D.C. Government, Please Don't Stonewall on Georgetown

The local press continues to keep the pressure on with respect to the DDA Health Initiative contract.  In the Post’s Metro section today, Theresa Vargas has another article about last Tuesday’s roundtable:  https://wapo.st/2GxBIJK and this week’s City Paper also covers the roundtable (https://tinyurl.com/y4uazgfs) as well as council member Brianne Nadeau’s response to the government’s resistance to advocates’ entreaties (https://tinyurl.com/y3n4nrbu).  Former HHS executive Bob Williams has a Local Opinion column, also in today’s Metro section:  https://wapo.st/2GvqIwH.

In short, this issue is not going away, nor should it.  At last night’s Quality Trust (https://www.dcqualitytrust.org/) gala the issue was on nearly everyone’s lips.  Speaking with DDS director Andy Reese, Bob Williams and I were dismayed to learn that even now, there is no give whatever from the D.C. government on this issue, even though most advocates have asked only for a slight extension of the contract - not an extreme position.

Frankly, I do not know how effective the transition plan issued by DDS a week ago could be at carrying on the essential services that have been available under the Georgetown contract.  The answer to that is intricate, and requires a degree of analysis with respect to Georgetown’s federally-funded activities in relation to those funded under the local contract.  What I do know without any question, however, is that by refusing to allow the time for a substantive dialogue that could build confidence in its transition planning, DDS is allowing the trust that has been built up painstakingly with the disability community to fray, seemingly without a recognition of the far-reaching consequences this will have.  It isn’t enough to say (I’m paraphrasing), “We made a little mistake here,” and then move on.  People want to know they are being heard.

I’ve said for some time, and I repeated to Andy last night, that since the closeout of the Evans contract, DDS has had the opportunity – which it has not taken up – to engage the community on its vision for disability services in D.C. going forward, and to have a serious, open-ended discussion with stakeholders about its strategy for addressing the needs of D.C.’s developmentally disabled residents.  As we know, the eligibility criteria for services under the DDS-administered waiver are too restrictive – excluding, in particular, many of our autistic citizens - yet budget concerns are keeping both the administration and the council from confronting this issue. 

The lack of receptivity to advocates’ dismay over the abrupt cancellation of the Georgetown contract is a major setback on the road to reaching a fair system of disability services in D.C.  Please – Reese, Turnage, Bowser – stop dismissing the legitimate concerns of the disability community.  It’s time to take this seriously.

Dialogue and Advocacy

You may be wondering why I haven’t written since the Tuesday roundtable on the Georgetown contract.  The reason is that I’ve sent a letter to the editor at the Post and am waiting to hear if it will be published, so I can’t repeat the same message here in my blog.  In the meantime, here is the link to the video from the Tuesday event:  http://dc.granicus.com/MediaPlayer.php?view_id=2&clip_id=5144.  There were more than twenty witnesses, myself included (on behalf of the DD Council).  And, to keep you up to date, an article in today’s Post:  https://wapo.st/2ZfvHZC.

I’d like to use my soapbox today, then, to make a couple of broader points about the way in which the relationship between DDS and the disability community is evolving. 

First, to Andy Reese:  I believe you were sincere in the comment you submitted on July 9 (see comments section on my blog post, “Andy, You Need a Plan” below or click here: https://www.ddinwdc.com/2019/07/andy-you-need-plan.html#comment-form).  I think you truly believe that the combination of HCBS Advisory Committee, Supporting Families Community of Practice, public Family Support Council, Project Action! and monthly person-centered organization meetings provides ample opportunity for input to DDS decision making.  I understand the point you’re making, but I do not agree, for these reasons: 

1)      The conclusion of the Evans case (look in the blog archive over to the right and read “Where We’ve Come From,” 9/25/14 and “Big Developments in the New Year,” 1/9/17) in January 2017 was a golden, and necessary, opportunity for DDS to spell out its proposed post-Evans vision and to invite a dialogue on future strategy with the advocacy community that had done so much to help achieve that important milestone.  Two and a half years later, this hasn’t happened, and none of the meetings you’ve cited pertains to the strategic direction DDS is taking.

