they don't. The 2005 conference featured some swell keynote speakers, two preposterous luncheon speeches on the second day and one highly valuable outcome. People who attended said it was grand. I'm looking forward to this year's conference equalling the previous one and will be sharing my observations live.

At present, I'm in a chair awaiting the first general session. Nice padding.