DDD “No Paid” Service Client – The Silo Effect

We hear a lot about the “no-paid” services and the many DDD clients who are on this list.  Most recently, Sylvia Fuerstenburg, Executive Director of The Arc of King County, referred to the this group in a recent blog posting – “ In Washington State, 13,600 people – in King County, 3768 people – are eligible for paid services but are not receiving them due to the lack of state funding.” 

(http://thearcofkingcounty.wordpress.com/2011/06/14/new-data-reveals-our-nation-is-neglecting-people-with-intellectual-and-developmental-disabilities/)

I asked Sylvia for her sources on her figures but she was unable to cite a source for her numbers.  I have gone back through various DSHS reports, JLARC Audits and DSHS reports to figure out what makes up this group of people who much is written about but little is known about. 

The most recent figures that are available are from the January 31, 2009 report “DDD Assessment.”  This report was prepared in response to recommendation #1 in “Division of Developmental Disabilities – Analysis of How Services are Prioritized” report by the Joint Legislative Audit and Review Committee, issued July 31, 2007.

Assessments on no paid services – 1307

Assessments for clients on paid services – 39,711

Total clients assessed – 41, 108.

 

Roughly 2/3 of DDD clients who do not receive paid services through DDD DO receive paid services of Medical and/or economic supports (JLARC, 03-6, page 12)

 

Discussions about the adequacy of services to the DD population focus almost exclusively on the services provided by DDD.  But as with most clients in DSHS, DD clients tend to use the services of many parts of DSHS.  This is a package and in order to assess the services it is critical to look throughout the DSHS programs and not just one division, as DDD does when talking about services to DD clients.  Eighty-one percent of the DD clients use services managed and budgeted for by other parts of DSHS. (JLARC, 03-6, page 9)

I do know that there is a portion of the DDD clients who are on a “no-paid service”  This term is very misunderstood and this number is misinterpreted by many to mean that these people are eligible for services, want services or do not receive any services.  This group is “no-paid service” for a variety of reasons.

The clients on the no paid service have had some contact with DSHS and at some point the Division had determined that the individual met the criteria of having a developmental disability.  However, the Division may have had very little contact with that person after the initial determination and the Division has very little knowledge, if any, about the level or need of service or even if that person has interest in receiving services from the Division (JLARC, 07-4, page 9)

Some people seek eligibility for DDD even though they have no need at the time but use this as a method to speed up services if they might require services in the future.  These clients, even though they do not need services are considered “no paid” clients and therefor counted as clients with unmet needs. (Fact sheet 5.29f)

According to DSHS and DDD documents and audits that have been done, DDD is unclear as to what this number really is anyhow.  The documentation has been so poor and disjointed that no-one in the department was able to make heads or tails of what any of the numbers meant.

Due to a Joint Legislative Audit report, priority was given to trying to locate these “no-paid” clients, have them assessed as to what their needs were and then support them as need be.  Many of these people do not even need services, some refused to have the assessment done, others may have a developmental disability but their needs are not so significant as to be eligible for paid services. 

Another issue is that many of these clients do receive services from other programs within DSHS.  This includes medical, economic aid and food stamps.  Due to “silos” of the various services within DSHS, one department is not aware of services that their client may be receiving from another department. (Fact sheet 5.29fs)

Persons for whom the Division is providing no paid services and who have no service needs are presumed to be persons who are capable of meeting all their own needs, or whose needs are being met through other DSHS division not included in the DDD assessment, through personal or community resources. (fact sheet 5.29

The lack of effective coordination and management of the package of services provided by DSHS was highlighted in the Joint Legislative Audit and Review Reports.  The creation of these “silos”,  not only makes it difficult for clients to navigate the maze but almost impossible for policymakers to get a “picture” of the package of services provided to DDD clients since they are only exposed to the DDD Silo of programs and not made aware of the other programs from which DDD clients receive benefits. (JLARC, 03-6)

Below is a current chart, provided to me by DSHS, indicating the number or programs which DD clients receive benefits from.  You can see that 79% of DD clients receive services from 2 or more programs within DSHS.  This is a fact that is not presented when DDD and some Advocacy agencies talk about services to DD clients. 