2)      Such a strategic dialogue – hopefully rich with data about the size and needs of the D.C. population with development disabilities – would have brought creativity and energy to shaping the future and also set the stage for new breakthroughs.  It also would have established a shared perspective for discussion of the types of individual issues such as housing, contributions to costs and now, health care issues that DDS is rolling out now with little context or connection.  It’s not too late, though, for this dialogue to take place.

3)      Taken on their own, the array of individual meetings you point to has its own set of inherent problems:  

a) They are often very lengthy, and a person would have to attend each and every one of them to stay aware - no one has time for all that;  

b) Many of the discussions are highly redundant “listening sessions” and provide little clarity as to what is going to be done with the comments provided;  

c) Often the meetings are filled with elusive technocratic jargon that anyone outside (and many inside) the bureaucracy can’t hope to understand fully.  

d) Finally, many of us doubt the effectiveness, and are concerned about the consequences, of candid discussion in sessions with operational, as opposed to policy-setting, DDS staff.

Now, to my colleagues in the local advocacy community:  In my most recent blog post, you got the sense that I do not believe “anything goes” with respect to tactics when we’re trying to effect change.  Specifically:

1)      Keep it local.  Although my blog centers on developmental disability issues, I never lose sight of the fact that we’re operating in the District of Columbia, whose democratic participation on the national stage is limited.  In fact, I would be tempted to add a third “D” for democracy to the title of my blog, and I hope none of my readers are happy to tolerate the denial of our right to determine our own future (and get voting representation in the House and Senate).  Read my last blog post on this, and let’s keep it local (meaning D.C. only).  Enough said.

2)      Respect roles and boundaries.  I worked in government for over three decades, and I respect the roles of people who are trying to make a difference and running large and complicated programs.  Andy Reese’s job as director of D.C.’s Department on Disability Services is an important one to which he brings integrity and dedication.  Let’s not immediately lord it over him by appealing to the mayor over his head.  Also, raising the specter of a return to court oversight is not a prospect that should be raised lightly.

3)      Don’t exaggerate or distort.  When government witnesses testify, they raise their right hands and swear to tell the whole truth.  The same is not required of other witnesses, but we need to hold ourselves to the same standard and ensure we are not overstating the case or stretching the facts.

4)      “I got mine” is not a solid basis for advocacy.  Many of my readers receive, or have family members receiving, services in D.C.  Others do not, and wish they did.  D.C. services don’t reach everyone they should, as we all know (another reason for a strategic dialogue!), so please remember, when you advocate don’t just talk about protecting what you’ve got.  There’s more at stake.

Some of what I’m writing in my blog lately is making me less popular, but I don’t expect everyone to agree with me.  These are difficult subjects and we need to wrestle with them together.  I do think, though, that we owe it to ourselves and to one another to be more reflective and to do a better job of remembering we’re in this together.

Have a good weekend.

The Georgetown Contract is a Local Issue

I’ve been writing a lot lately about two issues:  the DDA Health Initiative contract with Georgetown and the upcoming hearing in the House of Representatives (now postponed until September) on the D.C. statehood bill.  Little did I know that these would begin to converge.

I had wanted to write today about my dismay over the results of a Gallup survey showing weak support across the country for D.C. statehood: https://wapo.st/2JHx2BR?tid=ss_mail&utm_term=.cf9204734cb3.  Mostly this reflects a profound lack of understanding across the nation that there are real people, some with very deep roots, in the District of Columbia.  As those of us living here are painfully aware, D.C.’s lack of voting representation ensures that Congress in general, national politicians more generally, and sometimes other well intentioned people looking through a national lens, tend to lose perspective on what is national D.C. business and what is local business affecting residents of the District and our decision makers.

