The Dakota County Account Management Program attempts to better serve people with developmental disabilities and their families by giving them control over financial resources and allowing them to make service decisions. The program
evolved during a decade of changing attitudes about disabilities and the role of
government in providing services.
The idea of placing government funds under client management was fostered in part
by Lyle Wray and the Governor's Planning Council on Developmental Disabilities (DD
Council). When Wray took the post of Dakota County administrator, his agenda
included an intention to implement a voucher or similar cash grant system.
Favorable conditions at the county enhanced the feasibility of the account
management project. The structure of the community services division promotes
communication and cooperation among employees. A culture of innovation, fostered
by the county board of commissioners, the county administrator, and community
services management, enables' employees to be creative and provides incentives for
successful innovation.
II. DESCRIPTIVE
A WHAT
1. The Innovation:
The Dakota County Developmental Disabilities Account Management Program places funds previously controlled by the county directly into the hands of client families.
Before the account management program began, client families were limited to services available from providers licensed and paid for by the county. Because the county identified, licensed, and paid the service providers, the system was inflexible and often unresponsive to client families' needs. Moreover, because licensed service providers were expensive, families believed they could receive more services with the same amount of funds by hiring non-licensed providers. Dissatisfaction with the quality and level of service prompted some families to request changes in the system.
The account management program places funds in the hands of client families, giving them control over quality, type and level of service. Client families may purchase respite care, equipment, or non-traditional supportive services according to their preferences. Clients are not limited to county-licensed providers and may hire whomever they wish, including siblings or neighbors.
2. Uniqueness:
The use of direct unusual. Although cash grants to recipients of government assistance is voucher programs such as food stamps and Medicaid have long been used to disperse public funds, direct cash grants to clients are relatively uncommon. Because public agencies are accountable to taxpayers for the appropriateness of expenditures, few agencies have opted to provide cash grants which allow recipients to allocate funds according to their own preferences.
By focusing on customers, the account management program is part of the movement to make public services more responsive to customer needs. Unlike bureaucratic systems, which are based on the belief that professionals know best what citizens need, cash grants are based on the assumption that citizens are the best judges of their needs. Client fiscal control creates flexibility and results in service that better meets the needs of individual families.
The account management project also arises from the movement for full integration into communities of" individuals with developmental disabilities. As recently as the 1970s, most people with developmental disabilities spent their lives in large state institutions under the care of professionals, isolated from family and community. A 1972 federal district court decision (Welsch v. Likins) required the state to provide services to people with disabilities in home communities, rather than in large state hospitals. The county's account management program is seen as one mechanism that can support full participation and integration in family, school, and community life.
3. Origination/Invention:
The account management concept came from many sources. In the mid-1980s, the environment was fertile with ideas and activity focused on empowering individuals with developmental disabilities and their families. The Welsch consent decree had legitimized and fueled attempts to ensure that individuals remain integrated in the community.
Lyle Wray, Dakota County's Administrator from 1987 to 1992, had worked on DD issues, including empowerment and accountability, since the 1970s. While serving as court monitor for the Welsch decree from 1980 to 1984, he shared an office with the DD Council, which at the time was working to develop consumers' leadership and advocacy skills. The DD Council had also articulated the goal of putting social services money directly into consumers' hands.
In 1986, ARC-Suburban, a citizens' advocacy group, launched a program with funds from the DD Council to train parents of the children with developmental disabilities to be their families' own case managers. The program's objectives included citizen empowerment, service-provider accountability and the implementation of a "voucher" program.
Through their association with ARC, county employees and clients were introduced to the idea of cash grants for DD funds. ARC created a task force to explore the use of "vouchers" (their term for cash g-rants) in conjunction with its case management project. Dakota County DD section supervisor Susan Hanson was a member of the task force. During the program's third year, ARC arranged for a ,presentation by Kathleen McKaig from the Family Partnership Program of New York on that organization's experimental voucher program. The meeting was attended by staff from ARC and Dakota County, and county clients who were participating in the case management program.
