Thursday, April 6, 2017

Wishful Thinking

I find it interesting that, during a time of questioning science, alternative facts, fake news, fiscal accountability, and the demands for better outcomes, states have not focused on exactly what variables deliver the better outcomes for community based services for people with an intellectual and developmental disability.

 Here is the science part. Let's take the data from two very reputable resources, the Coleman Institute for Cognitive Disabilities' State of the States in Intellectual and Developmental Disabilities (2015 Edition), and United Cerebral Palsy’s The Case for Inclusion (2016 Edition). The State of the States data compares fiscal effort of each state and Washington, DC, and The Case for Inclusion compares service outcomes of each state and DC for Americans with intellectual and developmental disabilities. Fiscal effort in this case is spending for I/DD services per $1000 of aggregate statewide personal income. Service outcomes included measures of promoting independence, promoting productivity, keeping families together and reaching those in need, and tracking health, safety and quality of life.

One might expect the greater the fiscal effort would result in better service outcomes. In fact, there is no correlation between the two measures. Of the top six states ranked in service outcomes, five of them were ranked in the bottom half for fiscal effort. And of the top six states ranked for fiscal effort, three were ranked in the bottom half for service outcomes.

 Click on the image to enlarge

Add to this what we know of states reporting conflict free case management, and again there is no correlation between the measures of conflict free case management and service outcomes.

We know the Federal Government guides how Home and Community Based Services are regulated through the Centers for Medicare and Medicaid Services, and states are guided by their own statutes and regulation. Have any one of them identified the variables that deliver the better service outcomes and fiscal accountability?

Colorado, for example, has one of the worst rankings for fiscal effort and is among the better service outcomes. However, Colorado has declined in ranking of service outcomes from 6th to 11th over the recent years.

One would think it worthy of asking the question, “Why?” Have we hit the tipping point where fiscal effort does matter? Is the movement away from local control in our state contributing to the losses in service outcomes? Are there other variables that should be measured? Or are we simply hoping and wishing that the trend will reverse all by itself?

I’m leaning on the science to help us reverse the trend.

Then again, what do I know?

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