 

Developmental Disabilities Clients Receive Services from Multiple Programs
FY2008 (July 2007 – June 2008)

Number

of

Programs

Client Count

Percent

1

8,330

20.5%

2

11,917

29.3%

3

13,093

32.2%

4

5,978

14.7%

5

1,204

3.0%

6

111

0.3%

7

7

0.0%

Total Clients

40,640

100.0%

Source:  Washington State Department of Social and Health Services,Research and Data Analysis,

Client Services Database analytical extract of 3/5/2011.

Throughout the reports over the past 9 years, it has been fairly consistent that about 2/3 of the clients who DDD reports as “no paid” clients receive benefits and services from other DSHS programs and very little effective coordination of these benefits is taking place. (JLARC, 03-6)

While it  certainly is true that not all needs for DDD services are  being met,  it is important to recognize  and dispel the myth that the majority of clients counted in DDD’s   “No Paid Services” category are in need of services that they are  unable to obtain.  The fact is  that the opposite is true.  The majority  are already receiving   services  from other DSHS divisions and/or  they are listed, but  not  currently in need of any service .

Sources:

 

An analysis of Unmet Service Needs for Washington State’s Division of Developmental Disabilities.” Fact Sheet Number 5.29fs.
 http://www.dshs.wa.gov/pdf/ms/rda/research/5/29fs.pdf
 
“DDD Assessment” Report to the Legislature. Prepared in Response to Recommendation #1 in
Division of Developmental Disabilities – Analysis of How Services are Prioritized”
Report by the Joint Legislative Audit and Review Committee, issued July 31,2007. January 30, 2009
 
Joint Legislative Audit and Review Committee. “Performance Audit of the Division of Developmental Disabilities” Report 03-6.                                                                            http://www.dshs.wa.gov/pdf/adsa/ddd/JLARC_PerfAudit.pdf
 
Joint Legislative Audit and Review Committee “Division of Developmental Disabilities” Analysis of How Services are Prioritized” Report 07-9.
http://www.leg.wa.gov/JLARC/AuditAndStudyReports/2007/Documents/07-9.pdf
 
Joint Legislative Audit and Review Committee. “Division of Developmental Disabilities:  Analysis of How Services Are Prioritized” Interim Report 07-4.
http://www.leg.wa.gov/JLARC/AuditAndStudyReports/2007/Documents/07-9.pdf
 

 

 

2 comments on “DDD “No Paid” Service Client – The Silo Effect

  1. Saskia Davis says:

    Of course it is of concern that there is the illusion of far more people on an overloaded wait list that DSHS may manufacture because the myth suits the case they make with legislators.

    But there is another concern:
    I would like to hear from some “no paid services” “clients” who are not receiving any services for their family member, especially cases in which an assessment has been requested but not done.

    What troubles me is that DDD has admitted that they do not assess people on the list unless they request it and then, only if they have enough staff.

    CMS makes it crystal clear that Washington State must admit qualified disabled people to an institution or a “community” setting, according to the choice of the client, within a “reasonable” period of time following the assessment of the need. ” A month is considered “reasonable.” Not having enough staff to comply with request for assessment may be a convenient means of budget control. But what about the person/family, waiting for a requested assessment? Over time, their loved one’s condition &/or their family’s condition may be deteriorating.

    What could be of a higher DDD priority than knowing the conditions of clients and meeting their needs? .

    If there are readers who fall into this category, can you please let us try to help you?
    Find the contact information on this “Because WE Care” site, or send me an email: ddexchanges (at) gmail.com.

    Like

  2. Thank you for the comment – it is a critical piece of information that I did not point out. As one who was denied services over and over again while our son was on a waiver, I know how frustrating it can be.

    Like

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