Speaking of dialogue, a fable

The Coyotes, The Foxes and The Wolf

Once upon a time, in the east of the county, there was a fox hunting ground. The land was full of rabbits and the foxes lived well. One day, a wolf came and started eating rabbits and howling at the moon. The foxes feared that the howl would attract human hunters who would take all the rabbits and leave the foxes to starve. So the foxes snuck up on the wolf and quickly tore out his throat.

All was well in foxland until a pack of coyotes came and started hunting and baying. "We must get rid of the coyotes like we did the wolf," said one fox.
"There are too many and they're bigger than us," said another.
"I have a plan," said a third and all the foxes saw that it was a wise plan.

The foxes sent an emmisary to the coyotes to suggest a conference on sustainable lagoculture. For their empowerment, the fox ambassador suggested that the coyotes as immigrants should convene the planning committee which would develop, identify and elect the steering committee for the conference.

Moral: It is kinder to silence your neighbors by fang than by forum.

Oracle

The new legislative year is underway. Having consulted a crystal ball, or at least a coke bottle, I feel confident making the following prediction about the course of advocacy this year:

January: The first post of the year on Developmental Disability System Reform will post on or before the 22nd. This marks the traditional start of the Advocacy Calendar.

February: The 2007 A New Day California conference will promote a new approach to day services with a curriculum based on the assumption that change lags for want of public hectoring to encourage it. Various dignitaries and assorted charlatans will cure the disease but the symptoms will continue unabated. The Service Employees International Union (SEIU) will propose legislation to expand membership and stimulate activism at the California Rehabilitation Assocition (CRA.)

March: Many parts of the advocacy community will press for system reform, defined as funding increases.

April: Many parts of the advocacy community will press for system reform, defined as rate increases.

May: Upon release of the Governor's May Budget Revision and the "discovery" that costs and revenues are further out of balance than previously "thought." The advocacy community will press for ending the rate freeze, defined as system reform.

June: The budget will not pass by the constitutional deadline.

July: The budget will pass and will be okay except from an accounting standpoint.

August: Meetings will be held to develop a white paper on system reform.

September: Legislators will be educated on the needs of the system by advocates, then locusts.

October: There will be a vendor-organized conference based on the assumption that change lags for want of public hectoring of regional centers. Less luminous dignitaries and charlatans will address that deficit than will have at the ARCA conference.

November: An ILS agency Executive Director will turn 40 and wonder what's taking so long.

December: Meetings will be scheduled for the purpose of getting a head start on next year's advocacy and then postponed until February.

Lessons from 2006

Here are some things I learned or had (re)confirmed this year.

1. DDS is so angry at my writing about self-direction that they dropped CADDIS during my vacation to make me look stupid.
2. People with a taste for real change aren't always who you think.
3. System funding is as much an emotional issue for people as it is a practical one, but chocolates and flowers would be cheaper and more helpful.
4. "Efficiency" is a word people love to say and hate to hear.
5. "Accountability" is another.
6. Connecting people is the heart of every important reform.
7. The job of helping people with disabilities to live more fully is still worth doing.
8. The job of changing our system so it helps people with disabilities live more fully is most glorious because it is so unlikely.
9. Some people think living in solitary idleness in your own home is so much better than living with friends in a segregated setting that no one would ever choose the latter even if it came with a large stipend and DSL.
10. Saving the current system and funding it better is an errand for a superior and more committed fool.

Further on the topic of choice

On the topic of choice, I have expressed some opinions. I would like to elaborate on a related issue. In weighing the relative merits of choice and integration, I still remain committed to the idea that choice should trump and that neither the State nor Regional Centers, nor agencies have a compelling enough interest to push integration on those who prefer to live and receive services in a segregated system.

That said, after hearing a very compelling speech just yesterday on the topic, I also agree with two embellishments on that position.

The first additional point is that the boundaries of choice as a policy goal may vary in the advocacy of different people, but these distinctions are philosophical not moral. I may disagree with those who believe the state should differently fund integrated and segregated services in order to support the choice of integrated services, but I do so on practical grounds and with no truer compassion or greater honesty than those who take the opposite position. To the extent that state, regional center or agencies believe they have a compelling interest in limiting choice to a more integrated environment, it is appropriate for those entities to better support integrated services than segregated ones.

The second additional point I'll confess is that I agree absolutely with value-based funding as an improvement on the collossally irrational system we have now. I also agree that the supports necessary to sustain people with developmental disabilities in integrated lives are more valuable than those that support the same individual in a segregated setting, given that the former is harder to accomplish. If integrated services were to receive biased funding in their favor on the basis of value rather than cost, I could support such a policy.

OK, satisfied, J? And I posted in November, too.

Self-Directed Services (SDS) Regulations, an update.

The Community Services and Supports Branch of DDS held the second of a string of meetings with various specific stakeholders on Tuesday in Sacramento. There is to be a general stakeholder meeting on October 25 in Sacramento and a series of three teleconferences before the proposed regulations are filed with the Office Administrative Law which is planned for the dawn of the new year.

The first thing to be brought up in any discussion of SDS is the fact that it is currently linked in statute to the computer system CADDIS coming online. What has passed for progress with CADDIS is that in 2001-2004 DDS pushed back the "live" date by one year annually and in 2005 they pushed it back by a month every 30 days. They are backing up by a year, maybe, three times per annum so the true process for implementation of SDS almost certainly looks like this:

January, 2007 the regulations are to be filed with the Office of Administrative Law for a one-year process of acceptance.
January or, maybe, April 2008 the regulations are enrolled.

May, 2008, the live date for CADDIS is estimated to be March, 2010 and trailer bill language is sought to alter the statute so that SDS can be implemented following changes to the current data system and the roll-out date for SDS becomes January 1, 2009.

