LANTERMAN ACT

A series of laws which encompasses life enhancing services for people with developmental disabilities

 

STRUCTURE OF SERVICE DELIVERY SYSTEM IN CALIFORNIA

 

There are five official entities which are responsible for delivering services.  They are the State Council, the Area Boards, the Regional Centers and the Department of Developmental Services and Protection and Advocacy, Inc.

 

The State Council board of directors is composed of people with disabilities and/or family members and representatives of DDS (Department of Developmental Services).  Its function is statewide planning and administering grants funded by parent fees and other contributions.  The funding for the Council comes from the federal government.

 

The 12 Area Boards are responsible for regional planning and oversight of the regional centers and local providers of services.  The board of directors is, again,  people with disabilities and/or family members and community representatives.  They are funded by an appropriation from the State Legislature.[8/11/03 Now funded through the State Council, essentially destroying its ability to be another monitor for those with disabilities]

 

The 21 Regional Centers are private, non-profit corporations, at least half of whose board members must be  people with disabilities and/or family members, the remaining members are community people.   They are the  primary contact point for people with developmental disabilities.  As part of the intake process, they do assessments (physical, psychological, social, etc.), coordinate the Individual Program Plan or Person Centered Planning documents, help find appropriate community vendors and fund and monitor those vendors.  The funding comes through contracts with DDS.

 

The Department of Developmental Services (DDS) is a state agency, staffed by career bureaucrats.  The Director of the department is appointed by the Governor and reports to him.  The Department is responsible for long term planning, rate-setting and funding and monitoring the regional centers.  One of their responsibilities is budgeting and submitting that budget to the Legislature.  The Department must also report to the Legislature on an annual basis.  They are also responsible for the running of the state owned Developmental Centers and at least two smaller  newly acquired facilities.

 

Protection and Advocacy is the defender of rights and protector of consumers who have been abused by the system and have no avenue of redress.

 

The last and unofficial, and most important element, in the service delivery system are the individual providers (vendors).  This group is composed  of  non-profit corporations, some for profits and many individual mom-and-pop vendors.  They are the ones who actually give the day-to-day care and support to persons with developmental disabilities. 

A. Entitlement

The State of California accepts a responsibility for persons with developmental disabilities and an obligation to them which it must discharge.

In California all persons with a developmental disability which arose before the age of 18 are entitled to services which help ensure a life as normal as possible.

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B. Who

There are five disabilities covered under the Act: Mental Retardation, Cerebral Palsy, Epilepsy, Autism and other conditions which require the same or similar services to those for people with mental retardation.

 

C. Principles

The array of services and supports will be sufficiently complete to meet the needs and choices of each person with a developmental disability, regardless of age or degree of disability and at all stages of his or her life.

 

D. Services

Services shall be provided throughout the state.  Such services will make every effort to keep children with their families and adults living in the same environment as their non-disabled peers.

 

E. Outcomes

The State, through the Legislature, will require evidence by the regional centers and providers that their services have resulted in consumer or family empowerment and in more independent, productive lives for those served.

 

Consumers

A. Choice: Choice means the ability to choose where and with whom to live, who will provide services and what services will be provided.  The Lanterman Act states the preferred living arrangement for an adult is supported living - in his own home, be it apartment, condo or house, with staff necessary to allow him to function.  For a child, the preferred living arrangement is with his natural family.

         B. Rights: The right to freedom from pain and abuse in the name of treatment, the right to keep one=s own possesions, the right to safe and habitable housing, the right to communicate with whomever he chooses, the right to the same treatment and consideration as any citizen of California.

C. Providers: Providers will be held responsible for the safety and comfort of each client.  More importantly, they will strive to treat each client as an individual, with individual needs and desires.  They are charged with implementing the outcomes specified in the IPP.  They will report to the Regional Center on a regular basis the progress - or lack thereof - of every client for whom they are responsible.

         D. QA: Quality assurance is a joint responsibility of the Regional Center, the Area Board and the provider.  It is also the responsibility of the federal department of Health Services, if the person is on the Medicaid Waiver.

E. Outcomes: Desired outcomes are those which integrate the person into his community, allow him to live as independently as possible and participate with his friends and family in activities which are meaningful to him.

 

Department of Developmental Services

A. Responsibilities: DDS is the agency whose function is to help plan, budget, obtain funding, contract with Regional Centers for 164,000 [now closer to 200,000] persons with developmental disabilities.  It operates five Developmental Centers with about 3800 residents and has recently opened two smaller facilities, one north and one south with approximately 60 residents each.   It also has the responsibility to formulate regulations based on laws governing the state=s obligations to people with developmental disabilities.

            B. Funding: DDS must submit a budget to the governor each year which is incorporated into the state budget.  It must go to the Legislature to defend its budget and advocate for new programs or necessary improvements to old programs.  It also asks legislators to carry bills to enhance budgeted items or introduce new programs.  There are at least two funding streams, the California general fund and federal money funneled through the Department of Health and Human Services - basically Medicaid waiver monies.

