OVERVIEW
Services for persons with developmental disabilities are administered through the Department of Developmental Services (the Department), one of eleven departments in the Health and Welfare Agency. The Agency Secretary, in turn, reports to the Governor at the cabinet level.. The Department was created in 1978. Before that time, services for persons with developmental disabilities were administered through a mental health department or through a large health department that served the human service needs of the entire population. The creation of a free-standing Department ensured that the unique service needs of persons with developmental disabilities would receive the complete attention and be the sole priority of the administering department.

The Department administers a system serving approximately over 91,000 persons who are developmentally disabled and more than 7,600 infants who are at risk of becoming developmentally disabled. These persons are served through contracts with 21 private, nonprofit regional centers and through the direct operation of seven developmental centers (formerly known as state hospitals). Located throughout the state, the regional centers serve as the single point of entry into the system, including admissions to the developmental centers.

CHARTER
Californians are fortunate to have explicit, comprehensive, and exemplary legislation pertaining to the purpose, structure, and function of the developmental disabilities service system. The developmental disabilities services delivery system in California was created by the State Legislature through the Lanterman Developmental Disabilities Services Act (Lanterman Act). That Act states explicitly that the "State of California accepts a responsibility for its developmentally disabled citizens and an obligation to them which it must discharge" (W&I Code § 4501). The Lanterman Act goes on to establish the structure and principles of California's developmental disabilities service system and defines the roles and responsibilities of the Department, the regional centers, and other involved agencies.

ELIGIBILITY AND INDIVIDUAL PROGRAM PLANNING
Individuals are eligible to receive services when they are determined to have a developmental disability. 'Me State Legislature has defined developmental disability as follows:

"Developmental disability" means a disability which originates before an individual attains age 18, continues, or can be expected to continue, indefinitely, and constitutes a substantial handicap for such individual. As defined by the Director of Developmental Services, in consultation with the Superintendent of Public Instruction, this term shall include mental retardation, cerebral palsy, epilepsy, and autism. This term shall also include handicapping conditions found to be closely related to mental retardation or to require treatment similar to that required for mentally retarded individuals, but shall not include other handicapping conditions that are solely physical in nature (W&I Code § 4512[a]).

When a person is found to be eligible for regional center services, a client program coordinator (CPC) is assigned from the local regional center. The individual and an authorized representative (e.g., parent, guardian or conservator) then meet with the CPC and other necessary professionals to form what is called an interdisciplinary team (IDT). The IDT assesses the individual's strengths and weaknesses and develops a plan to enhance strengths and remedy weaknesses. This plan is called an Individual Program Plan (IPP).

The IPP sets measurable goals and objectives for the individual's progress, and identifies the services that will be necessary for the person to achieve those goals and objectives. The IDT meets whenever necessary (but at least annually) to update and revise the individual's IPP.

REGIONAL CENTERS: FIXED POINTS OF COMMUNITY CONTACT
In creating the developmental disabilities service delivery system, the Legislature determined that fixed points of contact in the community would be needed for persons with developmental disabilities and their families. These fixed points of contact are the 21 private, non-profit corporations known as regional centers. The goal of creating these fixed points of community contact was to provide persons with developmental disabilities access to the facilities and services best suited to them throughout their lifetimes.

Both geographic accessibility and population density were considered when selecting locations for the 21 regional centers. The catchment area boundaries for the regional centers conform to county boundaries or groups of counties, except in Los Angeles County, which is divided into seven areas, each served by a regional center. A map showing the location of the regional centers and a list of regional center addresses can be found in Appendix F.

Along with their responsibilities for individual clients, regional centers also serve vital functions in their communities. They provide information to the public on developmental disabilities and conduct educational sessions for both public and professional groups. Another major responsibility is resource development. Often too few vendors are available to meet current or expected client needs, the regional centers help to develop new community resources. They also monitor the quality of services provided to their clients and seek to improve those services through training, technical assistance, and other methods.

REGIONAL CENTER SERVICES
Three broad categories of services are available to persons with developmental disabilities. First the regional centers are required (by law) to refer clients to "generic agencies" in the community, if those services will help the individual meet the goals and objectives in his or her IPP. Generic agencies are publicly funded agencies that provide services to the general public and not to some single category of persons. The public school system, county hospitals, Medi-Cal, community health agencies, county social service departments and local parks and recreation agencies are examples of generic agencies. The services obtained through generic agencies include medical, nursing, dental, and other types of health care; social services, emergency housing, respite, in-home support and supplemental income; parent support groups, parent training and counseling; and social and recreational opportunities. Regional centers also are required by the Lanterman Act to obtain funding from insurance companies and other third party payors prior to expending their own funds on services.

