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Published by the Institute on Community Integration (UCEDD) · Research and Training Center on Community Living Volume 20 · Number 2 · Fall/Winter 2007/08

Feature Issue on Direct Support WorkforceDevelopment

From the EditorsFor many people with disabilities, life in theircommunities – in the workplaces, schools,neighborhoods, and multitude of placespeople gather socially – is influenced by theavailability of qualified, reliable Direct Sup-port staff. The Direct Support workforce ismade up of people whose skills, knowledge,and commitment equip them to assistindividuals with disabilities in maintaininghealth, self-determination, and communityparticipation. That workforce and the sup-ports it provides is in jeopardy today becausethe demand and need for such services isoutgrowing the pool of individuals willingand able to fill those essential positions. The forces impacting the availability ofquality Direct Support services are many:wages, benefits, education, professionalstatus and standards, and budgets, as well asthe steadily growing total number of DirectSupport staff needed. The articles in thisImpact describe how these issues are beingaddressed across the country through strate-gies that reach from the U.S. Congress to thehomes of individuals in local communities.We hope that these articles will provide read-ers with ideas that they can implement toensure that individuals with disabilitiescontinue to have access to the supports theyneed to live lives of their choosing in theirlocal communities.

What’s InsideOverviewsProfilesResources

For Laura Pittman, caring for her son, Jonathan, gave her the experience, confidence, and incentive to become acredentialed Direct Support Professional. See story on page 29.

[Hastings, continued on page 32]

Direct Support Then and Now:Reflections on My 35 Years in the Professionby Rita McAninch-Hastings

We’re sitting around a table discussing the upcoming Presidential election. The indi-viduals whose apartment I am in are hoping that the people they will vote for willchange the direction of the services they are currently getting. I’m hoping they willalso. The thought that runs through my mind is that when I started in this field thepeople I supported were never given the option of voting.

My life has come full circle. The people I support now are like the people I sup-ported when I started in this field 34 years ago. My role as a Direct Support Profes-sional (DSP) was just beginning. I didn’t know then what my role was going to be-come and how the lives of the people I support would change. Wisdom comes witheducation and experience. It also comes with living this life long enough to be able tolook back to where we were and where we are now. I say “we” because this is a journeyI have taken with the people I have been fortunate enough to support. I never plannedon this being my career. I stumbled across the job because it was close to my homeand I didn’t think it would be that tough. After all, I had two cousins with develop-mental disabilities who lived at home. Sometimes they needed a little more help thantheir siblings, but so what. I could not have been more wrong or more right.

Imagine a two-story building with brick walls that housed 50 women who slept inmetal cots one foot apart. There were gang showers and bathrooms where the toiletsdid not have any dividers for privacy. Things like the clothes room, the TV locked in a

2

Congress Recognizes Crisis in DirectSupport: Remedial Legislation Proposedby Charlie Lakin

In their 2003 Joint U.S. House/SenateDirect Support Professional RecognitionResolution (S. Con. Res. 21/H. Con. Res.94), Congress noted that “private [ser-vice] providers and the individuals forwhom they provide support and servicesare in jeopardy as a result of the growingcrisis in recruiting and retaining a directsupport workforce” and that “it is thesense of the Congress that the FederalGovernment and the States should makeit a priority to promote a stable, qualitydirect support workforce for individuals

with mental retardation and other devel-opmental disabilities that advances ournation’s commitment to community in-tegration.” In pursuit of greater specifi-cation of actions that would promote a“stable, quality direct support work-force,” in 2004 Congress requested thatthe Department of Health and HumanServices (DHHS) conduct a study on theshortage of Direct Support Professionals(DSPs) supporting persons with intellec-tual and other developmental disabilities(ID/DD). This study was to includeanalysis of “the root causes associatedwith high vacancy and turnover ratesand an examination of the impact thisshortage may be having on services forpeople with ID/DD.”

