Transcript Document

Core Competencies
Strengthening the Home and
Community Based Workforce
Pat Schommer, MA Associate Director
U of M, Center on Aging &
MN Area Geriatric Education Center
Laurissa Stigen, MS Executive Director
Central MN Area Health Education Center
Lori Sedlezky, MSW
Director of Knowledge Translation
Annie Johnson Sirek, MSW
Project Coordinator
U of M, Institute on Community Integration, Research &
Training Center on Community Living
PHENOMENAL FACT
2/3 of the people,
in the world,
who have achieved
the age of 65,
are still alive today
Robyn Stone, DPH of Leading Age, Distinguished Lecture 4.17.13 at the U of M
PHENOMENAL FACT
Minnesota is expecting a 54%
increase in the 65 and older
population between
2015 and 2030.
United Health Foundation, June 2013, 2013 Senior Report
Unprecedented Increases in
Minnesota’s 65+ Population
Source: Minnesota State Demographer using 2010 Census Data
Minnesotans Age 85+ Increases
150% Over next 30 Years
64.9%
17.4%
32.0%
Source: Minnesota State Demographer using 2010 Census Data
The New Norm: Empty Nesters
and Older Adults Living Alone
Minnesota Household Growth 2010-2020
Source: Minnesota State Demographic Center projection, 2012
29 Percent of Minnesota Care Center Beds Closed
or Laid Away Since July 2000
12,139 total beds statewide
(percent of capacity in parentheses)
(29.7%)
(25.2%)
(36.3%)
(35.0%)
(24.5%)
(28.9%)
(27.7%)
Source: Minnesota Department of Health, March 2013
More Than Twice As Many
Housing-with-Service Units as Care Center Beds
Source: Minnesota Department of Health, March of each year
PHENOMENAL FACT
Minnesota is ranked at the top
of the list of healthiest states
for older adults.
United Health Foundation, June 2013, 2013 Senior Report
Labor Force Growth
About To Slow Sharply
Source: Minnesota State Demographer, 2011
Minnesota Saw a 30% Jump in
Employees Turning Age 62 in 2008
Source: Minnesota State Demographer, 2011
Minnesota To Develop 46% More
Healthcare Practitioners To Meet Needs
Source: Minnesota Department of Employment and Economic Development (DEED) Occupation Forecasts, 2002-2012
Employee Retention Percentage Declining in
Care Centers
Source: DHS Nursing Home Cost Reports
The Wage Gap
Senior Living Workers Underpaid in the Marketplace
Gap=$17.39 per hour
or $36,171 per year
Gap=$15.77 per hour
or $32,802 per year
Gap=$2.07 per hour or $4,306 per year
Gap=$1.81 per hour or $3,765 per year
Gap=$5.79 per hour or $12,043 per year
Gap=$6.13 per hour or $12,750 per year
Sources: 2011 LTC Imperative Salary Survey and 2011 MN Health Care Cost Information Service Hospital Salary Data
Direct Care Workers will be Largest Occupation
Group in US by 2020
Source: Paraprofessional HealthCare Institute May 2012
US Demand for Workers from 2010-2020 Grows
Most for Home-Based Services
Source: Paraprofessional HealthCare Institute, May 2012
QUESTIONS?
