The BC government secretly initiated its own review of CLBC last August, before Minister Bloy's replacement, and months before Minister Cadieux announced the launch of two other internal reviews, the result of which were released last week (see previous post).
Unlike the other reports, the new Queenswood Consulting report is only available on request (but you can download a copy here). This is a must-read for families, self advocates, service providers and individuals from linked sectors such as Health and MCFD, and it re-emphasizes the urgency of securing an indepdendent review of CLBC and community living in BC!
Columnist Vaughn Palmer cites parts of this new report extensively in a Vancouver Sun column.
Below are key extracts from this report, which includes both eye-opening revelations and very troubling warnings about the direction in which the BC Liberal government may be hoping to take community living.
On the real reason for CLBC's creation:
Page 46: "One of the key motivations behind the devolution of service delivery from MCFD to CLBC was a belief that the proposed system would offer more predictability and overall sustainability than the historic model. There was a belief that a cost-effective model would be possible by utilizing options like individualized funding, increased role of families, and an increased use of generic and community services."
Christy Clark, Gordon Hogg, the BC Liberals, Doug Wollard, Doug Walls, the Community Living Coalition and families and self advocates on the Interim Authority board all assured us repeatedly that CLBC's creating was about a better life and empowerment for adults with developmental disabilities and their families MOMS, BC FamilyNet, DDA and other groups were denounced as contrarians for warning all the rosy promises and visions were a smokescreen for cutting funding.
So how to get the cost-cutting CLBC vision back on track??
1. More budget cuts:
Page 20-21: "In April 2010, CLBC committed to undertaking a one-time initiative to review all contracts managed by the organization... An overarching goal of the initiative is to examine each contract to identify areas where savings could be realized....This review is now underway, and a standard manner for regions to implement and report on the initiative is outlined in CLBC’s Savings Initiatives Tracking Template (SITT), which was distributed to CLBC offices in April 2011. The contract review process applies to all contracts except direct home share, individualized funding and microboards. As of August 2011, 696 reviews of staffed residential and community inclusion program contracts had been completed, with another 888 contract reviews still in process. The total amount of savings identified in completed reviews stood at $24.87M (on contracts with a total value of $145.45M), which CLBC will use to apply to caseload growth and addressing the needs of people who are on the RFSL. As a result of contract reviews, 64 homes have closed in staffed residential services, with 169 people moving into different residential arrangements. In community inclusion service contracts, 33 locations have closed. Where the existing service continued, 166 contracts had no reduction in funding, while 301 had funding reduced. Along with the 888 reviews still underway (estimated savings: $16.05 M on total contract values of $234.63), the contract review process will include an additional 1,303 contracts where reviews have not yet started. There is not yet an estimate of potential savings with respect to the 1,303 reviews that are still pending.
Page 26: "...It is likely that a review of community inclusion contracts will identify and illuminate opportunities for efficiencies, as has taken place with residential contracts. CLBC is now going through these contracts to assess whether services, supports and staffing levels are appropriate. Where discrepancies are identified, contract will be re- negotiated. Regions will be encouraged to identify efficiencies.
"...Communications must also consider how to address larger issues of entitlement and expectation, both from families and from service providers. Traditionally, these groups have directly or indirectly determined how services are provided. If CLBC and government more generally is to bring about a more efficient and rationalized service approach, considerable efforts must be made to address this traditional presumption."
Wasn't CLBC created to support more involvement of families and communnity as partners in developing more choice and personalized services?
Page 27: "CLBC is also promoting a conceptual shift towards meeting disability related needs by ensuring that family, community, and other "natural" supports remain in place and are not supplanted by funded services....The hope is that this will foster a greater shared understanding that, within current financial restraints, government alone cannot be responsible for serving people with disabilities. ... Overall, this is a fundamental shift that...holds promise for substantial and structural efficiencies."
So families will have to assume more of the responsibility for delivering community living with no help from government, while the bureacrats give us less say.