The DDA Health Initiative and the Georgetown contract under which it has been implemented are local business.   The roundtable planned by the D.C. council on Tuesday (https://dccouncil.us/event/committee-of-the-whole-human-services-public-roundtable/) is a completely appropriate response to the attention that has been brought to the abrupt closeout of the Georgetown contract by local advocates and by Theresa Vargas in the local section of the Washington Post.  I will be at the Tuesday roundtable and will make a statement on the part of the D.C. Developmental Disabilities Council, which I currently chair.  I feel strongly that Andy Reese owed it to the people served by the Department on Disability Services to engage far earlier with the disability community about DDS intentions with respect to this contract and the services it provides, and to engage very substantively in ensuring everyone understood well how those services would continue to be provided and, if appropriate after those consultations, transitioned from Georgetown.  The email Andy sent out a week ago was too little and too late to constitute meaningful consultation or inspire confidence.

That said,  I was taken aback by the comments made in the second Vargas article (https://tinyurl.com/y2kj7sjq) by former DDS director Laura Nuss, Andy’s predecessor at DDS, since she is no longer engaged in D.C. disability issues and is now working for Virginia’s behavioral health department.  I have even greater misgivings about the letter sent to Mayor Bowser yesterday by a group of former directors of DD services of other states, including Nancy Thaler who used to chair the national association of DD directors.  Nothing in their letter would be objectionable coming from local advocates, but there is something intrusive to me in their assumption that they should weigh in on a matter such as this, especially when they invoke the Evans case in a way which seems to imply its resolution by the courts was premature.

Governance in the District is tricky, precisely because the whole country sometimes thinks it has the right to look over your shoulder on local matters.  That’s even more reason, if he needed one, why Andy Reese needed to be consulting with, explaining, and – above all – listening and talking with – people who were going to be affected to make sure stakeholders had been heard and had their say about the direction things are taking.  In this post-Evans era it is essential – as I’ve written in these pages over the past several months – for DDS to be engaging people on the broad strategy it wants to pursue, not surprising folks by rolling out one policy after another or, in this case, withdrawing a trusted provider without ample prior discussion and appropriate transition planning. 

It’s a lot harder to clean up a mess than it is not to create one, and this is a mess of DDS' making.  However, while some may feel that any firepower, from wherever, against DDS is the right way to go, I am always concerned about what happens when our local prerogatives are upended by people with national agendas.  Local voices – even those of the 2000 or so people who actually receive the services in question  – can get drowned out in these circumstances.   I hope local families, advocates and professionals will all keep our eyes firmly on the ball and make sure we are amplifying the local voices who most need to be heard on this matter. 

See you on Tuesday -

D.C. Statehood Hearing Delayed

This weekend the Washington Post reported that the planned July 24 hearing in the House of Representatives on D.C. statehood has been postponed:  https://tinyurl.com/yy8dqves.  The hearing was delayed at the request of D.C. Representative Eleanor Holmes Norton, due to the postponement of former special counsel Robert Mueller’s hearing in the House from this coming Wednesday, July 17, by one week, to July 24.  Alas, no schedule yet for the D.C. hearing, but I promise to keep on top of it and to let you know!

Staying Informed on the Georgetown Health Contract

In addition to the comment that Andy Reese, director of D.C.’s Department on Disability Services (DDS) posted at the end of my blog post on July 5, “Andy, You Need a Plan” (https://www.DDinWDC.com/2019/07/andy-you-need-plan.html), he issued a formal statement via email on July 12 which I quote in full below:

Several people have reached out recently expressing concern that the Department on Disability Services’ (DDS’s) contract with Georgetown’s University Center for Excellence in Developmental Disabilities (UCEDD) will conclude at the end of August 2019.  Although this contract is ending, and the mechanism for providing these services may change, as DDS Director I want to clarify for you that no services currently available under this contract to people supported by DDS’s Developmental Disabilities Administration are being terminated.  DDS will continue to ensure that people receive high quality, innovative services from DDS and our provider network.

