Raising Expectations & Changing Roles of Direct Support - - PowerPoint PPT Presentation

Raising Expectations & Changing Roles

• f Direct Support Professionals

The Providers Association’s 25th Annual Conference March 26, 2015

Renate Macchirole, Project Coordinator North Carolina Alliance for Direct Support Professionals

The Evolution of Human Services

National Alliance for Direct Support Professionals (NADSP)

Actions To Complete For Compliance 441.301(c) (4) – Optimizes, but does not regiment, individual initiative, autonomy, and independence in 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

National Alliance for Direct Support Professionals (NADSP)

Providers must ensure that services are furnished: (i) Under a written person-centered service plan (also called plan

• f care) that is based on a person-centered approach
• 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

National Alliance for Direct Support Professionals (NADSP)

New Federal Requirements

Direct Support Professional Must Understand:

• 1. People will have the freedom and support to control

their own schedules and activities, and have access to 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?

National Alliance for Direct Support Professionals (NADSP)

Rethinking direct support professional development and education

• Demand for direct support professionals at an all

time high and will increase

• Demand for better quality and competence
• Diverse workforce
• Demographic, language and culture variables

impacting the development of direct support professional workforce.

National Alliance for Direct Support Professionals (NADSP)

“Preparing” Direct Support Professionals: How Have We Done?

“Tell me and I will forget. Teach me and I might remember. Involve me and I will learn”.

• Chinese Proverb

National Alliance for Direct Support Professionals (NADSP)

Training for Direct Support Professionals

• Direct Support Professionals seen as Entry Level

Jobs

• Requirements for Direct Support Professionals
• ften 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.

National Alliance for Direct Support Professionals (NADSP)

Addressing the challenge of developing this workforce:

• Classroom is the community
• Lectures and didactics must remain minimal
• 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

National Alliance for Direct Support Professionals (NADSP)

Invest in Direct Support Professionals

National Alliance for Direct Support Professionals (NADSP)

The Emerging Role of Direct Support Professionals

Historically….

• Primarily Seen as Caretaker
• Focus on Custodial Care
• Providing Companionship
• Providing Coverage
• Primarily Focused on Health &

Safety Issues

• Entry-Level Job

Now and in the Future….

• Ambassador, Mentor &

Teacher

• Culturally Competent
• Close Interactions with

Families - often in Family Settings

• Supporting Informed

Decisions – Assessing RISK

• Possession of Complex Skills

National Alliance for Direct Support Professionals (NADSP)

Raising the Expectations of the Direct Support Workforce

Now and in the Future….

• Creating plans with People

they support

• Building meaningful

friendships & relationships

• Inclusion – not recreation
• Advocating WITH – not FOR

people with disabilities

• Person-Centered

Identification

Historically….

• Follow the Plan
• Filling shifts
• Rely on readily available

supervision

• Community Outings
• System-Centered

Identification

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Building & Maintaining Friendships

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Speaking of Inclusion & Disabilities

National Alliance for Direct Support Professionals (NADSP)

The Financial Cost of Turnover

• 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…

“Decreasing turnover is about sustaining quality”

National Alliance for Direct Support Professionals (NADSP)

The Other Costs of Turnover

Impact on People with Disabilities

• Services are fractured
• Personal growth is disrupted
• Activities and events are

canceled

• Trusting relationships are broken
• Unsafe situations are created

impacting health & safety

• Revolving door of strangers

performing the most intimate interactions of daily life

Impact on Direct Support Professional Workforce

• Forced overtime
• Increased medication errors and
• ther incidents
• Increased job stress
• Reduced productivity
• Deteriorating job satisfaction
• Burn Out
• Ultimately….More Turnover

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Where is Quality Defined?

“It is defined at the point of interaction between the staff member and the individual with a developmental disability.”

John F. Kennedy, Jr. (1995) Chair, President’s Committee on Mental Retardation Developmental Disabilities

National Alliance for Direct Support Professionals (NADSP)

Where are those at the point of interaction of service delivery typically found on organizational charts?