2. Reduce expectations
"Page 47: "It was recommended that CLBC clarify and clearly communicate that its role is to appropriately and competently allocate resources, not to act as an advocate. This was part of an overall recommendation to better communicate with the sector, in order to manage expectations and reduce frustration amongst clients, partners, and stakeholders.
Progress: Beginning in the summer of 2009, CLBC started specific effort to clarify its role... increased efforts to manage and address unrealistic client and stakeholder expectations will be a focus of communications going forward."
3. More partnerships
Page 46: "A key component of this strategy going forward will be to more effectively communicate that the service delivery model for people in British Columbia is comprised of many parts, and that government-funded services are only one part of this support system."
4. More use of generic services
In other words, convince people requesting CLBC services to rely instead on community centres, etc.
Page 47: "CLBC annually conducts public awareness initiatives to raise awareness of the importance of inclusive communities and the work that CLBC does. The Start with Hi’ initiative is now in its third year, and aims to increase understanding
Page 48: "An Ageing Parents Planning Pamphlet was developed and explained to a number of community agencies, including mayors, community colleges, police departments, health services, hospitals and first emergency responders, and recreation and seniors centres."
5. Promote innovation
For more on how CLBC defines and measures success in achieving innovation, see Performance Metrics below.
6. More emphasis on employment
Page 25-26: "Transition from children’s services is challenging, in part because families are relatively richly served through MCFD and the education system. There is a wide perception that children and families come to CLBC with expectations that far exceed the ability of CLBC to financially meet, partly because they have become accustomed to special education and MCFD-supported services that are not as vigorously tested for relevance to disability-related need. Particularly with respect to the education system, there are clear opportunities to streamline service provision, rationalize approaches, and address discrepancies in family expectations versus government and public resources.
"...CLBC estimates (very roughly) that about 50% of its current clientele is employable, but have grown up in a system that assumes they will not work, and fails them by not teaching relevant skills and abilities. CLBC, looking to jurisdictions like Washington State, is at the start of a process to put much more emphasis on employment supports and services. There is recognition that it will be challenging and require significant investments to shift individuals and families from a fully supported, service-dependant environment to an approach that emphasizes employment readiness, as it must be based (at least initially) on a very individualized approach.
"...CLBC is now exploring ways of promoting employment readiness and employment support services. Options under consideration include the recognition and fostering of agencies who are committed to employment first programs over those who retain community inclusion/day programs."
If you've been following the decade-long community living restructuring, you will have read all this before - it's the same old failed zombie ideas presented by the same people in report after report since the Doug Walls glory days of 2001: In short: a serious attitude adjustment is all that's needed to compensate for government's unwillingness to pay its share to maintain supports for adults with developmental disabilities."
Once again, here are all the key components of the same old failed strategy:
1. De-emphasize paid supports
Page 90: "Many participants [See below for participants list - the only "participants" Queenswood consulted for this study were ministry and CLBC bureaucrats] in this review characterized CLBC (and the developmental disabilities sector in general) as being over-professionalized and overly focused on assessing need for paid care in its service delivery approach. This is not out of the norm with other jurisdictions, who also tend to emphasize paid supports. However, there is a growing recognition that, in the context of increasing demands and scarce resources, governments must address daunting financial restraints in a different manner."
2. Individualized funding
"Individualized funding was...at the core of CLBC’s service delivery and operational model... (Implementation has) been hampered by a general resistance...amongst CLBC’s front-line staff...There has also been a reluctance among families to assume the role of employer (and)...efforts have also suffered from a lack of leadership and support at the governance and political levels to strongly move families towards this option."
If families refuse to choose this option (as they failed to "choose" to give up group homes across the board), government should simply choose it for them.
"CLBC has been placing a greater emphasis on employment supports and services. Many believe the current system, from MCFD and Ministry of Education, prepares people to expect paid supports, and to specifically not consider the option of employment."
On the contrary, families of adults and youths who are capable of employment or supported employment have been fighting for more supports that promote independence, not less. That includes families fighting CLBC efforts to cut and restrict access to supported employment and training programs.