The UCEDD has been a vital partner with DDS for the past thirteen years, and its Developmental Disabilities Administration Quality Assurance Health Initiative (DDA Health Initiative) was a critical component over many years. Together, we strengthened our system’s ability to support people with intellectual disabilities living with complex clinical and medical needs within our community. Today, our service delivery system has matured to the point that the services not already provided under the Medicaid Home and Community-Based Services (HCBS) Waiver for Persons with Intellectual Disabilities can be successfully transitioned to agency staff and other providers.  

With the expiration of Georgetown’s latest contract on August 31, 2019, which included a base year and four, one-year options, DDS revisited each of the elements of the contractual requirements to determine how best to deliver those services. Two of the services included in the current contract (i.e. Parenting Support and Sexuality Education) are now HCBS waiver services for which DDS has adequate providers. For the remaining services, DDS will be continuing services through in-house staff or external contracts. The development and provision of training, technical assistance and onboarding of new nurses will continue and be provided by the DDS’s State Office of Policy, Planning and Innovation (SOPPI). Already SOPPI has hired a registered nurse trained as a nurse educator who has experience providing this type of support. Having this position within DDS’s office on innovation ensures a focus on best practices in the field of ID. Coordination of care will continue to be supported during hospitalizations, sub-acute, and long-term acute care placements by a transition specialist under a contract, with the flexibility in hours and scheduling to enable the specialist to successfully support people in their evening, night and weekend work. DDS plans to contract with a physician who will continue the work of serving as a liaison between physicians, specialists, surgeons, providers and DDS. This contractor will have the same flexibility in both hours and scheduling. 

We are actively working with Georgetown University to transition all of these activities. This transition has been thoughtfully planned. I am confident that all necessary services will continue, without interruption. DDS will continue to move forward in ensuring the health and safety of people with intellectual disabilities and providing innovative high quality services that enable people with disabilities to lead meaningful and productive lives as vital members of their families, schools, workplaces and communities in every neighborhood in the District of Columbia.

(signature)

Andrew Reese, Director

DC Department on Disability Services

At the same time, today’s Washington Post contains this follow-up article by Theresa Vargas: https://tinyurl.com/y2kj7sjq, which quotes former DDS director Laura Nuss on the subject.  Andy’s comment on my blog, and his follow-up statement above, tells such a different story from that told in the Post that it can be quite hard to disentangle.  Hopefully, the human services committee’s roundtable on July 23 (https://dccouncil.us/event/committee-of-the-whole-human-services-public-roundtable/) will give everyone the full picture.  What I will say for now is this, though:

This is yet another example of DDS’ not engaging its stakeholders adequately at the front end – having not adequately explained and discussed ahead of time with stakeholders where it’s proposing to take health services in the future, it has laid itself open to a media furor.  Much of this could have been avoided.  More broadly, I do not personally feel satisfied by the invitation Andy extended in his July 9 comment contained below, for people to join established DDS working groups in order to shape the future of disability services:  DDS needs to reach out to people in a more open-ended, receptive way about the strategic direction of the Department.  Otherwise I’m afraid we will all be seeing too many disagreements playing out in the pages of the Post, and that is in no one’s best interests.

More on DDS Cancellation of the Georgetown Contract

Quick update:

·       In my last blog post (“Andy, You Need a Plan”) I wrote about cancellation of the DDS contract with Georgetown for health services.  In response to that blog post I received a response from Andy Reese, DDS director, which you’ll find in the Comments section underneath that post.  Andy’s views as expressed in that comment are his own – like you, I’ll be examining it to determine my further thoughts on the subject.

·       Also relevant is the fact that Brianne Nadeau’s committee of the DC council is planning a roundtable on this matter on July 23:  https://dccouncil.us/event/committee-of-the-whole-human-services-public-roundtable/.

This issue is clearly creating  some serious buzz.  I happen to find myself in New Orleans at the moment so the weather is a bit on my mind.  You’ll hear more from me on this, I promise!