4. Organizational Structure:
Dakota County is growing rapidly. A growing population presents new challenges for government service delivery. One employee recalled that the county originally did not have structures or procedures for many functions. Government is constantly being invented ill Dakota County
Dakota County has a lower ratio of employees to residents than other Minnesota counties. As a result, employees often work in more than one area and are not pigeonholed into narrowly defined roles. Of necessity, employees have greater flexibility and the opportunity to work and interact with others outside their area
Dakota County offers a high quality work environment compared to other counties, and as a result its workforce is very stable. Dakota County is a desirable place to work; the pay and benefits are very good for county level positions. As a result, the staff turnover rate is low. However, because of staff longevity and a relatively flat management structure, there is not much opportunity for advancement.
The community services division contains departments often separated in other counties. The division includes public health, developmental disabilities, corrections, economic assistance, social services, veterans services, and extension services. Many are housed at the Dakota County Northern Service Center in West St. Paul. The proximity of these departments to one another facilitates easy communication and open working relationships between departments. One employee said that with everyone in one building, "you can get work done in the halls."
The planning department is also located in the Dakota County Northern Service Center. Locating the planning department with the community services division allows better communication between planning and line staff. The planning department was previously located in Hastings.
5. Organizational Culture:
The County promotes an innovative, client centered image. "We are constantly looking for better ways to serve you . . .." These words in a Dakota County government information pamphlet say much about the county's self-image regarding innovation.
The innovative culture of Dakota County begins at the top with the county board of commissioners. Many employees perceive the board as active promoters of innovation and client-centered services. The perception derives partly from the relative ease with which proposed innovation wins board approval, and partly from statements attributed to board members. Board members have articulated the importance they attach to quality and to innovation as a means of achieving it.
The county administrator helped instill a culture of innovation, especially with regard to human services. Lyle Wray came to the county quite knowledgeable and concerned about DD issues. Every person interviewed mentioned Lyle Wray when speaking about the county's culture. He was generally credited with instilling or promoting a culture of innovation.
Departmental management has also promoted the culture of innovation. Dakota County managers are seen by their employees as innovators. Managers give people room to fail. Because most innovations at the county start small, if they fail, they fail small. When successful, innovation is rewarded by management with better performance reviews, raises, and recognition. Innovation is so strongly stressed by management that some employees feel they are expected to innovate. Management also actively seeks the resources necessary to fund innovation. Several employees said that county managers "chase grants" as a means of promoting innovation.
The culture has been successfully transferred to county staff. Staff who have worked in other settings are impressed with the possibilities Dakota County offers for change and describe the county's general approach as "finding new ways to tackle perceived problems." Staff also feel free to approach their supervisors with new ideas and suggestions for improvement.
B. WHEN
1. Chronology:
1972: The Welsch decree is announced by the U.S. District Court; the decree requires community based services for individuals with developmental disabilities.
1980: Lyle Wray, a psychologist at the Brainerd Regional Treatment Center, becomes court monitor for the Welsch decree. He shares office space with the Governor's Planning Council on Developmental Disabilities in St. Paul.
1986: Wray becomes human services director at Dakota County. Dave Rooney, director of human services at Olmsted County, discusses the establishment of vouchers on a wide scale in Olmsted County. Lura Jackson takes a job as social worker in the county's social services department. The DD Council funds ARC's case management program and plans its own "Partners in Policymaking" program; both efforts are intended to develop parent leadership and foster accountability within the service system.
1987: Wray is promoted to county administrator. Familiar with DD issues from his previous work, he takes special interest in DD policy. Partners in Policymaking program begins; one of the first participants is Linda Rother, an Eagan mother of three children with disabilities.