C. Quality control: DDS, through its specific contract with each Regional Center, sets standards and has the authority to audit and give assistance to the Regional Center in order for it (RC) to fulfill its responsibilities as specified in the contract and in the Lanterman Act.

Regional Centers

            A. Responsibilities: A regional center is the main contact point for a family who suspects its child has a developmental disability. It has the responsibility to broker services for its clients, act as case managers, advocate for their well-being and inclusion into their communities and educate them and the general public about developmental disabilities. 

B. Eligibility: To be eligible for services by and through the regional center, a child must fit one of the stated categories, autism, cerebral palsy, epilepsy, mental retardation or require specialized services of a like nature to those with the above diagnoses and the disability must have arisen before the age of 18.

C. Assessment: Various assessment tools are used to determine the services which would benefit the person with developmental disabilities.  Examples would be the Vineland, CDER (a state-developed tool not used anywhere else and is now somewhat irrelevant), developmental, academic, social, psychological, emotional, behavioral, adaptive,  medical and physical tests.  The results would help to define  the support services and devices needed to normalize the person=s functioning at home, in school and in the community.

D. IPP=s, Person Centered Planning: Each client of a regional center must have an Individual Program Plan developed every year as a child.  As an adult, the IPP could be as seldom as every three years.  The IPP is coordinated by the regional center.  Members of the IPP team are the consumer, his family or conservator, his regional center case manager, and anyone else he or his family wishes to attend.  Others could be school personnel, therapists, doctors, the service providers, etc.  The IPP is a short term document/plan.  A Person Centered Plan is a long term document, usually developed when the client is a teenager or an adult.  It encompasses hopes, dreams, long range goals.  The PCP is a document to which the IPP should aim.

E. Funding: The regional centers= funds come through contract with DDS.  The largest portion is state money appropriated from the general fund.  Some is federal money used for special purposes, such as keeping people out of hospitals and nursing homes.  A small portion is from individual grant programs, such as the Healthy Families program for low income people.

F. QA: The regional centers must monitor the client=s programs by having at least a quarterly visit (face to face) with the client, review all programs quarterly to follow the implementation of the IPP and make at least one unannounced visit to the provider per year.  In addition, RC=s must audit the vendor to make certain the clients= rights are being honored, the clients= money is not misspent and is accounted for, the clients are satisfied with the service provider and safe and healthful facilities are maintained.

G. Outcomes: Outcomes are measured by client satisfaction and support by the RCs of the least restrictive environment possible for all clients.  They are also measured by how well the RC has managed its annual budget.  The contract with DDS is a capitated budget, based on average costs for previous years, plus caseload growth. 

Providers

            A. Vendorization: Each provider must apply to a regional center to be vendored.  It is an exhaustive process to determine its fitness to render the services required for the clients it plans to serve.  When issued a >vendor number= by any regional center, it is valid in all regional centers.  Each separate category of program must be vendored individually.  Each vendored program must meet staffing standards, curriculum content, hours of service and other criteria to be able to offer day and/or residential programs to regional center clients.

B. Licensing: A program which has a fixed location to provide services, such as a small group home, a workshop, etc. must also be licensed by a separate department in the State Department of Health.  Licensing is more concerned with square footage per client, safe buildings, fire safety, healthy menus.  They also have some minimum staffing standards.

C. Programming: Each vendor must submit a program design flexible enough to address the needs and IPP mandated goals of each consumer he will serve.  The regional center may apply a state-mandated rate for each program or may, by contract, set an individual rate for a program design that doesn=t fit into any previous category. 

D. QA: Each program is reviewed for consumer satisfaction, IPP goals met and  good practices, among other things,  by the local regional center.

E. Outcomes: Progress toward independence of each consumer and good life quality are important outcomes.  An important outcome is  integration into the community, access to local resources such as theaters, restaurants and swimming pools without barriers - either physical or social.

Area Boards                                                   

Area boards have a general responsibility to oversee one or more local regional centers.  The Los Angeles area board oversees seven regional centers, the greatest number of any area board in the state. The area boards are funded by federal money funneled through the State Council.   Their oversight and advocacy is important as an outside eye looking over the shoulders of the regional centers.  They do the mandated ALife Quality Assessments@ each year.  They also provide representatives to individuals who reside in the developmental centers, many of whom have no families, conservators or other interested parties.

 

Protection and Advocacy

Protection and Advocacy, Inc. (PAI) is a non-profit legal firm, funded by federal dollars, which has the obligation to represent people  with developmental disabilities as well as people who are mentally ill.  They provide Clients= Rights Advocates to the regional centers, they represent consumers in courts, they file class action suits to redress wrongs committed against disabled people.  They have a board of directors each of  whom represents a  specific area of disability.  They also advise the legislature about disability issues and have bills introduced to cure systemic problems on a regular basis.