Summer, 2018 the necessary changes to the current SANDIS data system are completed and an entirely different set of regulations take effect.

All of that said, I can offer a few impressions of the current state of the regulations.

First, the budget setting methodology has been fairly well articulated. I'm not mammothly impressed by the statistical methodology on the surface but in fairness, I have no idea what was tried and how it worked. A demonstration of the methods and charts of the underlying data might lead to the conclusion that the methods were wholesome and fair or offer the community at large a means to improve them, apart from our instinct to just make everything more expensive where possible.

Notably, DDS has separated durable medical and environmental adaptations from the initial budget calculation to allow people who need long-lasting equipment to purchase that without fear of depleting the budget for ongoing needs. That was a smart and positive change. Unless such expenses are with-held from the calculated averages that make up one of the available budget methodologies, the cost-savings from SDS might be diminished and cost-savings will be important toward sustaining SDS.

Also, the readiness of the regulations was not what I might expect from something two months from filing. There seemed to be a lot of discussion points and items DDS seemed ready to reconsider. This suggests one of two things:

Either the meeting was something of a placebo with sincere intention to make improvements but also the willingness to make notes in the draft at more points than staff was willing to alter; or

There is no right version where the community will be happy and changes will continue to be suggested until we are all dead, which would suggest the previous possibility as the smartest strategy.

In either case, there are two new areas where I would have concerns somewhat more compelling than my usual flippancy:

1. In the eligibility requirements there was a disagreement between staff and some of the attendees whether or not the requirements in the regulations were more restrictive than in the underlying statute. As a historical note: During the discussions convened by Senate staff, the original DDS proposed statutory language contained this: that the eligibility criteria include, but not limited to. The Senate staff made clear that the "but not limited to" would be dropped in the statute and it was. The history is important because it makes clear that DDS was not meant to be empowered with the right to tighten the the eligibility criteria. For this reason, I think it is only appropriate, as long as there is controversy about the meaning of the regulatory language, to use the statutory language verbatim in that section. It will, after all, be the interpretation of the individual regional centers, not the intent of DDS which govern the implementation of regulations in nearly every case.

2. The "accountability system" as it is currently constructed seems to be as fraudulent as the one we now "use." In the current draft of regulations it will be the responsibility of the SDS client to submit an evaluation of vendors, which would be a wonderful thing to do if and only if the requirement to evaluate is enforced, something the current regulations offer no mechanism for, and the evaluations are aggregated and easily obtained, something else the current regulations offer no mechanism for. I would strongly urge DDS, if the authority exists in statute, to provide for a useful reporting system on quality. Granted, one of the virtues of SDS is the ease with which individuals can fire unhelpful supports, but a far more helpful method of improving quality would be to allow SDS participants some method for identifying those providers most apt to provide helpful support. If that cannot be done under existing authorities this requirement ought to be struck as a useless intrusion on the client's time.

Related to this second point, there are some elements, SIR reporting by unvendored providers comes to mind, that seem unenforceably mandated. Unenforceable mandates tick me off.

Two where the regulations seemed surprisingly strong:

A. The budget allocation process is magnificently transparent and predictable which will make it easy for potential participants to judge whether or not they will be well-served by SDS and which method to choose. There can't be three other sections in Title XVII as well-designed. That said, and as noted above, the right method for developing the actual funding attached to the process will make the difference between SDS being popular or almost unuseable.

B. The descriptions of the Financial Management Service, the role of regional center personnel, and the assignments of service providers are less overdefined than I expected them to be, compelling me to partially and semi-sincerely apologize for my previous post. In my opinion, DDS still erred on the side of over-regulating but not by as much as I was prepared to rant against.

On a whole separate note, I wish to grouse that those who pressed for eligibility criteria to exclude people receiving services in congregate settings will regret that decision a year or two after SDS rolls out, should they be blessed with world enough and time. I still believe that the effect will be to minimize community integration as a byproduct of the new system. That error being now enshrined in law, there isn't much to be done about that but whine, as I do here.

Self-Direction, Finale (for now)

To those who have noticed and inquired and thank you to those that have, I thought I'd wait until the new self-directed services regulations come out and then fume about how prescriptive they are and how they over-regulate while under-protecting the enrollees. I thought the new regulations would be out by now. That much I was wrong about.

Organic farming and row crops.

In some ways, the DDS system is the future of effective government, depending on entitled rights and an engaged private sector to serve the needs of a challenged population. The mission of the whole edifice is to sprawl, broad and variable enough that each person served can find their own access point to the help they need for their challenges and aspirations. An organic approach like this parallels innovations in the business world where individualization has proven more efficient in many scenarios than the standardization that the industrial revolution brought and maintained.

The culture of government, however, has trouble with risk and risk is synonymous with variation. So, having envisioned an ecology of support, the organs of government soon fall back to establish control and order. Instead of encouraging relatively unfettered innovation, the regulations develop over time to specify the types of service available and to constrain the freedom of the service providers, rather than specifying outcomes and allowing competing and co-existing models for delivering such. For example, if you compare the older regulations governing Independent Living Services with those governing Supported Living Services, their are significantly more barriers established in the latter. Consequently, individuals who would be classic supported living clients may receive Independent Living Services instead as a result of, perhaps, economic or health risks which result in sometimes leaving apartments to stay long-term with family.

Over time, the instinct at regional centers has often been to harden and sharpen the distinctions. For example, to deny any individualized living support or training to individuals who live with their families or in group homes, which often has the effect of limiting people to their current setting. The consequence has tended to be to regiment the people served rather than to liberate them.