RESOURCES
Core Competencies Applied in the
Direct Service Workforce
Annie Johnson Sirek, MSW
Research Project Coordinator
Agenda (Part 2)
I. Overview of the Direct Service Workforce
II. Role of Competencies
III. CMS Road Map Project to Define
Core Competencies
in Long Term Services & Supports
IV. Strategies to promote quality outcomes in HCBS
V. Plan next steps: How to prepare our workforce
National Direct Service Workforce Resource Center
Partners
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A Cross-Disability Perspective on the
National Direct Service Workforce
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Long-term Services and Supports (LTSS) Sectors:
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Aging
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Behavioral Health
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Intellectual and Developmental Disabilities
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Physical Disabilities
Direct Service Worker (DSW) Roles
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Personal care/ hygiene
Home skills
Health and safety
Monitoring health/
health tasks
Transportation
Employment
Positive behavior
support
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Crisis intervention
Assessment, referrals
Teaching new skills
Self-determination/
self-direction
Working with families
Community integration
Companionship/ relationships
Occupational Titles
No single, unified title…
More commonality in aging and physical disabilities
services
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Nurse Aide
Home Health Aide
Personal Care Assistant
Paraprofessional vs. professionalism within I/DD
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Direct Support Professional
Behavioral Health
 Peer Support Specialist
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Where DSWs Work:
The continuum of long term care settings
Institutional Settings
Nursing facility and residential rehabilitation
State operated institutions and large operated
institutions
Home and
Communit
y
Based
Settings
Community
Residential
24-hour residential supports & services
Supports to
Individuals
and Families
Home health care services
Less than 24-hour residential supports & services
Personal care services
(agency-directed)
Personal care services
(consumer directed)
NonResidential
Community
Supports
Day programs, & rehabilitative or medical supports
Job or vocational services
Trends Across Service Sectors
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Deinstitutionalization
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Community based settings
Smaller in size
Increase in variety and difference in places
Geographic dispersion of service delivery locations
Implications
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DSW roles requiring greater skill, judgment, and accountability
Greater autonomy and responsibility
More independent problem-solving, decision-making
Need for adequate supervision and co-worker
interaction
Direct Support Workforce Challenges
Experienced Across Sectors
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Status and Image
Vacancy rates
High Turnover / Low wages
Poor access and utilization of benefits
Limited access to training and education
Increasingly absent or ineffective supervision
Strategic Areas for
Collaborative Planning and Action
• Training and education
• Retention
• Wages and benefits
• Payment rate and procurement structures
• Data collection, research and evaluation
• Status and awareness
Defining Competencies
KSAPs:
The knowledge, skills, abilities, and personal characteristics that DSPs
demonstrate when delivering effective supports.
(O’Nell & Hewitt, 2005)
Interconnected:
Successful completion of most tasks requires the simultaneous or
sequenced demonstration of multiple competencies.
(Hoge, Tondora, & Marielli, 2005)
Promote recognition:
The utilization of competencies in the workforce reinforces shared values
of DSPs’ skills and growth.
(Hoge et al., 2008)
Role of Competencies
Used as a guidepost for workforce development activities
and tools:
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Recruitment, hiring, and selection
Curriculum development
Training program implementation
Career pathways, ladders and lattices:
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Apprenticeship programs
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Credentialing and certification systems
Continuing education and ongoing staff development
Performance evaluation
(Campion et al., 2011)
Outcomes Associated
with Competency-Based Training
(Direct Service Workforce
Resource Center, in draft)
Building Quality in HCBS
Improved
quality of
service
Workforce development
tools to achieve
Competent Workers
Core Competencies
Road Map of Core Competencies for
the Direct Service Workforce
Project Framework
 Objective: Identify a common set of core competencies
across community-based long-term services and supports
(LTSS) sectors:
 Aging
 Behavioral health (mental health and substance use)
 Intellectual and developmental disabilities
 Physical disabilities
 Goals: Application of core competencies to facilitate:
 Evidence-based practices for DSW training and employment.
 Interagency collaboration in workforce development activities.
 Assessment of workforce capacity within states and agencies.
 Effective training policies to meet participants’ needs.
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Road Map of Core Competencies
for the Direct Service Workforce
Phase I:
DSW Competency Inventory
22 sets inventoried; across LTSS sectors: Aging, Behavioral Health, Intellectual and
Developmental Disabilities, and Physical Disabilities services
Phase II:
DSW Competency Analysis
Content analysis completed among 7 nationally-recognized competency sets
Phase III (Ongoing):
DSW Core Competency Validation and Synthesis
Modified Delphi process with leader/expert panel to determine core competencies
Project Framework
 Focus on Community-Based Settings
• As defined by Section 2401 of the Affordable Care Act:
Community First Choice State Plan Option: Home and
Community-Based Setting Requirements (§ 441.530)
 Content Based on Best Practices
• Balance between best practice and “here and now.”
 Strive for Common Language and Terminology
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Structured to translate to workforce development tools.
 A Foundational Lens for Direct Support Workers
• Audience of all DSWs and those who supervise and train them.
