Creating a Culture of Direct Support Professional Competence

Creating a Culture of Direct Support Professional Competence Statewide Conference Grand Island, NE October 15, 2014 Joseph M. Macbeth, Executive Director and John Raffaele, Training Consultant National Alliance for Direct Support Professionals

“They got up this morning, early, and left their families on this holiday Monday, to go out and make this thing called 'community living' happen. Their work, done well, doesn't look like labour. Their work, done well, is, however, work. It's the kind of labour that changes lives, changes families and changes communities. It's the kind of labour that requires dedication and self-discipline and determination. It's the kind of labour, done well, that is exhausting". - Dave Hingsburger, 2014 National Alliance for Direct Support Professionals (NADSP) A Thought from a Friend…

National Alliance for Direct Support Professionals (NADSP) Quick Introductions Joe Macbeth Executive Director John Raffaele Training Consultant & Facilitator

“Not Ready for Apartment Living” A DSP with Good Intentions, the absence of a Code of Ethics & the understanding of Skills National Alliance for Direct Support Professionals (NADSP) A Day In the Life of a DSP…

New Federal Requirements 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” Direct Support Professional Must Understand: People will have the freedom and support to control their own schedules and activities, and have access to food at any time. People will be able to have visitors of their choosing at any time. People will have the freedom to furnish and decorate their sleeping or living units ARE THEY PREPARED? National Alliance for Direct Support Professionals (NADSP) Actions To Complete For Compliance

Historically…. Now and in the Future…. • Primarily Seen as Caretaker • Ambassador, Mentor & Teacher • Focus on Custodial Care • Providing Companionship • Culturally Competent • Providing Coverage • Close Interactions with Families - often in Family Settings • Primarily Focused on Health & Safety Issues • Supporting Informed Decisions – Assessing RISK • Entry-Level Job • Possession of Complex Skills National Alliance for Direct Support Professionals (NADSP) The Emerging Role of Direct Support Professionals

Historically…. Now and in the Future…. • Follow the Plan • Creating plans with People they support • Filling shifts • Building meaningful friendships & relationships • Rely on readily available supervision • Inclusion – not recreation • Community Outings • System-Centered Identification • Advocating WITH – not FOR people with disabilities • Person-Centered Identification National Alliance for Direct Support Professionals (NADSP) Raising the Expectations of the Direct Support Workforce

National Alliance for Direct Support Professionals (NADSP) Building & Maintaining Friendships

National Alliance for Direct Support Professionals (NADSP) Speaking of Inclusion & Disabilities

Recent Trends in Direct Support • % change in employment (2012 – 2022): 48. 8% • Number employed (2012): 1, 190, 600 • Number employed (2022): 1, 771, 400 • Median annual income: $19, 190 ($9. 23/hour) • Nationwide median of $34, 750 • The BLS expects that over 580, 000 jobs for Personal Care Aides will be created in the decade through 2022 US Department of Labor, Bureau of Labor Statistics, 2014 National Alliance for Direct Support Professionals (NADSP) The Second Fastest Growing Occupation: Personal Care Aides

Recent Trends in Direct Support • % change in employment (2012 – 2022): 48. 5% • Number employed (2012): 875, 100 • Number employed (2022): 1, 299, 300 • Median annual income: $20, 820 ($10. 01/hour) • Nationwide median of $34, 750 • The BLS expects that over 424, 000 jobs for Home Health Aides will be created in the decade through 2022 US Department of Labor, Bureau of Labor Statistics, 2014 National Alliance for Direct Support Professionals (NADSP) The Third Fastest Growing Occupation: Home Health Aides

• 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… National Alliance for Direct Support Professionals (NADSP) The Financial Cost of Turnover “Decreasing turnover is about sustaining quality”

The Other Costs of Turnover • Services are fractured Impact on Direct Support Professional Workforce • Forced overtime • 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 • Increased medication errors and other incidents • Increased job stress • Reduced productivity • Deteriorating job satisfaction • Burn Out • Ultimately…. More Turnover National Alliance for Direct Support Professionals (NADSP) Impact on People with Disabilities

“Preparing” Direct Support Professionals: How Have We Done? Teach me and I might remember. Involve me and I will learn”. - Chinese Proverb National Alliance for Direct Support Professionals (NADSP) “Tell me and I will forget.

