Transcript Workforce Transformation: Why? How? &What Does It Look Like?

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Workforce Transformation:
Why? How? &
What Does It Look Like?
February 2015
Regis.M.Obijiski @opwdd.ny.gov
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New Services = New Workforce
From……………………………………….....To
• Congregate…………………..Individualized
• Workshops………...................Employment
• Group homes………………………At-home
• Program plans………….Self-determination
• Program compliance……Individual metrics
• Status quo………….Struggle for relevancy
• State contracts…………..DISCO contracts
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DSP Transformation: Why?
• http://www.opwdd.ny.gov/transformationagreement/OPWDD_Road_to_Reform_Ap
ril2013 : “DSPs are the cornerstone of
service system”
• Scarce resource and not fully prepared
• Require more than following instructions
• Ethics and professional skills
• MCOs evaluate DSP service deliverables
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DSP Transformation: How?
• Culture improvement initiative
• Cascading commitment to respect and
competence
• Culture is not morale, but the environment
• Culture is unwritten rules for getting along
• Culture is personality of organization
• Culture is everyone’s responsibility
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How: Successful Cultures
1. Inspiring a shared vision
• Sharing a purpose in common = powerful motivator
• Consider axioms of quality:
– Self-determination is the core value because all people
have the right to define and control their own quality of life.
– Services are meaningful only when they facilitate personal
outcomes.
– Person-centered planning is not the same as personal
outcomes.
– Learn how to serve through listening, interviews,
observations, sudden discoveries.
– Measure and analyze what works for the person.
– Organizational success is co-extensive with personal
outcomes.
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How: Successful Cultures
2. Modeling the Way
• Being available, supportive, always telling the truth
• Shift power from top-down to bottom-up.
• If human services is a relationship business that is
intensely personal in its outcomes, build
relationships by understanding before being
understood.
• Listen.
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How: Successful Cultures
3. Enabling Others to Act
– Employees achieving their potential breeds
ownership.
– Mediocrity to Excellence
• Valorize and develop the capacities of direct
support.
• Measure your success against the service success
you enabled.
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How: Successful Cultures
4. Challenging the Status Quo
– Keeping an organization fresh and
competitive
• Create a “can-do” culture that strives toward
excellence.
• Create an environment of openness to failure and
success.
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How: Successful Cultures
5. Encouraging the Heart
– acknowledging excellence, lauding
champions, and emulating legends
• Equip staff with skills they need to listen to and
understand people and enable them to make
informed choices.
• Collect data on what works and makes a positive
difference for individuals. Data analysis should be
useful and understandable to stakeholders.
• Tell stories and celebrate the success of personal
outcomes.
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How: Cascading, Steps to Take
• Face-to-face learning on the Code of Ethics
and Core Competencies
• Instructional videos with manuals
(Orientation, Transformation, FLS
supervision, Families…)
–
–
–
–
Executive Leadership Team
Middle Managers
Frontline Supervisors (FLS)
DSPs
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How: Regional Centers for
Workforce Transformation RCWT
• Regional collaborations to develop
capacity of DSP workforce in NYS
• Shape system-wide cultural thinking
• Share leading practice, trainings, etc.
• Combine Code & Core with POMs,
HCBS,PROMOTE
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What Do Transformed DSPs
Look Like?
• Evolving roles of DSPs
1. Custodians, task workers
2. Care-givers: human potential feels
personal; bring your heart & your
values to work; “love my guys”
3. Support professionals: includes,
tasking, caring, professional ethics &
competencies
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What Does Service
Transformation Look Like?
• Proof is in the “putting”…people first
1. a life valued by the person with IDD;
2. determining choices through informed
decision-making;
3. friendships & community participation;
4. learning skills for valued social roles;
5. enjoying self-esteem due to positive
relationships & realizing abilities.
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What Does a Transformed
Organization Look Like?
• Takes steps toward a preferred culture;
• Embraces Ethics, Comps & their metrics;
• Valorizes person with IDD as #1 purpose
of the organization;
• Values, develops DSPs as #2 in
importance and key to defining quality;
• Values, develops FLS as the key to DSPs
success.
