Thinking Out Loud

How do we measure an idea?

By if it makes you wiser or freer?

By echoes rung from mumbling lips?

By boats afloat on questing trips?

By whether it can start a war?

By poetry and metaphor?

By destruction of walls and fences?

Or inflation of pretenses?

By orators taking up the cause

for promulgation of new laws?

By if it gives your spirit wings

Or your pocket cash to spend on things?

Whatever thought quickens your blood,

If it leads a conference, it's a dud.

FIRST PRINCIPLE, n. An Afterthought.

Yammer Masala

I have been accused by private email of being a bad representative of the obsessive compulsive blogger, having taken August off. Now, the accusation is from a friend who has an employee tasked with producing a blog and still doesn't have one, but, leaving that aside, probably something needs saying and I should say something else in this space once a month. It doesn't seem too much to ask.

So, a couple of news updates: AB 1427, the subject of my most recent post on this site (conveniently linked to for those with broken scroll bars) passed out of committee and is due for a final vote this coming week. The primary function of this bill is to serve as an organizing and recruiting tool for anti-union trade associations. Ironically, my prediction is that the pro-union legislature will pass the bill and the union-surly Governor will veto it. But we'll see,

AB 18, The Warren Mattingly Signature Stamp Act, authored by Assemblymember Blakeslee survived an attack by Protection and Advocacy, Inc. and also awaits final passage, but probably has a better chance of being signed into law by Governor Schwarzenegger. The many of us who remember Warren fondly wish this bill well and thank Mr. Blakeslee and his staff.

Now, regarding representation, Assemblymember Buell began a process of public hearings on the future of the Lanterman Act with a private one. At the private "roundtable" discussion, Mike McCoy, the new Executive DIrector of the California Rehabilitation Association (CRA,) described his organization as "The Statewide Organization of Providers." As one of the 8,000 plus service providers not represented by CRA, it seems worth reminding stakeholders to stay on the honest side of hyperbole when claiming to represent others. CRA has represented its membership honorably, so far as I am aware, but more providers are eager to distance themselves from that representation than are members. "A statewide organization of providers" isn't much of an edit but in front of the legislator it's best to prevent real time editing by colleagues. Especially when your arrogance is matched and your sarcasm inadequate as compared to your peers with blogs who happen to be in the room.

Microphobia

AB 1427 is a bill, now in suspense (whatever that means) with provenance that may as well be SEIU (it is not, per se, a union bill but close enough for blogging standards.) It contains no real mechanism for organizing and discussions with opponents, including one I had with a good friend yesterday, typically involve concerns around incrementalism. The fear seems to be that if the union accomplishes something in legislation around this system that the next step will be more invasive and followed by the eschaton.

Many who know me and the few who read this blog may remember that I don't love this bill. But I do think it's a small thing and unworthy of vigorous opposition. Change works best in small steps and if incrementalism is a fear advocates indulge in, a frozen system that can't improve is the natural result, kind of like the one we already complain about. While we are counting increments to fear, here are some the bill contains, other than a unionized workforce:

1. Accountability. The evaluation scheme outlined in the bill seems a little questionable to me, requiring comparison to a control group but offering no incentive or mechanism to establish that control group. To call the evaluation outcome measurement one has to assume that better-trained, longer serving staff automatically lead to better outcomes, which is not unreasonable but is still a process measure. Despite the flaws, the proposal is the first in a while that attempts to measure its own success. If this bill passes, actual valid quality accounting might become a standard part of our system in my niece's lifetime, although it would be rash to presume that it will.
2. Professionalism. From many perspectives, receiving healthcare benefits and regular training units can be more or less indistinguishable from professionalism. Professionalism does not grow more vigorously in a culture of CEUs, like mold in agar, but it is at least true that training and benefits can confer the appearance of a professional class. If the pilot project is successful in making staff more professional-seeming, there is a risk that one day the cowardly lion, tin man and scarecrow will end up agency executives if they aren't already.
3. Incremental Incrementalism. AB 649, a massive, systemic goliath of a bill failed. Last year, a more ambitious predecessor to this bill failed as a gut-and-amend amendment. If AB 1427 passes, we must be concerned that eventually, massive labor unions, trade associations and other special interests will put forward bills encouraging italicization of ambiguous words using permissive language.

Checking in

We still have a structural deficit and lots of bills going through appropriations. Not much to report on accountability. Will let you know if I hear anything.

The Oracle of Santa Clarita

To a lonely desert village, just outside of L.A.
Came a wanderer searching for meaning.
There was said to be an Oracle, far less rare today,
And two dogs to interpret the gleaning.

For the legend was written from sidebar to scaffold
That, without even charging a fee,
The magus was kind to the bitter and baffled
And a master of lexicography.

The journey was long and the way hard to follow
And mystery shrouded the labors.
For the pathway was bent like the flight of a swallow
And the house, it looked just like it's neighbors.

But the seeker, at last, discovered the master
Sitting sagely beneath a broken tree
"Tell me, Oh wise one, for my life's a disaster,
What does it mean to live free?"

The oracle nodded his head, wise and kind
and spoke in a voice soft and hoarse
"That is a verb, intransitive, and defined
'To elect your slaveholder', of course."

And then the wise man rose with a flourish
And, turning his wise and kind head,
Pointed to the seeker and addressed the chorus
"If you don't mind, please explain what I said."

LIVE FREE, v.i. To elect one's slaveholder.
ORACLE, n. A prophetic lichen.
SEEKER, n. A rolling moss.

Cynical Reform

I haven't posted in a spell and a new friend asked me today about whether I thought reform worked better from within or from without. Aristotle, Muhammed, John Huss, Martin Luther, Jean Paul Rousseau and Benjamin Franklin all have given us wise counsel on this very question, which, not being smart, I won't bother to include.

Being a dog-fancier, though, I think it is useful to consider the 4th Century B.C. Philosopher, Diogenes, the Cynic. The word Cynic originally meant dog. The reform Diogenes followed and taught was to live as a dog lives, unashamed of ones habits and desires and at once self-indulgent and propertyless. When Alexander The Great offered Diogenes to give him any gift the philosopher asked, Diogenes asked the conqueror of the known world to step out of Diogenes' sunlight.

What does this have to do with reform being more effective internally or externally? Diogenes of Sinope sought to change his environment by concentrating on his appetites, nourishing those consistent with living and disregarding those he saw as distractions. He became wealthy by changing his standard of well-being. All reforms begin by choosing the right appetite.

So we in this system, when we are near to home complain about choices made for us, the frustration of our own will by others and the impositions of other emperors on our daily activities. I would contend that the central appetite of the system is for autonomy, that the enemy of autonomy is sovereignty and that the chief distracting appetite is for funding.

So, this cynic, would propose that the first reform to be attempted is to stop worrying about funding, refrain from trying to command the neighbor and concentrate on cynical choices. Then we can get to reliable, person-centered outcome data.

This, by the way, is what happens when you post because you haven't posted in a while. Silence has its own muses.

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.