4. Adult transition
"There is a widely shared sense that the level of service that children and youth obtain from MCFD and the education system is so full [They actually said that - see Page 92] compared to what is available to them as adults that they are inevitably disappointed when they come to CLBC for assistance. Many believe that these systems result in a sense of dependency and an automatic presumption of paid services and supports... Earlier, more integrated communications to families – even if the message is only that there will be far fewer services to draw from when youths turn 19 – can only help to reduce conflict and smooth the transition to the adult service delivery system."
Good luck with that.
5. New assessment tools
"Steps are underway to identify options for assessment tools that would have a wider application, with the goal of identifying and implementing a standardized tool for assessing disability related needs for individuals with developmental. This work will include identifying the issues and options associated with implementing cross-ministry tools to enhance consistency of decision making, resource allocation and service fairness. "
See #7 below. The direction indicated is a single system serving CLBC and the broader disability population, with a simplified needs rating system (high, medium, low) and each individual gets a standard individualized funding allocation (covering health needs, community living, employment support, disability supports, social assistance etc) to buy what they can.
6. Disparity between DD and other disabilities
"The average amount of funding that is available for an adult with a developmental disability far exceeds that of adults with other disabilities... It is partly due, for example, to the relatively rich funding contracts that accompanied the closure of the institutions...but the sector remains characterized by a well-organized advocacy arm that is vigilant against any attempts to structure lower level services into the system."
Where does this bizarre comparison come from? Does the wheelchair-using Minister Cadieux think that an adult with IQ below 70, autism, life- threatening health issues and no verbal ability is a "lucky ducky" who should stop complaining and count him/herelf fortunate compared to her because they might at some point qualify for a home share placement and she doesn't?
7. Rational approach
"A different option would be to work towards a system that provides much more predictability and stability, perhaps through the automatic granting of set levels of funding. Different funding levels could be based on key factors such as the individual’s age and broad level of need (high, medium, low, for example).... Set, capped levels of funding would also provide government with much more predictability for financial planning."
This model is beloved of bureaucrats for its simplicity, but highly unfair to individuals and families, and an ineffective way to allocate scarce tax dollars in terms of benefits per dollar. Like the controversial new UK model and the autism funding models, everyone gets the same funding, regardless of the wide range of actual individual need within their category. It works well for those who can afford to top up their allocation out-of-pocket (i.e. wealthier folks) but is a disaster for those who have no resources to add when the funding is not enough to cover urgent needs. The result is an additional burden on other social services that are already severely stressed.
8. Cultural challenges
"Many participants in this review [i.e. bureaucrats] spoke of a sense of entitlement among families in this sector that is stronger than other sectors. Many of the families that lead advocacy in the sector are highly skilled, resourced, and committed to increasing the level of funding that individuals receive, rather than considering alternative support methods including an expanded custodial and care role for families themselves. Many families in this sector have high expectations for supporting their sons and daughters, and the sector has a demonstrated history of political sophistication to advance its goals. This is a fundamental contributing factor to the difficulty in making meaningful changes to the service delivery system as evidenced, for example, in the challenges that CLBC experiences when trying to shift individuals living in group homes whose needs do not match the need for this level of service to living in community.
"Addressing this culture should be at the core of any directions that government takes towards the service delivery system for people with developmental disabilities."
The problem is not CLBC, it's the families trying to hold the CLBC bureaucracy accountable for living up to the mandate that its political masters promise. Silence the families/Outside Noise and the problem magically goes away. (Forgive the profanity, but only a bunch of a$$-kissing bureaucrats could come up with such a brilliant solution!)
Other observations of interest:
CLBC Performance metrics:
Page 30 - 31: Performance indicator: "Innovation"
"Explanation: - Percentage of individuals newly entering into residence who do not go to staffed group homes; - Number of individuals who started the fiscal year in group home, but moved to another setting."
Performance indicator: "Quality of Life and Safety"
"Explanation: Total number of individuals deceased in the reporting period."