1988 (March): A mother from Cannon she complains of the lack of adequate
Falls sends a letter to the county in which licensed providers in her community. A
conciliation conference is arranged for April. Jackson and her supervisor, Susan Hanson, learn about ARC's case management program, possibly from Linda Rother, who is one of Jackson's clients. Hanson serves on ARC's voucher task force.
1988 (April): The conciliation conference between the Cannon Falls mother and Dakota County social services staff takes place on the 15th. As a result of that meeting, a "voucher" system is briefly considered on test basis for this family only. Susan Hanson submits a memo to Sally Moran on May 16 recommending the voucher idea for this family; the request does not get action.
1988 (May): An ARC-Suburban conference features a speaker from New York who describes a voucher program in her organization. Jackson, Hanson, and at least one of the parents attends.
1988 (June): The community services department's Sectoral plan, prepared by a consulting firm, recommends consideration of vouchers. Dave Rooney arrives from Olmsted County and assumes the post of' community services director.
1988 (September): Rother returns home from a meeting one day to find her licensed provider, at $30 an hour, watching television as the kids tear up the house. She requests a conference with Dakota County staff to complain about the unresponsiveness of such providers to the families expectations. After the conference, providers "disappear" and the family goes without services for three months.
1989 (February): Request-for-proposals from DD Council is received at county, is considered as a vehicle for implementing vouchers. Jackson is asked to select individuals for possible participation is and given responsibility for future action if the program is funded. Social services staff select 23 candidates for the pilot project.
1989 (March): With the grant deadline approaching, planners Meg Grove and Gay Bakken call selected individuals, reaching 10 of them. Two indicate support for the voucher idea. Proposal is submitted; it requests $15,000 and outlines a plan to involve twelve families of children ages 18 and under in a test project. ARC agrees to cover the cost of two of the families.
1989 (October): Cash grant program is implemented. Training sessions for parents begin, with journals to be kept to document parent expenditures. Internal conflict arises between social services and the data processing department over accounting procedures, and attorneys raise questions about liability. Neither issue proves to be a setback.
1990: In February and March, the second year grant proposal is prepared which calls for program expansion, even though program has only been operating a short time and little is known about what works. Eligibility is expanded to include people over age 18. DD Council approves grant for second year in July.
1991 (spring): The DD Council grant focus is changed; the cash grant project does not fit the new focus. The county does not seek funding for a third year, but continues it as an ongoing activity. Program expands to serve 50 people. County staff takes over responsibility for parent training.
1992 (spring): County makes plans to institutionalize the cash grant program, now called the Account Management Program, for fiscal year 1993. Concern is expressed among board members and county management about the risk of improper purchases with public funds; new rules and allocation guidelines are being developed.
Supervises the supervisors of the three units which provide direct services to persons with disabilities and their families.
Meg Grove. Senior Planner, Dakota County Planning Department (1987-present). M.A., Humphrey Institute at the University of Minnesota. Her role is to prepare grant proposals and provide ad hoc program development assistance; she has worked on diverse issues including child care, welfare reform, medical assistance, and employment. Grove has also worked for Hennepin County.
Susan Hanson. Supervisor, Children's Unit (1985-present). MSW from UCLA in 1968. Reports to Milt Conrath. Member of ARC's Consumer Case Management program task force on vouchers.
Lura Jackson. Social Worker. Graduated from University of Minnesota-Morris with bachelor's degree in human services. Career history includes work in several group homes in rural Minnesota. In 1985, Lura and her husband started a family farm. When the farm business faltered in April 1986, she applied for and was offered her current position in Dakota County, Carries a caseload of 20 to 36 families. Helps devise service plans; refers clients to services; troubleshoots; provides other support and counseling. Reports to Susan Hanson.
Marijo McBride. Hired as staff at ARC-Suburban to run the Consumer Case Management program. She and the program are now housed at the University of Minnesota.
Sally Moran. Deputy Director of Community Services and Director of the Social Services Division. (1988-present). Previously section manager in social services. Reports to Dave Rooney.
