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Caseload Compliance: An Open Letter from Valley Mountain Regional Center

August 12 - August 20

August 9, 2019

To: Individual’s Served by Valley Mountain Regional Center (VMRC), Families, Employees, and Community Members (State Council on Developmental Disabilities North Valley Hills Office, Disability Rights California, the Family Resource Network, and the Vendor and Consumer Advisory Committees for VMRC.

Caseload Ratio Report and Public Comments
Almost every year the Department of Developmental Services (DDS) finds Valley Mountain Regional Center (VMRC) to be out of compliance with the requirements of a law[1] that says all the regional centers shall maintain service coordinator-to-persons served caseload ratios at or below specific averages. This year is no different and DDS has informed VMRC that on March 1, 2019, we “did not meet required caseload ratios for the highlighted categories noted in the following table:

As shown this the table VMRC is out of compliance in all categories and we are reported to be above the state average in three of the six categories (2 of the categories don’t apply to VMRC because we don’t have anyone served in those categories).

Some of our community partners are well aware of this annual result but many of you may not be. You may be wondering why this happens and what do we do about it. According to the law[2] we must make a plan to correct the problem if it happens two reporting years in a row, which it has. Immediately following our board of directors meeting on August 19, 2019 in our Stockton office, we will submit the final plan to DDS and we sincerely hope to get your input to help us develop this plan reflective of our community.

To help understand and build context for this issue consider the following facts:

Case Management
It has been a continuous effort to not only recruit more Service Coordinators, but also to retain them. We currently are experiencing a 10% turnover rate over the past year and the majority of our employee turnover occurs within the first few years of employment. We continue to see the value of the additions of positions for specific critical areas such as Employment Specialist, Cultural Specialist, and Program Evaluator of the Home and Community Based Services New Rules.  These new positions represented promotional opportunities for case carrying staff and serve in a support role of the case managers and the overall mission of the regional center.

Caseload Numbers
Over the past year we have experienced a 5% increase in our census for consumers found eligible under the Lanterman Act and those served in our Early Start program. It is important to note here that “Lanterman” and “Waiver” numbers are different because of two reasons. First the “Waiver” refers only to those on the federal “Medi-Caid Waiver” and “Lanterman” includes a combination of consumers on the waiver and not on the waiver. Second these numbers reported by DDS are from March 2019 and the numbers below are from August 2019. Our total consumers served across all services (includes intake) is about 16,000 as of today. Below are the current case load ratios for Lanterman Caseload (), Early Start Caseload (ages under 3 years), and our latest Intake numbers:

  • Lanterman Caseload Averages by Team:
    • Stockton: 949 / 12.5 =76
    • Stockton: 164 / 3.5 = 47 (*Deflection numbers not used in caseload ratio calculation)
    • Stockton: 988 / 11.5 = 86
    • Stockton: 944 / 12 = 79
    • Stockton: 1,004 / 12.5 = 80
    • Stockton: 1,005 / 11.5 = 87
    • Stockton: 979 / 11.5 = 85
    • Stockton: 1,072 /12.5 = 86
    • San Andreas: 922 /12 = 77
    • Modesto: 825 / 11.5 = 72
    • Modesto: 973 / 13.5 = 72
    • Modesto: 752 / 10.5 = 72
    • Modesto: 821 / 11.5 = 71
    • Modesto: 977 / 12.5 = 78
  • Early Start (ages 0-3 years) Caseload averages:
    • San Andreas: 142 consumers divided by 1.5 staff = 98.
    • Modesto: 975 consumers divided by 9.5 staff = 103 (2 unfilled caseloads)
    • Stockton: SE—717 consumers divided by 8 staff = 90.
    • Stockton: SL—641 consumers divided by 7.5 staff = 85.
  • Lanterman Totals: 12,375 (-164 in “Deflection”)= 12,211 divided by 155.5 staff = 1:79 or Team Caseload Ratio Total of 1,021 divided by 13 teams =1:79
  • Early Start Average: 1:94
  • July Intakes resulting in eligibility:
    • Out of 90 processed for people over age 3, we found 48 to be eligible
    • Out of 243 processed for people under age 3, we found 198 to be eligible

Why Doesn’t the State Budget Increase for Growth Cover the Cost of New Case Managers?
VMRC received an increase of $1 million in our operations for this new year to account for the growth in our regional center. However this amount actually matches the annual cost of our salary differential from year to year as a result of annual step increases and our recent union contract cost of living of 1% (regional consumer index is at 3.5%) cost the regional center about $1 million dollars annually essentially wiping out our allocation increase.

Since the cost of annual increases exceeds our ability to expand our case management capacity, Are we paying too much?
Periodically our human resources department completes a regional scan of compensation comparisons for the profession in our region.  Last year our study looked at the surrounding counties pay for social workers and found that our case managers are among the least paid (only Tuolumne County pays slightly less).  In looking at specific social work classifications we are actually even less competitive in our recruitment efforts in our region (see the chart below).

Position Compensation
California Prison $84,287
Child/Family Services $51,000
Medical Social Worker $50,000
Clinical Social Worker $44,700
Foster Families $42,427
In Home Social Worker $41,680
VMRC $39,728 with a Bachelor’s Degree

Are we hiring enough case managers to decrease the high caseload ratios?
We have clearly not hired enough case managers to meet our caseload requirements.  However, over the past three years VMRC has increased its case management staffing by 10% by hiring 30 expansion positions. Nevertheless, since the 2016-2017 fiscal year we have increased our consumer population by 25%. If all the new case managers were to absorb the workload of all of the new consumers they would have to assume caseloads of 100 to 1 to allow VMRC to maintain their ratios from prior to the hiring (which was out of compliance then). Last year we reported that, “While we have projected in past years that our consumer growth would continue to exceed our caseload ratio trends, we can actually report that our efforts are having an impact.  Today we have a 1:75 ratio and we now have our best caseload ratio we’ve had in several years”, as you can see above our numbers have already slipped to a higher ratio and we anticipate that this trend will get worse.

Transfers: Are people moving into our area or out of our area?
In addition to caseload growth naturally, our transfers in from other regional centers versus out to other regional centers over the past six years continues to reflect a net increase annually of about 100 people. This means we should be adding almost one and half case managers a year just due to transfers.

Do we have the right balance between case management and all other supports?
The most direct administrative support for the case management function is the program manager who actually performs several case management functions in their regular duties. The program manager provides the training and feedback necessary to develop person centered Individual Program Plans and Individual Family Service Plans. Program Managers often accompany the case manager to these and other meetings. Traditionally, the span of control estimates 5-6 per supervisor but as McKinsey Consulting reports eight is the typical span especially when supervising professionals. Our targeted span is 12 and many of our teams are now at 12-15 range which for our organizational structure falls in line with an expected contemporary perspective and given our expanding use of technology today it works efficiently in our view.

We Would Love to Hear from You 
If any of these factors we have described have sparked an idea for you about what your regional center can do to meet our case load ratio requirements please share your ideas with us. Also if you’d like to let us know your experience with case management from Valley Mountain Regional Center we’d love to hear about that as well. Regardless of the caseload ratios, we at VMRC sincerely strive to provide our consumers the very best person-centered case management we can and hopefully we achieve this daily.

Sincerely
Tony Anderson
Executive Director
Valley Mountain Regional Center
702 N. Aurora Street
Stockton, CA 95269

[1] Section 4640.6 (c) of the Welfare and Institutions (W&I) Code

[2] Section 4640.6 (f) of the W&I Code

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Start:
August 12
End:
August 20
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