A note: I recognize that I am working here from a very limited data pool. But, in my opinion, the two documents referenced below are the two best researched, most comprehensive sources of data in our field that I am aware of. I welcome other sources of data or other interpretations that would contradict my takeaways, but so far few are forthcoming.
Let’s start with some statistics from right here in Colorado. According to the 2015 edition of the Coleman Institute for Cognitive Disabilities’ “The State of the States in Developmental Disabilities,” which tracks nationwide financial and programmatic trends in I/DD services, Colorado ranks 48th in the nation in terms of fiscal effort for I/DD funding. At the same time, according to the United Cerebral Palsy’s (UCP) “The Case for Inclusion,” which ranks all 50 states and the District of Columbia (DC) on service outcomes for Americans with I/DD, Colorado ranked 11th overall in service outcomes.
Remember, Colorado ranked 48th in fiscal effort and 11th in outcomes.
Using the same studies, let’s take a look at some of the few states who are reporting conflict free case management (CFCM):
Minnesota ranked 7th in fiscal effort and 12th in outcomes;
Montana ranked 26th in fiscal effort and 48th in outcomes;
Nevada ranked 51st in fiscal effort and 37th in outcomes; and
Wyoming ranked 20th in fiscal effort and 43rd in outcomes.
Picture Mr. Rogers saying, “Neighbors, can you say the word, 'confusion'?”
Can one draw some conclusions from above?
- Fiscal effort alone does not translate into better performance.
- A CFCM design does not translate into better performance.
- Colorado is unique in its local control design through the use of Community Centered Boards. Could this be the influencing factor in the remarkable results?
- Perhaps the collective wisdom of those making decisions about system design is subjective and often flawed. And perhaps a more consistent, analytical, and evidence-based approach to system design is in order. Moneyball, anyone?
- The number of residents in state operated facilities is growing. This is contrary to all of the gains we’ve made in the past few decades around providing more opportunities for community-based living with the least restrictive environments possible.
- The trend above doesn’t make financial sense, either. When looking at spending on state operated facilities, it appears that a disproportionate percentage of dollars is spent on those versus dollars spent on people served in the community.
- There are a fewer number of families receiving support.
- The average cost per person living in the community is flat over half a decade.
- Colorado’s ranking, although impressive, is trending downward from 6th to 11th in the past few years.
- Do these measurements and trends matter?
- Is anyone really paying attention to them?
- Is our goal better performance? If so, are we focusing on the right things?
- Should we focus solely on the issues that will improve the outcomes for people with I/DD?
- Can many (or even most) families manage their own resources?
- If/when families are given the resources, could the providers not set market rates that support living wages for a higher quality workforce?
- Could we utilize available technologies to improve security, self-reliance, and social networks?
Then again, what do I know?