Lori Perryman. Staff member at ARC Suburban. Worked on Consumer Case Management program for its last six months.
Dave Rooney, Director of Community Services Division (June 1988-present). Former community services director in Olmsted County, MN. Recruited to current job by Lyle Wray.
Linda Rother. Parent of three children with disabilities. Participated in DD Council's "Partners in Policymaking" in 1987. Is a board member of many local and regional disabilities organizations. Participated in ARC's Consumer Case Management program. Was on the DD Council 1989-1992. Received M.A. in public administration from Hamline University this year; thesis was on Colleen Wieck's leadership of the DD Council. Now speaks nationally on disabilities issues, and is currently running for state representative. Lives in Eagan.
"Second Parent." Lives in Cannon Falls. Filed formal request for conciliation with Dakota County staff regarding her inability to find services in her rural community. She and Linda
are friends
Colleen Wieck. Executive Director, Governor's Developmental Disabilities. Nationally recognized expert on new models of service for persons with disabilities; outspoken advocate for empowerment and accountability. Designed Council process to emphasize innovation and implementation by community agencies, as well as by the DD Council itself, Co-authored with Lyle Wray three scholarly articles on new models of service, each of which mentions vouchers. Holds a Ph.D.
Lyle Wray. Dakota County Administrator (November 1987-February 1992) and Human Services Director (January 1986-November 1987). M.A. and Ph.D. in psychology, focusing on mental retardation. Career experience as program director in residential facilities for developmentally disabled persons, including one year at Brainerd regional treatment center. Court monitor for Welsch decree (1980-1984).
2. Role of Significant Actors
An important element of" this innovation is the complex network of overlapping relationships and history that catapulted the concept into a plan. Many people of diverse interests were involved in the innovation. There were strong links between the county, ARC, and the DD Council that were marked by mutual understanding and trust (though not always the absence of friction). Staff members knew one another, and had shared experience in grappling toward new ways of doing things. The professional rapport between Lyle Wray and Colleen Wieck was critical; both were in @ leadership positions and had already articulated, together, a vision of how the system needed to change.
Within this network, county clients played a key role. Linda Rother, whose personal leadership had been nurtured by ARC and the DD Council, provided a link between the Council, ARC, and the county. Her complaint to county authorities provided one of the "shocks" that propelled the idea into action. The complaint can also be viewed as a natural progression in her emergence as a leader on disabilities concerns.
Inside the county, the initial program development included a few key people in the DD section and senior management. Senior Planner Meg Grove served as a boundary spanner enlisting expertise from Lura Jackson, Susan Hanson, and Rob Sawyer (Milt Conrath's predecessor). Together they were responsible for preparing the grant proposal to the DD Council to fund the innovation. The process did not include significant participation by families, even though the program had been precipitated partly by parent complaints. Senior managers acted as "cheerleaders;" Dave Rooney and Lyle Wray encouraged the process, but had little direct involvement. Grove's attention to securing top management and board support led to program features that focused on accountability. By attending to management concerns, she not only described the program in the grant proposal, but shaped the design itself.
D. WHERE
The account management program was created primarily in one unit, the developmental disabilities section of the social services department. The purpose of DD section is to provide support services such as case management to people with developmental disabilities and their families. In the first year, the cash grant program involved only one social worker but, as the project expanded, more social work staff became involved. Staff from the planning department of the community services division worked with staff in the developmental disabilities section to design the project, write the grant proposals, and evaluate the impact of the program. The project remains localized in the developmental disabilities section and has not spread to other areas within the social services department or community services division.
The account management program required only a small amount of additional resources. The $15,000 needed to train client families in choosing providers and managing funds was covered the DD Council grant. Since existing social work and planning staff were available to implement the program, no additional resources were needed for new staff positions. Finally, the program required few additional resources because the project did not allocate additional money to families for purchasing services. Under the cash grant program, the dollar amount given to each family was equal to the amount of funding previously allocated to them under the established system.