Second, if appropriate services are not available from generic agencies or third party payors, the regional centers may purchase the necessary services from providers who have been "vendored" by a regional center. Funds for these purchases come from the Department, which annually budgets and allocates funds to the regional centers for "purchase of service" (POS). More than 100 separate vendor categories exist and thousands of individual vendors (service providers) are available across the state. Among the general categories of vendors are providers of residential services, day programs, and transportation; physicians, dentists, nurses, physical therapists and occupational therapists; home health aides, respite workers and respite care agencies; behavior modification specialists, psychologists, and speech and language therapists.

Third, regional center staff provide direct assistance to clients and families. Regional center intake workers provide information to clients and families at the time the individual is being assessed for eligibility. Regional center clinicians such as psychologists, nutritionists, physicians, nurses, and other therapists provide diagnostic testing, program plannings, and instructional services. In addition, each client is assigned to a regional center case manager who serves as the liaison to the regional center, helps obtain services for the client, and t4 provides a wide range of direct services -- information, education, problem solving, counseling -- to the client.

DEVELOPMENTAL CENTER SERVICES
If the person has serious medical problems or extremely maladaptive behavior, or needs a highly structured environment for other reasons, he or she may be placed in one of the seven state developmental centers (SDCs). Placement of a person with developmental disabilities in an SDC requires either a formal determination that the client meets stringent SDC admissions criteria, or a court order. - In December 1989, approximately 6,750 persons, or 7.4 percent of the regional center clients, resided in the state developmental centers [3].
3. Source: Developmental Centers Division, "Developmental Centers Populations," Actual population December 13, 1989.

The Department operates seven state developmental centers: Agnews, Camarillo, Fairview, Lanterman, Porterville, Sonoma, and Stockton [4]. (See Appendix F.) The developmental centers provide intensive training and supervision to clients whose needs cannot readily be met by available community-based services. Developmental centers provide efficient and effective care, treatment, and habilitation services to all persons admitted on referral from the regional centers, county mental health departments, or the judicial system [5].
4. One of these facilities, Camarillo, serves patients with mental illness as well as persons with developmental disabilities. Services to persons with mental illness at this facility are managed by the Department of Developmental Services through an interagency agreement with the Department of Mental Health (DMH).
5. Persons can be admitted directly to developmental centers from the judicial system. This usual occurs when there is a need to evaluate the person 's competency to stand trial on criminal charges, when incompetency has been established or when an individual with a developmental disability commits a crime and is found to be "not guilty by reasons of insanity. " A person with mental retardation may also be transfer-red by a court order from the criminal justice system to a developmental center for up to two years with the person's consent. A person with developmental disabilities who is also a danger to self or others can be Judicial committed to a developmental center. (See the following California Statutes, Penal Code §§. 2684, 1026, 1369, 1370. 1, and W&I Cod4e §§ 702.3 and 6500, et seq.)

Developmental centers provide habilitation and training programs which are designed to increase clients' levels of independence, ability to control their environment, and normalcy of behavior. Special emphasis is placed on teaching skills that will allow clients to reside in community settings. These services are supplemented with medical, dental, and other health-maintenance services. Individuals with medical conditions receive special nursing and medical care, and residents having maladaptive behaviors receive special supervision and behavior intervention services. If able to participate, residents under the age of 22 are referred to community schools or state developmental center classes by the interdisciplinary teams of the state developmental centers. Individuals also participate in vocational, recreational, and skill-development programs both on SDC grounds and in the community.

Services in the developmental centers are provided by a wide range of licensed, specialized staff. This includes physicians, nurses, psychiatric technicians, psychologists, teachers, social workers, rehabilitation therapists, speech pathologists, audiologists, dietitians, and other licensed or registered staff.

BUDGET
Chart A shows the dollars expended by the Department for Fiscal Years (FY) 1978-79 through 1989-90. As can be seen from the chart, expenditures have risen markedly in the 12-year period represented. Since FY 1978-79, Department expenditures have increased 126 percent (from $484 million to almost $1.1 billion). The decreases evident in 1982-83 and

1986-87 are due to the transfer of a state facility to the Department of Mental Health at the start of each of those years, as well as to a decline in the population of the developmental centers [6].
6. Responsibility for Napa State Hospital and Developmental Center was assumed by the DMH on July 1, 1986. Patton State Hospital became the responsibility of DMH on July 1, 1982.

Chart B shows regional center purchase of service and operations expenditures for FY 1978-79 through FY 1989-90. Purchase of Service (POS) dollars are those that buy services for clients from approved vendors. Operations dollars fund the regional centers' direct services, such as assessment and case management, and include costs of staff, physical plant, equipment, supplies, travel, and administration.

