Raising Expectations & Changing Roles of Direct Support Professionals The Providers Association’s 25 th Annual Conference March 26, 2015 Renate Macchirole, Project Coordinator North Carolina Alliance for Direct Support Professionals
The Evolution of Human Services Support Professionals (NADSP) National Alliance for Direct
New Federal Requirements Actions To Complete For Compliance 441.301(c) (4) – Optimizes, but does not regiment, Support Professionals (NADSP) individual initiative , autonomy , and independence in National Alliance for Direct making life choices , including but not limited to: daily activities, physical environment, and with whom to interact. Proposed State Transition Plan Deliverables : “Identify, develop, and distribute training tools and policy updates that are needed for compliance”
New Federal Requirements Providers must ensure that services are furnished: (i) Under a written person-centered service plan (also called plan of care) that is based on a person-centered approach Support Professionals (NADSP) National Alliance for Direct • Reflect risk factors and measures in place to minimize them, including individualized back-up plans and strategies when needed. • The individual will lead the person-centered planning process where possible • Includes people chosen by the individual. • Reflects cultural considerations of the individual
New Federal Requirements Direct Support Professional Must Understand: 1. People will have the freedom and support to control Support Professionals (NADSP) their own schedules and activities, and have access to National Alliance for Direct food at any time. 2. People will be able to have visitors of their choosing at any time. 3. People will have the freedom to furnish and decorate their sleeping or living units ARE THEY PREPARED?
Rethinking direct support professional development and education • Demand for direct support professionals at an all Support Professionals (NADSP) time high and will increase National Alliance for Direct • Demand for better quality and competence • Diverse workforce • Demographic, language and culture variables impacting the development of direct support professional workforce.
“Preparing” Direct Support Professionals: How Have We Done? “Tell me and I will forget. Support Professionals (NADSP) National Alliance for Direct Teach me and I might remember. Involve me and I will learn”. - Chinese Proverb
Training for Direct Support Professionals • Direct Support Professionals seen as Entry Level Jobs Support Professionals (NADSP) National Alliance for Direct • Requirements for Direct Support Professionals often minimal • “On-boarding” training is often quick and minimal in content • Regulatory read and sign and classroom style versus competency based and experiential • Direct Support Professionals often report that their training is lackluster and frankly boring.
Addressing the challenge of developing this workforce: • Classroom is the community • Lectures and didactics must remain minimal Support Professionals (NADSP) National Alliance for Direct • Stories connected to competencies • Ethics live and breathe in all activities of a direct support professional’s daily work • EXPERIENTIAL learning is key to successful direct support professional development programs • Adult Learning models promote active involvement • Good direct support professional trainers are translators of the competencies and ethics to the non- academic workforce
Invest in Direct Support Professionals Support Professionals (NADSP) National Alliance for Direct
The Emerging Role of Direct Support Professionals Historically…. Now and in the Future…. • Primarily Seen as Caretaker • Ambassador, Mentor & Support Professionals (NADSP) Teacher National Alliance for Direct • Focus on Custodial Care • Culturally Competent • Providing Companionship • Close Interactions with Families - often in Family • Providing Coverage Settings • Primarily Focused on Health & • Supporting Informed Safety Issues Decisions – Assessing RISK • Entry-Level Job • Possession of Complex Skills
Raising the Expectations of the Direct Support Workforce Now and in the Future…. Historically…. Support Professionals (NADSP) National Alliance for Direct • Creating plans with People • Follow the Plan they support • Building meaningful • Filling shifts friendships & relationships • Rely on readily available • Inclusion – not recreation supervision • Advocating WITH – not FOR people with disabilities • Community Outings • Person-Centered Identification • System-Centered Identification
Building & Maintaining Friendships Support Professionals (NADSP) National Alliance for Direct
Speaking of Inclusion & Disabilities Support Professionals (NADSP) National Alliance for Direct
The Financial Cost of Turnover “Decreasing turnover is about sustaining quality” Support Professionals (NADSP) National Alliance for Direct • Cost per hire • Long-term Supports and Services(2005): $3,278 (UMN) • Long-term Supports and Services(2011): $6,000 (PHI) Good Turnover? Bad Hiring…
The Other Costs of Turnover Impact on Direct Support Impact on People with Disabilities Professional Workforce • Services are fractured Support Professionals (NADSP) • Forced overtime National Alliance for Direct • Personal growth is disrupted • Increased medication errors and • Activities and events are other incidents canceled • Increased job stress • Trusting relationships are broken • Unsafe situations are created • Reduced productivity impacting health & safety • Deteriorating job satisfaction • Revolving door of strangers performing the most intimate interactions of daily life • Burn Out • Ultimately….More Turnover
Where is Quality Defined? “It is defined at the point of interaction between the staff member and the individual Support Professionals (NADSP) National Alliance for Direct with a developmental disability.” John F. Kennedy, Jr. (1995) Chair, President’s Committee on Mental Retardation Developmental Disabilities Where are those at the point of interaction of service delivery typically found on organizational charts?
Typical Organizational Chart Future Organizational Chart Direct Executive & Admin Support Staff Support Professionals (NADSP) Professionals National Alliance for Direct Clinical, Clinical, Middle Middle Management Management & Other & Other Support Staff Support Staff Direct Executive Support & Admin Staff Professionals
Quality Intersection (Training Based on Research) Knowledge Support Professionals (NADSP) National Alliance for Direct Ineffective Unethical Practice Practice Quality Support Values Skills Uninformed of Best Practice (NADSP Code of Ethics) (CMS Core Competencies)
What are CMS Core Competencies? The National Direct Service Workforce Resource Center (DSW RC) funded by Centers Support Professionals (NADSP) for Medicaid & Medicare Services (CMS) National Alliance for Direct • Inform direct support service delivery and promote best practices in community based LTSS. • Serve as a resource in developing worker training and performance improvement practices for community-based LTSS. • Serve as the foundation for career lattices and ladders that further recognize the many competencies needed for direct service workers across service sectors.
What are CMS Core Competencies? Focused on: Support Professionals (NADSP) National Alliance for Direct • Aging and Senior Services • Behavioral Health services, including Mental Health and Substance Use • Intellectual/Developmental Disability Services • Physical Disability Services
What are CMS Core Competencies? The WHY: Support Professionals (NADSP) National Alliance for Direct During the initial project phase, the team verified the lack of a single national recognized and validated competency set to guide the training the development of the entire LTSS workforce.
What are CMS Core Competencies? The HOW: Support Professionals (NADSP) Phase 1: An inventory and overview of competency initiatives developed National Alliance for Direct in the US to improve training and proficiency of the DSW within and across LTSS sectors. Phase2: A comparative analysis and systematic review of DSW competency sets identified during Phase I. Results of the analysis indicated that a significant number of common competencies across sectors. Phase 3: Synthesized the results of the competency analysis (Phase II) in collaboration with stakeholders across sectors to reach consensus on a n initial set of core competencies for direct service workers.
CMS Core Competencies 1. Competency Area: Communication (3) Support Professionals (NADSP) National Alliance for Direct The DSW builds trust and productive relationships with people s/he supports, co- workers and others through respectful and clear verbal and written communication.
CMS Core Competencies 2. Competency Area: Person-Centered Practices (7) Support Professionals (NADSP) National Alliance for Direct The DSW uses person-centered practices, assisting individuals to make choices and plan goals, and provides services to help individuals achieve their goals.
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