The innovation occurred in a social and political environment which shared a common vision that people with developmental disabilities should be provided with adequate support services to enable them to take advantage of the freedoms and opportunities in society. Although there was not a consensus on the best Wray to achieve this vision, the environment was rich with ideas, energy, and commitment for improving the quality of life for people with developmental disabilities.
E. HOW
1. The implementation Process:
Two events provided the shocks that began the implementation of the account management program:
First, two client families complained to Dakota County about the quality and level of services their families were receiving. One family filed a request for a conciliation conference (a formal grievance) with the county. The family believed they could arrange service that would better meet their needs and requested that the county look into the feasibility' of a "voucher" program. Soon after the conciliation conference in April 1988, a memo was prepared recommending the authorization of a demonstration account management program. The recommendation was not followed at that time; the reason for the lack of follow-up is not clear. The second family began experiencing problems later that year (September, 1988). Although they did not file a formal grievance, they repeatedly called county employees requesting the implementation of a voucher system. One employee recalled that the family was very persistent, calling "anyone who would listen. "
Second, the DD Council announced a request-for-proposals for experimental programs to empower individuals with developmental disabilities and improve access to services for those currently underserved. The county decided to respond to the RFP with a proposal for a "voucher" program. No one we spoke to could identify who made the formal decision to apply for the g-rant; however, it seemed that the RFP catalyzed an idea which had been present for several months but lacked resources.
The planning staff had only three weeks to prepare the proposal for the DD Council. The response was to work fast, get a basic program design sketched out, and turn in a proposal. There wasn't time for elaborate planning among all the players, or for attention to details of how the model would be implemented. An example of the hastiness of the proposal formation was a phone survey taken to assess client support for a "voucher" program. The survey results showed that those surveyed were hand-picked as potentially interested clients; however, of the ten contacted, only six were familiar with the concept of vouchers and only two felt they were equipped to arrange their own services.
The account management program was designed as a small-scale demonstration project. Although ARC's staff had urged that the first program be truly experimental, involving diverse families in order to draw conclusions about who benefitted most and why, Dakota County staff" considered it more important to create a small program that could be expanded and institutionalized. Consequently, the design was oriented toward ensuring success (for example, by carefully selecting participants, and by emphasizing financial accountability).
Formal planning of the account management program began after the DD Council grant was approved. "It wasn't until after we got the money that we actually started figuring out how the program would run. " The planning department worked with DD section employees and ARC to develop the final plan.
During the planning phase, the county attorney's office notified the county that the account management program exposed the county to liability for injury and worker's compensation claims brought by private service providers paid with county funds. The issue was a potentially serious setback; other counties have considered but failed to implement account management programs because of the liability issue. County management decided not to let the issue stop the program; "we just ignored it. " The Board of Commissioners was informed of the problem and has nonetheless approved the program for the past three years. The County has tried unsuccessfully to get a change of the Minnesota liability law on the legislative agenda.
Internal conflicts between departments also arose during the planning phase. A protracted argument ensued between data processing and the DD section regarding the mechanical aspects of program accounting. There were no accounting procedures allowing for the disbursement of cash to client families. During the early stages of the program, accounting was clone manually as the conflict continued. The dispute was apparently settled several months later following a memo in which a manager directed the data processing staff, in effect, to do whatever it would take to make the system work.
Early in the program's first year, the county was confronted with expenditures that pushed the boundary of client discretion. .Although the program was intended to empower clients, certain client expenditures raised concern about public reaction to non-traditional uses of tax payers' money. Many county employees referred to the "I-Team test" as their rule of thumb in judging purchases: How would this expenditure appear to a taxpayer hearing about it on the 10:00 news? The county did not respond by creating rules or tightening client accounting procedures, but social work staff did counsel clients about making good judgments. Parents exerted pressure on one another to "be careful" about accountability in order not to risk losing the program.