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Proposed Final Project Phase
Phase IV :
Field Testing and Validation of Core
Competencies
Stage 1. National Validation Workshops
• DSWs, Supervisors, and Participants Across Sectors
Stage 2. National Validation Survey
• Large Representative Sample
Stage 3. Dissemination and Technical Assistance
•Potential development of common training programs
across sectors, basic curricula for all entry level HCBS
workers, and specializations within each sector
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Structure of the DSW Core Competencies
Expert-Validated Core Competency Areas
# of Statements
1. Communication
4
2. Facilitation of Individualized Services
9
3. Evaluation and Observation
4
4. Participant Crisis Prevention and Intervention
6
5. Safety
5
6. Professionalism and Ethics
8
7. Participant Empowerment
4
8. Advocacy
4
9. Supporting Health and Wellness
9
10. Community Living Skills and Supports
5
11. Interpersonal and Family Relationships
6
12. Community and Service Networking
4
13. Cultural Competency
5
14. Education, Training and Self-Development
4
TOTAL: 77
Structure of the DSW Core Competencies
Competency
Area
• A broad category within a
competency set containing related
information that describes knowledge,
skills, or abilities for effective work
performance.
Competency
Description
• A statement describing themes of
knowledge, skills, or abilities for
effective work performance within a
discrete competency area.
Skill
Statement
• A description of a competency
standard that incorporates a highly
specific, observable action that
may be demonstrated by the
worker.
Competency-Based Training Model
Identify desired outcomes for individual receiving supports
Identify DSW skills needed to deliver desired outcomes
Measure skills to identify training needs
Set expectations for learning
Select training curricula and format; deliver training; measure learning
Transfer skills to job and sustain expectations
Measure training effectiveness by improved performance
(O’Nell & Hewitt, 2005; Hewitt & Larson, 1994)
 College of Direct Support (CDS) - UMN
 College of Employment Services - UMASS
 College of Personal Assistance & Caregiving - UCSF
 College of Recovery & Community Inclusion - Temple
Every lesson is designed to give DSPs the
knowledge, skills and attitudes they need
through innovative, engaging and
interesting training.
CDS Instructional Design
 Competency-Based
Accredited by NADSP
 Evidence-Based
Best Practices in HCBS
Research translation (e.g. self-determination, social inclusion,
community living, employment)
 Adult learning
Highly interactive and multi-media
Reflective exercises
Used in combination with classroom and mentoring
 Self-paced, asynchronous, just in time
 Various Assessments Methods
 Moving toward pad and handheld
DSW Performance Development
applying the Core Competencies
Competency Area
Competency
Description
Skill Statement
DSW Performance Development
with Core Competencies and CDS
Skill Statement:
The DSW respects
unique cultural needs
and preferences of
each participant to
provide culturally
competent services
and supports.
• CDS Course:
• Cultural Competency
• Lessons:
• What Is Cultural Competence?
• Understanding Your Own Culture
• The Culture of Support Services
• The Cultural Competence Continuum
• Cross-Cultural Communication
• Cultural Competence in Daily Support
• DSP Roles in Culturally Competent
Organizations
Contact Information
Annie Johnson Sirek, MSW
[email protected]
(612) 626-0535
Research and Training Center on Community Living
Institute on Community Integration, University of Minnesota
Discussion:
What are your goals
for preparing our workforce
to better meet individuals’ needs?
Reasons to Collaborate
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Collective voice is needed to bring attention and solutions.
Efforts to improve financing, reimbursement, and regulatory
structures should benefit all sectors.
We do not have the resources to duplicate efforts.
Must share innovative solutions across sectors.
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State agencies & providers are increasingly cross-sector.
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States are seeking cross-sector solutions & efficiencies.
In many ways, it is the same workforce.
Health and quality of life of individuals served is not organized by
silos.
Strategic Areas for
Collaborative Planning and Action
• Training and education
• Retention
• Wages and benefits
• Payment rate and procurement structures
• Data collection, research and evaluation
• Status and awareness
Building Quality in HCBS
Improved
quality of
service
Workforce development
tools to achieve
Competent Workers
Core Competencies
For Further Information
www.DSWResourceCenter.org
[email protected]
1-877-822-2647