Rollout Timeframes: State
Operations & Voluntaries
ADM 2014-003, July 1, 2014
• July 2014: end of piloting, beginning of
implementation of Code & Core
• April 2014 to April 2016: Code and Core
cascading through all organizations;
• April 2016 to April 2017: Evaluating all direct
support staff on the Code of Ethics & Core
Competencies.
DSP expectations
Specialized knowledge
Culturally competent
Work well with others
Person-centered
End shift neat & tidy
Teach
Medical Support
Comply with rules
and regs.
Maintain health &
safety
Respect rights
Support Choice
Problem-solve
Document
State of Direct Support
DSP competencies
•
•
•
•
•
Community Support Skill Standards
NADSP Competencies & Code of Ethics
US DOL DSP National Standards
NY OPWDD Core Competencies
NYS DOL Apprenticeship
CSSS
1996
Hewitt
1998
NADSP
Est 2002
DOL LTSS
2010
• CMS Core Competencies
2013 NY
OPWDD
CMS DSW
2014
What does “Competent” mean?
• Knowledge: knowing what to do
• Skills: demonstrating what you know
• Ethics: embracing the principles
underlying what you do
Competency Defined
Quality & System Transformation
• Individualized supports requires more than
ability to
– follow instructions
– just being a nice person
Individualized supports requires
* effective independent judgment
* high ethical commitment
* skills to affect personal outcome measures
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POMs: Think Differently
• MY SELF: Who am I? My history? My
family? My decisions? My experiences?
My supports?...my starting point for
tomorrow.
• MY WORLD: Where I live, work, express
myself, belong, build relationships
• MY DREAMS: How I want to live, my life
to become, my footprint matters.
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Process vs. Outcomes
• Focus: program vs. impact on person
• Service: staff as experts vs. person as
expert
• Service delivery: person assigned to
program vs. service designed after person
defines
• Quality: defined by program vs. defined by
person
BUT.. These challenges
remain
• Challenging demographic changes
• Wages are worse when adjusted for
inflation
• Turnover remains challenging
• Vacancies and growth stagnation continue
• Little to no real penetration of post
secondary education job market
• Pervasive lack of data among IDD
providers
From Pilot to Design
• 2013-14 NYS Budget: Pilot & No Funding
– Passed both Senate and Assembly
– Necessary Veto
• 2014-15 NYS Budget: Pilot
– Agencies and DSPs having “skin in the game”
– Negotiations with Div. of Budget
– OPWDD’s rejection of pilot
– Change to Credentialing Design
Credentialing Design: Budget
National & International Models
Career ladders for DSPs & Supervisors
Current DSP salaries & requirements
Credentialing impact
-Operations & Services
-Financial incentives for DSPs, Costs
Report due 1/6/16; Delivered 8/1/15
Who Will Lead the Project?
OPWDD
Contract with University of Minnesota RTC
-National Leader Workforce Development
benefitting persons with IDD
-Subcontractors: NYSACRA with NYSRA
Scope of Work
• Focus groups (SA, DSPs, FLS, Fam, Adm)
• CMS Toolkit: DOH Rate Setting, DOB
• 346 Provider Surveys, 71 questions
– Workforce indicators: turnover, wages,
benefits, desirability/preferences for credential
• Build a Financial Model into Medicaid
Rates
• Communication Plan
What is Credentialing?
Compared with Core Competencies
Compared with Certificates
Compared with Apprenticeship
Comparing Voluntary vs. Mandatory
Competency-Based: skills & knowledge
demonstrated by written & hands-on
proficiency measurement (US DOL)
Why Credentialing?
Stabilize the workforce: professional,
proficient, positive examples, skill mentors
Increase productivity and effectiveness in
services for individuals
Increase productivity and effectiveness for
Provider Agencies
Transformation of services will not occur
without a transformed workforce
Building Training Costs into Medicai
Reimbursement Rates
Coverage of Direct Service Workforce Continuing Education
and Training within Medicaid Policy and Rate Setting:
A Toolkit for State Medicaid Agencies
Submitted by:
National Direct Service Workforce Resource Center
http://www.dswresourcecenter.org/tiki-index.php?page=reports
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Need for provider survey
• This information is unavailable w/o survey
• Staffing ratios
• Size, scope and demographics of
workforce
• Wages and other costs data will inform
credential costs and financial model
• Vacancies and turnover also factor into
costs and feasibility of credentialing
• Regional differences
• Current practices
• Credentialing options/opinions