Soon after its initiation, the county decided to expand the program. The decision to expand was prompted by the rapidly approaching DD Council proposal submission deadline and the need to add "whistles and bells" to earn DD Council finding for a second year. Program changes included an expansion from 10 to 25 client families; the inclusion of dependent adults with developmental disabilities; a reduction in the amount of training required per family; and the mainstreaming of the program to include social workers other than Lura Jackson.
Social worker resistance to the program emerged as the program was expanded in the second year. The program's expansion required the participation of more social workers to handle the increased load of clients. Many social workers distrusted clients' ability to manage DD funds and disliked yielding control to parents. Some social workers resisted indirectly, failing to attend meetings or complete required paperwork. Apparently no serious effort has been made to overcome social workers' skepticism. Managers have ignored the issue, for the most part, assuming that social workers will do what they are told.
The program was expanded again in the third year, without DD Council funding. The third year program included fifty client families. Without DD Council finds, the county was required to absorb program administrative and client training costs of the program. The obstacle did not prove to be a setback. Training was taken over by Jackson and the additional clients were spread among DD social workers.
The program is now being institutionalized at Dakota County as the "Account Management Program." Beginning fiscal year 1993, all families with developmentally disabled children will be eligible to receive cash to purchase their own services. A data and social workers have been financial management system is in place at the county and trained to implement the program.
As the county prepares to institutionalize the program, the board has expressed concern about the possibility of inappropriate use of funds. When the program included few clients and potential loss to the county was small, the Board was apparently unconcerned about this issue. Now that the program can potentially include all DD client families, the Board is more concerned. To control their risk, the Board has mandated that funds not be dispersed in yearly lump sums as in the past.
2. Process type:
The implementation process contained elements of both the "policy planning" and "groping along" models. As in Olivia Golden's groping along model, there was no legislative mandate nor policy statement which the innovation attempted to address; rather, the ,account management program was a rapidly planned and implemented program intended, in part, to respond to a specific problem. On the other hand, uncharacteristic of" the groping along model, the program did not experience frequent, substantial changes. Potential setbacks arose but for the most part failed to require changes in course. Program modifications were minor.
3. Leadership type:
Despite the presence of a highly visible county administrator, the type of leadership characterizing the innovation process was collaborative, not heroic. Wray seems to have played the leadership role of sponsor. He is widely credited as promoting the culture of innovation and surely had a part in pushing "the innovation idea into good currency." As the program was planned and implemented,
1. Golden, Olivia (1990) "Innovation in Public Sector Human Services Programs: The Implications of Innovation by "Groping Along," Journal of Policy Analysis and Management, 9(2)219-248.
2. Angle, H.L. & A.H. Van de Ven, "suggestions for Managing the Innovation Journey," in Van de Ven, et al., Research on the Management of Innovation, Chapter Twenty-one, pp. 663-697.
leadership roles were shared within and outside the organization. Social worker Lura Jackson is credited by many with a significant shepherding role. Jackson not only played a primary role during the implementation phase but had substantial input during the planning phase as well. Outside actors also assumed leadership roles; ARC played the role of critic, keeping pressure on the county to "remove the strings."
III. ANALYTIC
The "why" component of this innovation has two parts. The first concerns the genesis of the account management concept; why it surfaced when it did. The second, related part, concerns why the innovation succeeded once the idea had gained currency. The two components overlap considerably. We try help to keep them apart as much as possible.
1. The idea:
The Dakota County account management program can be viewed as one result of a strategic, long-term effort by Lyle Wray and the Governor's Planning Council. The story of this innovation lies not just with its advent at Dakota County, but with the entrepreneurial process of developing leaders and creating the fertile environmental conditions that allowed the innovation to take root.