National Alliance for Direct Support Professionals (NADSP) Invest in Direct Support Professionals

“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 Where are those at the point of interaction of service delivery typically found on organizational charts? National Alliance for Direct Support Professionals (NADSP) Where is Quality Defined?

Future Organizational Chart Executive & Admin Staff Direct Support Professionals Clinical, Middle Management & Other Support Staff Direct Support Professionals Executive & Admin Staff National Alliance for Direct Support Professionals (NADSP) Typical Organizational Chart

Quality Intersection Knowledge Ineffective Practice Values (Code of Ethics) Unethical Practice Quality Support Uninformed of Best Practice Skills (Universal Competencies) National Alliance for Direct Support Professionals (NADSP) (Training Based on Research)

NADSP Monitors the News… National Alliance for Direct Support Professionals (NADSP) Direct Support Professionals and the Media

“Caregiver who stole from disabled men gets prison time” The Chicago Tribune, Illinois January 11, 2013 National Alliance for Direct Support Professionals (NADSP) In the News….

“Report: State ignoring abuse at group homes” The Seattle Times, Washington December 17, 2012 National Alliance for Direct Support Professionals (NADSP) In the News….

“Fragile Lives; Needless Deaths” (Multi-Part Series) Hartford Courant , Connecticut March 6, 2013 National Alliance for Direct Support Professionals (NADSP) In the News….

“Sex crimes alleged at care facilities” The San Francisco Chronicle, California November 29, 2012 National Alliance for Direct Support Professionals (NADSP) In the News….

“Caregiver arrested for abusing disabled man in Columbia group home” The Baltimore Sun, Maryland. February 5, 2013 National Alliance for Direct Support Professionals (NADSP) In the News….

“Senator Seeks Federal Probe Of Group Homes” Disability Scoop March 6, 2013 National Alliance for Direct Support Professionals (NADSP) In the News….

And finally, the big one… “At state-run homes, abuse and impunity” The New York Times, New York March 13, 2011 National Alliance for Direct Support Professionals (NADSP)

Which led to…. . “Legislative Leaders Announce Agreement on Legislation to (New York Times, June 18, 2012) Legislation Establishes Justice Center for the Protection of People with Special Needs to Prevent, Investigate and Prosecute Abuse and Neglect of Vulnerable New Yorkers National Alliance for Direct Support Professionals (NADSP) Protect People with Special Needs and Disabilities”

Closing the Barn Door after the horse has bolted. Legislation that focuses on Prosecution is NOT considering Prevention & Building Excellence National Alliance for Direct Support Professionals (NADSP) Which is sort of like…

“Direct Support jobs are compensated poorly, with many workers living at or near the poverty level or forced to work multiple jobs to make ends meet. One might summarize the job description of the direct support worker as requiring the wisdom of Solomon, the patience of Job and the caring of Florence Nightingale… While much is said about the value of these direct support jobs, the traditional hallmarks of value are often missing – qualifying credentials, adequate pay, career ladders, attention to working conditions, adequate training, managerial and supervisory support and so on…” The Measure of a Society: Protection of Vulnerable Persons in Residential Facilities Against Abuse & Neglect. Clarence J. Sundram, National Alliance for Direct Support 2012 Professionals National Alliance for Direct Support Professionals (NADSP) But it also led to this….

“Take Me Out to the Ball Game” A Nice Afternoon National Alliance for Direct Support Professionals (NADSP) A Day In the Life of a DSP…

The Five Elements of a Profession Body of Knowledge Code of Ethics Universal Skill Standards 1. 35 Million in US License, Certificate or Credential Affiliation with Professional Organization Approximately 4 Million Cross-Sector PHI, 2012 National Alliance for Direct Support Professionals (NADSP) Direct Support Professionals

Pediatricians Back in the Day Kanner & Bettleheim Journals, Studies Evidence-Based Practices Becoming a MD College of Direct Support and other curricula National Alliance for Direct Support Professionals (NADSP) A Body of Knowledge that is based on sound research and provides practitioners with a universally accepted skills base.