This chart shows that POS expenditures are substantially higher than operations expenditures. Over the years this difference has increased as a proportion of total expenditures and in actual dollars. Regional centers are spending larger portions of their budgets on purchase of services for clients than in prior years. For example, in FY 1978-79 total regional center expenditures were $124 million, 60 percent of which was spent on purchase of services and 40 percent on operations; in FY 1989-90, $542 million were spent, with 72 percent going for purchase of services and 28 percent for operations. Overall, regional center expenditures more than tripled over the 12-year period displayed on the chart, increasing from $124 million to $542 million, a 337 percent increase.

OTHER AGENCIES INVOLVED IN THE SYSTEM
The expansion of the developmental services delivery system outside the traditional limits and supports of institutional care and supervision over the past 20 years has involved many agencies. The Departments of Social Services and Health Services work closely with the Department in regulating services delivered to regional center clients in residential facilities and day programs. The Department of Health Services also provides services directly to children with developmental disabilities through its California Children's Services Branch and through the Maternal and Child Health Branch. It also operates the Medi-Cal (federal Medicaid) program. Many regional center clients, particularly those in out-of-home care, receive benefits and services regulated by other governmental entities.

The Department of Education became increasingly active in the delivery of educational services to children with developmental disabilities with the advent of Public Law 94-142, The Education of the Handicapped Act [7]. This Act mandates free public education for all children, regardless of disabilities. The Department of Rehabilitation provides vocational training, sheltered employment, supported employment and vocational-rehabilitation services to persons with developmental disabilities. The Department of Mental Health provides services to persons with mental illness in addition to developmental disabilities. The State Department of Aging has been working with the Department in designing ways to serve older persons with developmental disabilities in senior citizen and other programs that are designed for the general population of elderly persons.
7. Formerly called 7he Education for all Handicapped Children Act of 1975.

The Department has developed interagency agreements with many of these departments to specify the responsibilities of each agency in serving persons with developmental disabilities. Comparable agreements are also developed at the local level, between the regional center and the local component of the various state agencies.

The State Council on Developmental Disabilities (SCODD) was established through the federal Developmental Disabilities Act, and is defined in California within the Lanterman Act. The SCODD has members who are primary consumers and the parents of consumers, as well as representatives from all of the major state departments involved in serving persons with developmental disabilities. It serves as a forum for the identification of issues in the developmental disabilities services system and recommends solutions to those problems. It has a statutory role in the planning of services for persons with developmental disabilities through review of the plans of other agencies. The SCODD prepares a "state plan" every three years in compliance with federal requirements.

Finally, a network of area boards on developmental disabilities was established under the Lanterman Act. The responsibilities of the 13 area boards include: service needs assessment and planning, advocacy on behalf of persons with developmental disabilities, and conducting public hearings to receive testimony on issues related to services for persons with developmental disabilities.

The Vital Role of Parents, Advocates and Other Organizations
A driving force behind the creation of the developmental disabilities services system in California has been parental concern. Many parents of persons with developmental disabilities, as well as others who share their commitments, are organized into large and active advocacy groups. Members of these organizations recognize that persons with developmental disabilities have a potential for continued intellectual and social development, and have worked actively to ensure that services will be available to help fulfill this potential.

Parents and their professional advocates called for legislative hearings and drafted proposed legislation that eventually culminated in the Lanterman Act. They continue to take an active role in encouraging the development of needed services, pointing out deficiencies in existing systems, and providing suggestions and advice to both the Department and the regional centers.

Another significant element in the developmental disabilities service system is the service provider industry. Persons who provide services to people with developmental disabilities -- the "vendors" of services -- have formed organizations within which information can be disseminated and problems can be discussed and resolved among the membership. These organizations have served an important role in monitoring and upgrading the quality of services that are provided by the members. They also have become a significant force for change within the service system through their lobbying efforts and development of legislative proposals.

The Department recognizes the importance of these organizations and has included their representatives in task forces, committees, and study groups to address and recommend solutions to major system problems.

A Complex System
As can be seen from this brief description, the developmental disabilities service delivery system in California is complex, with interrelated and sometimes overlapping components. No component dominates the others. Rather, each provides checks and balances for the others. Sometimes these components cooperate to achieve common goals, and sometimes they compete for authority and resources.

This complexity has a direct effect on the ability of the Department to plan for the future. To the extent that the Department's goals and objectives have general approval, success is virtually assured. But when priorities and points of view differ, achievement may be obstructed. The Department does not view the complexity of the developmental services delivery system as an insurmountable barrier to effective planning. Rather, these checks and balances can help to address the diverse needs of the people whom the system serves.

The goals and objectives in this plan seek to resolve many of the major issues facing the service delivery system. Just as these goals and objectives have resulted from the joint efforts of the Department and other components of the service system, so too will their accomplishment depend upon the collective efforts of the entire system.