Andy, You Need a Plan

If you took the time to read through the Post yesterday you saw this article:  https://wapo.st/328YVLp concerning DDS’ cancellation of the contract with the Georgetown University Center (https://ucedd.georgetown.edu/index.php) for medical services.  My son has not had a need for these services as yet, but I can well understand the concerns of people for whom such supports can smooth the path from hospital to home.   At a more fundamental level, what I see here is another example of DDS springing a surprise on the disability community rather than engaging with its partners and stakeholders about the directions it is taking and its forward planning to meet future challenges.  I wrote about this early last month, and invited my readers to contact Andy and others in the senior DDS management – have you done that?  DO IT TODAY!  Here are those addresses again:

Andrew Reese, DDS director andrew.reese@dc.gov

Jared Morris, DDS chief of staff thomas.morris@dc.gov

Winslow Woodland, DDS/DDA deputy winslow.woodland@dc.gov

Erin Leveton, DDS deputy, quality and performance   erin.leveton@dc.gov

(she’s not gone until July 19!)

Darryl Evans, DDS/RSA deputy darryl.evans@dc.gov

It’s well past time for Andy and other senior managers to take some time to get real with stakeholders on DDS strategy, and to invite a dialogue (no, a series of dialogues) on how best to address core challenges.  Continuing to launch surprises is not the way to sustain support in the community. 

And before closing – I promised the information on the time and place of the hearing in the House of Representatives on DC statehood on July 24.  The time is 10:00 a.m. at the Rayburn House Office Building (Room 2154).  Mayor Bowser has declared this month DC Statehood Month in honor of this historic event:  https://content.govdelivery.com/accounts/DCWASH/bulletins/24ec935.  PLAN TO BE THERE!

NOW HEAR THIS

I hope that you, your families and friends are looking forward to a happy and healthy 4^th tomorrow.  In the holiday spirit, I’m keeping this new blog post brief, with just a few important announcements:

·       First, the sad news that Erin Leveton will be leaving DDS on July 19.  She will become a consultant on systems change to the state of Maryland’s disability services.  D.C.’s loss will be Maryland’s gain.  I hope that Andy Reese will select someone who is equally focused on innovative systems change in D.C. and outreach to the full D.C. community.

·       Congratulations to Molly Whalen, co-chair of the DDS Family Support Council, for this opinion piece in the new online newspaper DC Line (https://thedcline.org/) on dwindling education options for D.C. students with disabilities:  https://tinyurl.com/y5hyqpc3

AND

·       MARK YOUR CALENDARS FOR THREE IMPORTANT EVENTS DURING THE WEEK OF JULY 22!

o   On July 24 there will be a hearing on D.C. statehood in the U.S. House of Representatives. It will take place in the Rayburn House Office Building, and as soon as I have the exact time and room number I will share those.  (If you know, please leave a comment on this post!)  I am hoping to gather a dedicated band of D.C. folks from the disability community to show up in force – WE NEED TO MAKE OUR NATIONAL REPRESENTATIVES SEE REAL PEOPLE WHO LIVE IN D.C. AND WANT OUR RIGHTS! (note the 51 stars!)

o   On July 25, 12:30-2:30 (location TBD), the Family Support Council will hold a public meeting focused on recent developments with HSCSN (https://hschealth.org/health-plan) that affect Medicaid services for those 26 and under.  This is a great opportunity to get up to speed on what the recent changes mean, and the Department of Health Care Finance (DHCF), which oversees all Medicaid waiver programming, will also be present.

o   On Saturday, July 27, 5:30 onward, Quality Trust for Individuals with Disabilities will hold its annual Summer Breeze gala (https://tinyurl.com/yydzdxdv), at the Ronald Reagan Building, 1300 Pennsylvania Avenue NW.  Please come and support QT – I serve on its board and know better than most all the essential contributions it makes behind the scenes on behalf of people with developmental disabilities in D.C. as well as on the national scene.  Buy your tickets and be there!