Typical Organizational Chart

Executive & Admin Staff Clinical, Middle Management & Other Support Staff

Direct Support Professionals Direct Support Professionals

Clinical, Middle Management & Other Support Staff Executive & Admin Staff

Future Organizational Chart

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Knowledge Skills Values

Unethical Practice Ineffective Practice Uninformed

• f Best

Practice

Quality Support Quality Intersection

(NADSP Code of Ethics) (CMS Core Competencies) (Training Based on Research)

National Alliance for Direct Support Professionals (NADSP)

What are CMS Core Competencies?

The National Direct Service Workforce Resource Center (DSW RC) funded by Centers for Medicaid & Medicare Services (CMS)

• 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.

National Alliance for Direct Support Professionals (NADSP)

What are CMS Core Competencies?

Focused on:

• Aging and Senior Services
• Behavioral Health services, including

Mental Health and Substance Use

• Intellectual/Developmental Disability

Services

• Physical Disability Services

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What are CMS Core Competencies?

The WHY:

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.

National Alliance for Direct Support Professionals (NADSP)

What are CMS Core Competencies?

The HOW:

Phase 1: An inventory and overview of competency initiatives developed 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.

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CMS Core Competencies

• 1. Competency Area: Communication (3)

The DSW builds trust and productive relationships with people s/he supports, co- workers and others through respectful and clear verbal and written communication.

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CMS Core Competencies

• 2. Competency Area: Person-Centered

Practices (7) 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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CMS Core Competencies

• 3. Competency Area: Evaluation and

Observation (4) The DSW closely monitors an individual’s physical and emotional health, gathers information about the individual, and communicates observations to guide services.

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CMS Core Competencies

• 4. Competency Area: Crisis Prevention and

Intervention (7) The DSW identifies risk and behaviors that that can lead to a crisis, and uses effective strategies to prevent or intervene in the crisis in collaboration with others.

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CMS Core Competencies

• 5. Competency Area: Safety (5)

The DSW is attentive to signs of abuse, neglect

• r exploitation and follows procedures to

protect an individual from such harm. S/he helps people to avoid unsafe situations and uses appropriate procedures to assure safety during emergency situations.

• Abuse and Neglect
• Emergency Preparedness

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CMS Core Competencies

• 6. Competency Area: Professionalism and

Ethics (6) The DSW works in a professional and ethical manner, maintaining confidentiality and respecting individual and family rights.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

• 7. Competency Area: Empowerment &

Advocacy (5) The DSW provides advocacy, and empowers and assists individuals to advocate for what they need.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

• 8. Competency Area: Health and Wellness

(7) The DSW plays a vital role in helping individuals’ to achieve and maintain good physical and emotional health essential to their well-being.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

• 9. Competency Area: Community Living

Skills and Supports (4) The DSW helps individuals to manage the personal, financial and household tasks that are necessary on a day-to-day basis to pursue an independent, community-based lifestyle.

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CMS Core Competencies

10.Competency Area: Community Inclusion and Networking (4) The DSW helps individuals to be a part of the community through valued roles and relationships, and assists individuals with major transitions that occur in community life.

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CMS Core Competencies

• 11. Competency Area: Cultural

Competency (5) The DSW respects cultural differences, and provides services and supports that fit with an individual’s preferences.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

• 12. Competency Area: Education, Training

and Self-Development (3) The DSW obtains and maintains necessary certifications, and seeks opportunities to improve their skills and work practices through further education and training.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

The core competency set is NOT intended to impose requirements for community based LTSS direct service workers upon entry into the workforce but rather they provide guidance for the development of initial and ongoing DSW education and training resulting in improved direct support practice.

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

The DSW Core Competencies may be customized in practice to reflect the specific needs of the people supported. The set of Core Competencies can form the basis for practical tools to strengthen the DSW

National Alliance for Direct Support Professionals (NADSP)

CMS Core Competencies

• Workforce Development tools such as:
• Individual learning plans
• Coaching guidelines
• Performance evaluation tools
• Recruitment
• Selection strategies and post-secondary

certificate and degree programs

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Questions….

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Join Our Membership at www.nadsp.org!

Contact Renate Macchirole rmacchirole@benchmarksnc.org (252) 256-0347

National Alliance for Direct Support Professionals (NADSP)