Lyle Wray and Colleen Wieck shared a clear vision of how the system serving people with disabilities needed to change, and an agenda for carrying out their vision. Both were in top leadership positions. Outside the county, the DD Council had a long-term plan for change that included developing the leadership and advocacy skills of' 500 people with disabilities and their families, and prompting government programs to be more accountable to consumers. One of the Council's ultimate goals was to put social services money into the hands of consumers; it viewed the ARC program as a preliminary step toward that goal, with the Dakota County program as the next step toward the institutional change they were seeking. Their funding for the ARC project also reinforced ARC's ongoing advocacy role in its relationship with Dakota County. The vocal complaints of Linda Rother and the Cannon Falls mother were also not the result solely of chance, but they partly emerged from the DD Council's work to empower individuals to advocate for themselves.
When Lyle Wray came to Dakota County, one item on his personal agenda was implementing a voucher program. Inside the county, he reinforced the board's `concern with innovation and hired other staff who shared this penchant. He may have spurred the staff to apply for the Council grant, and blessed the grant preparation process from afar.
2. Implementation:
Letters from parents provided a "direct personal confrontation with the source of the problem" which was needed to move staff to action. The concept of an account management program had been discussed by many people prior to the onset of the innovation. However, it seems that staff needed direct confrontation from parents in order to stimulate them to action. Before the shock, the problem remained below the staffs "threshold of concern.":' Confrontation with parents seems to have most affected Jackson, who dealt with parents including Linda Rother daily. Jackson was also the social worker most involved in planning and implementing the program.
The grant program was an important driving force behind this innovation, and its impact extended beyond its cash value. In the context of Dakota County's multimillion-dollar budget, $15,000 represents a minuscule expenditure, and one that presumably could have been funded internally. It doesn't seem plausible that the $15,000 administrative cost of the program would stand in the way of its implementation, yet the process of securing this relatively small sum from the Council catalyzed the innovation. The results of our interviews suggest several descriptions of the role of grant funds at Dakota County:
the process of applying for a grant provides motivation for people to come together and plan;
during any innovation, the old system must be run concurrently with the new, and money is needed to fund the overlap;
3 Schroeder, R. G., et al., "The Development of New Ideas," in Van de Ven, A. H., Angle, H.L. & M.S. Poole (eds~, Research on the Management of Innovation: The Minnesota Studies, Harper & Ro\v, New York.
securing grants is a way for county employees to demonstrate that they are aggressive and innovative;
"proposal criteria shape program plans. The cash grant program was expanded in the second year not because the county believed it needed expansion, but because it needed a new feature to justify a second year of support.
the county's concern with ensuring that the pilot project succeeded suggests that it may be easier to implement a new idea if it has already been proven. That is, while it maybe impossible for the county to spend $15,000 on a completely new idea, it is relatively easy to assume that cost on a program in operation.
while nobody we spoke with mentioned this issue, we hypothesize that the fact that this project was funded by an external grant may have provided momentum to carry it through potential setbacks. The project could not simply be abandoned, but had to be fulfilled in some fashion.
Dakota County's culture of innovation was essential to the success of the program. The perception, shared by management and staff, that Dakota County is an innovative organization interested in providing quality service gives employees the incentive to be creative. Employees' confidence that the county was willing to take risks and tolerate failure supports their creativity. Management was oriented toward risk-taking. Staff said that Rooney and Wray's motto was "do first, apologize later. " One senior person noted that when the concern about liability was raised, he figured he'd been sued before "and that's what lawyers are for." Incentives for successful innovation push employees to create successful programs.
The proximity of the planning department and the DD section allowed client concerns to be directly incorporated into the planning process. Lura Jackson, a DD section social worker, assisted the senior planner in developing the account management program. Jackson's direct client contact gave her insight into her clients' frustrations that are unavailable to planning staff.