Airplane Pilots… Becoming a MD (continued) The Community Support Skill Standards State’s Developing Core Competencies The NADSP Competency Set – US DOL Adopted National Alliance for Direct Support Professionals (NADSP) Universal Skill Standards or Competency Areas for the Consistency of Professional Practice

Area 1: Participant Empowerment Area 2: Communication Area 3: Assessment Area 4: Community and Service Networking Area 5: Facilitation of Services Area 6: Community Living Skills & Supports Area 7: Education, Training & Self-Development Area 8: Advocacy Area 9: Vocational, Educational & Career Support Area 10: Crisis Prevention and Intervention Area 11: Organizational Participation Area 12: Documentation Area 13: Building and Maintaining Friendships and Relationships Area 14: Person Centered Supports Area 15: Supporting Health and Wellness National Alliance for Direct Support Professionals (NADSP) NADSP Universal Competency Areas

NADSP Competency Area Skill Statements • The competent DSP assists and supports the participant to develop strategies, make informed choices, follow through on responsibilities, and take risks. • The competent DSP promotes participant partnership in the design of support services, consulting the person and involving him or her in the support process. • The competent DSP provides opportunities for the participant to be a selfadvocate by increasing awareness of self-advocacy methods and techniques, encouraging and assisting the participant to speak on his or her own behalf, and providing information on peer support and self-advocacy groups. • The competent DSP provides information about human, legal, civil rights and other resources, facilitates access to such information and assists the participant to use information for self-advocacy and decision making about living, work, and social relationships. National Alliance for Direct Support Professionals (NADSP) Area 1: Participant Empowerment The Direct Support Professional enhances the ability of the participant to lead a self-determining life by providing the support and information necessary to build self-esteem, and assertiveness; and to make decisions.

Nail Techs and Jiffy Lube Guys Becoming a MD (continued) Using the Knowledge Demonstrating the Competencies Recognition by an Authority as a Profession National Alliance for Direct Support Professionals (NADSP) A License, Certificate or Credential to Practice

NASW, AMA, ANCOR, AIEJI Become part of something larger Participate in Training & Networking Opportunities Recognition of the Profession’s Best Practices Professional Empowerment & Status National Alliance for Direct Support Professionals (NADSP) Affiliation with a Professional Membership Organization

Person-Centered Supports Confidentiality Relationships Promoting Physical & Emotional Well-Being Justice, Fairness & Equity Self-Determination Integrity & Responsibility Respect Advocacy National Alliance for Direct Support Professionals (NADSP) A Code of Ethics that provides practitioners with a universally accepted values base.

The NADSP Code of Ethics Adopted by New York in 2012 Adopted by New Hampshire in 2014 Universally Accepted National Alliance for Direct Support Professionals( NADSP) Developed by NADSP in 2001

National Alliance for Direct Support Professionals (NADSP) Code of Ethics Word Cloud

“Disney Isn’t for Me” A Great Life National Alliance for Direct Support Professionals (NADSP) A Day In the Life of a DSP…

“Disney Isn’t For Me” Deconstructed with Skills & Values • Participant Empowerment • Communication • Assessment • Community Living & Supports • Education, Training & Self Development • Advocacy • Organizational Participation • Documentation • Providing Person Centered Supports Values: • Person Centered Supports • Integrity and Responsibility • Respect • Self-Determination • Advocacy National Alliance for Direct Support Professionals (NADSP) Skills:

C -Citizen H -Harm/Risk O -Opportunities I -Informed Decision C -Community E -Experience National Alliance for Direct Support Professionals (NADSP) CHOICE

National Alliance for Direct Support Professionals (NADSP) CHOICE

Working on writing his autobiography Getting tattoos Jumping out of airplanes Living his life, on his terms “The System opens the door to community; direct support professionals help people go through that door”. National Alliance for Direct Support Professionals (NADSP) Ed: Nearly 25 Years Later

Customized Trainings, One-Day Workshops and Culture of Direct Support Competency Technical Assistance Join us on Facebook! YES, We’re on You. Tube Follow us on Twitter @NADSPINC – jmacbeth@nadsp. org National Alliance for Direct Support Professionals (NADSP) Join Our Membership at www. nadsp. org!