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Early Start Changes make the press

September 21st, 2009 Posted in Changes to CES

Anyone feeling similarly or differently?

-Karen Baas, Infant Development Association of CA

O’Brien: How one agency’s cuts point to California’s bleak future

By Chris O’Brien
Mercury News Columnist

I am feeling more bleak than ever about the future of my adopted home state.

Years of budget lunacy in Sacramento culminated in a series of catastrophic cuts made this summer. It’s unlikely that any part of state government escaped the hatchet. I’ll leave it to historians to sort out just how badly we were failed by our governor and legislators.

But it’s all too easy to forget, amid all the talks of billions cut here and billions cut there, the impact of each cut, and how those cuts may eventually make our dire budget situation even worse. This situation did more than just demonstrate the madness of the short-term thinking that drove the cuts. It provided a stark example of how, by choosing to focus on cutting rather than investing, we, the people and the politicians, could end up paying more in the long run to deal with our problems.

In this case, I’m talking about the brutal reductions made to early intervention services for at-risk and developmentally delayed children under the age of 3.

I happen to know a fair bit about this subject because my son received these state-funded services between the ages of 18 months and 3 years. Liam is now 6 years old and has been diagnosed as high-functioning autistic. Thanks to those early intervention services, he’s now in first grade at a mainstream elementary school.

Understanding the impact of these cuts is difficult because the state’s system for providing these services is complex. But let me walk you through the maze.

At the top is the California Health and Human Services Agency. Under the CHHS is the Department of Developmental Services. The DDS doles out money to 21 nonprofit regional centers that serve 244,000 adults and children with various degrees of disabilities.

Back in 2003, when Liam was found to have speech and other developmental delays, we were referred to the Regional Center of the East Bay. Through the regional center, Liam received speech and occupational therapy that put him on the path to closing the development gap with his peers.

But it’s just such services that are now being cut. And because I know how invaluable they are, my heart breaks for all the families that won’t receive them.

The folks who run DDS and an advisory task force have been heroically trying to make the best of a horrific situation. The agency projected that the number of folks it would serve this year would increase by 12,800. But rather than getting a budget increase to cover that growth, which DDS estimated would run about $384 million, the agency got a bump of only $22 million to its $4.7 billion budget, so it needs to find savings to make up the difference. The agency convened a large number of stakeholders to try to find the most humane solution.

“How can we do the least harm?” said Julia Mullen, deputy director of the community services and support division at DDS. Perhaps we need to adopt that phrase as our state motto.

The political insistence on cutting put the department in the impossible position of trying to decide how to split the baby. For which group of people with autism, epilepsy or cerebral palsy do you reduce services? The solution was painful. The department focused on three categories of kids it serves. The first are kids who are at risk, perhaps because of a problem at birth, but have not shown a delay. California was one of only six states that served these kids. But no more.

The second category are kids who come to the regional centers after age 2 and are less than 50 percent delayed in one area, such as speech.

Both groups of kids will no longer receive direct services such as speech, occupational or physical therapy.

Fortunately, the agency managed to shift some money around to create a new prevention program for these kids. The new program won’t provide services, but the kids will be assigned a case manager to watch them closely to see if they’re getting worse, and if so, pull them into the system.

“We wanted to have a safety net,” Mullen said. “To make sure they did not fall through the cracks.”

This carefully thought-out plan has been further complicated by our knife-wielding governor’s decision to make a last-minute line-item cut that sliced another $50 million off the DDS budget. The agency is still weighing how to take that into account if it withstands a legal challenge.

From a moral perspective, the choice forced on the agency is indefensible. Rather than taking aggressive preventive action, the department must now gamble with these kids’ lives and hope as few as possible develop more severe delays.

From a treatment perspective, you’d be hard pressed to find any expert who would advocate a “let’s see what happens” approach. Mullen said the agency is going to be extremely vigilant when it comes to watching these kids for any signs they’re regressing.

But beyond all that, I’m troubled by the potential economics. Researchers are clear that early and preventive treatment saves money down the road. Conversely, by waiting, fewer kids will come into the system but they will likely have more severe issues, and thus will likely cost more to treat.

“The state is essentially disinvesting in young children,” said Steven Barnett, co-director of the National Institute for Early Education Research at Rutgers University. “And that will result in more expenditures later on.”

So this is the economic bargain our governor and Legislature have asked us to make: Let’s hope that the higher expense of waiting to treat fewer kids doesn’t eat up all the money we’re saving by cutting early intervention services.

I can’t help but think what my family would have done had we been told that our son wouldn’t be eligible because he was only 40 percent delayed. Because our insurance didn’t cover such direct therapy, we probably would have borrowed thousands of dollars to pay for services out of pocket.

This is the grim choice the state will be forcing on to thousands of families. So let’s be clear about one thing: These cuts are not really cuts. As a society, we will still end up with costs, directly or indirectly, down the road. These kids will go to schools, where they may require more services or support. Or they’ll be less productive when they grow up and can’t get jobs. Our failure to invest now may cost us more later, making it even more daunting to solve the budget mess. And if we can’t fix that, the quality of life that’s critical to our economy will continue to decline.

And in the end, this is only one of many such cuts enacted. Repeated over the billions of dollars sliced from the state budget, I wonder if the governor or any of our legislators know how much the cuts today will end up really costing tomorrow.

In truth, none of us knows. And that’s what has made me doubtful that the Golden State will ever regain its luster.

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