3. Conclusion:
This innovation emerged from more than a decade of effort to empower individuals with developmental disabilities. The innovation resulted from a clear vision of what services should be; ongoing leadership by two highly-placed individuals; strategic work to educate citizens and policy makers; development of leadership and advocacy at the grass roots level; sustained, conscious effort to promote a climate of innovation within the county government; development of trusting relationships between professionals and community groups; creative problem solving by county employees; and--not least--the personal persistence of two parents and their families.
CHRONOLOGY
1972: The Welsch decree is announced by the U.S. District Court; the decree requires community based services for individuals with developmental disabilities.
1980: Lyle Wray, a psychologist at the Brainerd Regional Treatment Center, becomes court monitor for the Welsch decree. He shares office space with the Governor's Planning Council on Developmental Disabilities in St. Paul.
1986: Wray becomes human services director at Dakota County. Dave Rooney, director of human services at Olmsted County, discusses the establishment of vouchers on a wide scale in Olmsted County. Lura Jackson takes a job as social worker in the county's social services department. The DD Council funds ARC's case management program and plans its own "Partners in Policymaking" program; both efforts are intended to develop parent leadership and foster accountability within the service system.
1987: Wray is promoted to county administrator. Familiar with DD issues from his previous work, he takes special interest in DD policy. Partners in Policymaking program begins; one of the first participants is Linda Rother, an Eagan mother of three children with disabilities.
1988 (March): A mother from Cannon Falls sends a letter to the county in which she complains of the lack of adequate licensed providers in her community. A conciliation conference is arranged for April. Jackson and her supervisor, Susan Hanson, learn about ARC's case management program, possibly from Linda Rother, who is one of Jackson's clients. Hanson serves on ARC's voucher task force.
1988 (April): The conciliation conference between the Cannon Falls mother and Dakota County social services staff takes place on the 15th. As a result of that meeting, a "voucher" system is briefly considered on test basis for this family only. Susan Hanson submits a memo to Sally Moran on May 16 recommending the voucher idea for this family; the request does not get action.
1988 (May): ~ An ARC-Suburban conference features a speaker from New York who describes a voucher program in her organization. Jackson, Hanson, and at least one of the parents attends.
1988 (June): The community services department's Sectoral Plan, prepared by a consulting firm, recommends consideration of vouchers. Dave Rooney arrives from Olmsted County and assumes the post of community services director.
1988 (September): Rother returns home from a meeting one day to find her licensed provider, at $30 an hour, watching television as the kids tear up the house. She requests a conference with Dakota County staff to complain about the unresponsiveness of such providers to the family's expectations. After the conference, providers "disappear" and the family goes without services for three months.
1989 (February): Request-for-proposals from DD Council is received at county, is considered as a vehicle for implementing vouchers. Jackson is asked to select individuals for possible participation is and given responsibility for future action if the program is funded. Social services staff select 23 candidates for the pilot project.
1989 (March): With the grant deadline approaching, planners Meg Grove and Gay Bakken' call selected individuals, reaching 10 of them. Two indicate support for the voucher idea. Proposal is submitted; it requests $15,000 and outlines a plan to involve twelve families of children ages 18 and under in a test project. ARC agrees to cover the cost of two of the families.
1989 (October): Cash grant program is implemented. Training sessions for parents begin, with journals to be kept to document parent expenditures. Internal conflict arises between social services and the data processing department over accounting procedures, and attorneys raise questions about liability. Neither issue proves to be a setback.
1990: In February and March, the second year grant proposal is prepared which calls for program expansion, even though program has only been operating a short time and little is known about what works. Eligibility is expanded to include people over age 18. DD Council approves grant for second year in July.
1991 (spring): The DD Council grant focus is changed; the cash grant project does not fit the new focus. The county does not seek funding for a third year, but continues it as an ongoing activity. Program expands to serve 50 people. County staff takes over responsibility for parent training.
1992 (spring): County makes plans to institutionalize the cash grant program, now called the Account Management Program, for fiscal year 1993. Concern is expressed among board members and county management about the risk of improper purchases with public funds; new rules and allocation guidelines are being developed.
