A series of laws
which encompasses life enhancing services for people with developmental
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.
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
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.
The State of California accepts a responsibility for persons
with developmental disabilities and an obligation to them which it must
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.
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
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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
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
D. QA: Each program is reviewed for consumer satisfaction, IPP goals
met and good practices, among
other things, by the local
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 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
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
N Jane DuBovy, M.A.,
J.D. (Attorney & Certified Mediator)
Nancy R. London (Attorney)
Karen Acedo (Advocate)
Carolina D. Watts (Advocate)
16712 Marquez Avenue,
Pacific Palisades CA 90272
Phone 888-IDEA-ADA (888-4332-232) FAX (310) 573-1425