These are extraordinarily narrow measures of how well CLBC is doing, especially if one of the founding principles of CLBC was supposedly to improve the quality of lives of the people it serves. Not dying is currently about as good as it gets in terms of a good quality of life, as far as CLBC is concerned.
Queenswood's 2008 recommendations
Although 12 of 27 recommendations from the 2008 Queenswood review are incomplete or ongoing, Queenswood concludes that the "vast majority" are "substantively" complete. The issues it deems substantively resolved include performance management, integration with other government systems, fostering use of generic services and managing expectations, which Queenswood specifically identifies in this latest report as key concerns going forward. This is a significant contradition. Further, those deemed "complete" were checked off largely if not solely on the strength of CLBC's claim that the issue had been resolved (thanks to sloppy editing, Queenswood inserted "CLBC completed but forgot to delete the "we" from text that was clearly inserted verbatim from CLBC). One such example was the 2008 recommendation to review use of the controversial GSA assessment tool:
Page 43: "In March 2010, testing and feedback indicated that the a revised version of the GSA had greater reliability than the previous version. It was recognized that further enhancements would continue to enhance the tool’s efficacy and CLBC decided not to adopt another planning tool. The GSA remains in place as the primary tool for assessing need and allocation appropriate resources. Complete. "
So what about all those complaints in fall 2011 that CLBC staff rigged/ revised GSA scores to justify a proposed contract reduction?
Confusion over CLBC caseloads
Page 7: "CLBC currently carries a caseload of 13,696 individuals with a developmental disability and 181 individuals with FASD or ASD (September 2011)."
In other words, when CLBC says it's serving 13,700 adults, plus another 181 individuals through the PSI program, they're counting anyone they're in contact with, regardless of whether they're actually receiving any CLBC services or not. Many of the individuals whom CLBC claims to be "serving" are not receiving any CLBC-funded services at all.
Although it's hard to see how there could be any confusion between the verb "serve" and the noun "service," Queenswood accepts CLBC's outrageous misrepresentation of whom it is actually "serving."
- 10,856 individuals who are receiving services and supports appropriate to their needs.
- 2,126 individuals who are currently receiving services but who have also requested additional services.
- 832 individuals who are currently not receiving services."
Page 14: "For people not receiving service, the most frequently requested service is community inclusion such as skill development or employment.
Page 15: "While the demand for services is certainly growing and outstripping available resources (the RFSL included 2,327 individuals one year ago and 1,895 individuals two years ago), the bare numbers do not provide any sense of the more nuanced context. As summarized on the table below, 72% of people on the RFSL currently receive services and are waiting for more. Only 16% have been without any services for more than six months."
Glass half full/half empty: Almost 30% of those on the list (a number equivalent to CLBC's annual caseload increase - i.e. a full year's backlog) are receiving no services at all. When you add those who are only receiving services for 1 day a week or less, the number waiting is almost equivalent to a full 2-year backlog of new clients receiving no services or minimal services.
Families have also complained that many service requests are not included in this list. These gaps are not mentioned in the review, so the numbers waiting may be far higher.
Data on CLBC service delivery
- Residential services: 2,508 in group homes, 3.176 in other residential (average residential cost $75,202)
- Individual and family suport services: 7,797 users (average cost of $27,445)
- Employment services: 1,534 (average cost $4,563)
- Compared to other jurisdictions, CLBC's eligibility criteria to access services are more restrictive, so the population served has relatively higher needs on average (Page 71).
- CLBC's average spending per client, compared to other jurisdictions: housing (average); facilitation and referral (much lower); individual and family supports (average); and employment services (lower).
- BC's disability benefit rates are also the lowest among the comparable jurisdictions.
Although BC spending per client is average or less than other jurisdictions, despite limiting access to a smaller, higher-needs group, Queenswood concludes that "BC is a leader in meeting the demands of families of people with developmental disabilities."
Participants in the Queenswood review
For this report, the only individuals whom Queenswood actually consulted were the same Ministry and CLBC bureaucrats responsible for the current crisis in the first place. (See Appendix 2).