That requested report was transmit-ted to Congress in 2006 (U.S. Depart-

ment of Health and Human Services,2006). It confirmed the crisis in directsupport, reporting back to the Congressthat in the 15 years between 2005 and2020 the number of DSPs needed to pro-vide long-term supports for individualswith ID/DD would increase by about323,000 or about 37% because of popu-lation growth, increased life expectancyamong persons with ID/DD, aging offamily caregivers, and expansion ofhome and community-based services.The report further observed that “meet-ing the future demand for DSPs will beextremely difficult to achieve through en-hanced recruitment,” and that “it will becritically important to improve the re-tention of existing DSPs along with ef-forts to attract new ones” (U.S. Depart-ment of Health and Human Services,2006, p. vi). To highlight the importanceof retention the report summarized 26studies yielding an average turnover rateof 50% among DSPs supporting personswith ID/DD. To demonstrate the signifi-cance of retention to the challenge ofmaintaining a sufficient DSP workforceup to 2020 the report provided the graphabove (see Figure 1) to show the dra-matic effects of very modest decreases inDSP turnover on the total number ofnew DSPs that would need to be re-cruited each year to meet the projected

growth in service need. It shows thenumber of DSPs who will be neededeach year between 2005 and 2020 if (asshown in the dark line) DSP turnover re-mains at 50% each year as opposed to analternative scenario (shown in the lightline) in which DSP turnover were re-duced by 2% each year for 10 years andthen remained at 30% between 2015 and2020 (i.e., 48% in 2006, 46% in 2007,etc.). As shown, the net effect of the sec-ond scenario would be a need to recruit289,000 fewer DSPs to meet the needs ofpersons with ID/DD in 2015 than ifturnover were to stay at current levels,and a need to recruit 346,000 fewer newDSPs in 2020.

There are many factors that have beenidentified over the past 30 years to haveconstant association with DSP turnover.But without question the most consis-tent and consistently strong predictorsof DSP turnover are factors related tocompensation (e.g., amount of pay,value of wages and benefits, satisfactionwith pay, pay relative to local cost ofliving). Concerns about the low pay ofcommunity DSPs, its effects on staff re-cruitment and retention, and ultimatelythe links between these and the viabilityof the nation’s commitments to commu-nity lives for people with disabilities haveled to Congressional activity.

Overview

The links between DSP pay,

recruitment, and retention and the

viability of the nation’s commitments

to community lives for people with

disabilities have led Congress to act.

At constant

50% turnover

At 2% annualreductions to30%

Figure 1: Demand for DSP Recruits to Meet Projected Demand for Long-Term Support Services 2005-2020at Current 50% Turnover and with Annual Reduction of 2% Until Reaching and Stabilizing at 30%

1,000,000

800,000

600,000

400,000

200,000

0

2005

2007

2009

2011

2013

2015

2017

2019

At constant50% turnover

At 2% annualreductionsto 30%

Source: U.S. Department of Health and Human Services (2006).

3

In March 2007, Representatives Capps(D-CA) and Terry (R-NE) introduced theDirect Support Professionals Fairnessand Security Act of 2007 (H.R. 1279). Itsoperational purpose is to provide federalfunding to States to allow them to re-spond to the crisis in recruiting and re-taining DSPs in private community ser-vice settings. The legislation specificallytargets private agency DSPs because, asthe DHHS report to Congress notes,DSPs in private agencies earn on average26% less in wages and substantially lessin fringe benefit contributions than pub-lic agency DSPs. To address the crisis inwages for private agency DSPs, H.R. 1279focuses on the discrepancy between pub-lic and private employee wages and au-thorizes states to develop a “Direct Sup-port Professional Wage EnhancementPlan” by which the State would utilize

federal funding augmentations over afive-year period to equalize average wages(and fringe benefits up to 20% of wages)for private and public agency DSPs. Inaddition to its primary provision, H.R.1279 would authorize State planninggrants and require Inspector General andGovernment Accountability Office auditsof the implementation and outcomes ofthe program.

The proposed legislation has a steadilygrowing number of co-sponsors, morethan 100 at this writing. Its critics viewthe proper environment for such policiesto be with States, which control Medicaidexpenditures and are free to implementpolicies to increase DSP wages, but arealso responsible for paying the State’sshare of those increases (25-50% depend-ing on the state’s per capita income). Thecritics in Congress should, however, be

held accountable for their own character-ization of the current situation as a crisisand their associated responsibility to actaccordingly. Alternatives to H.R. 1279are certainly possible, but doing nothingin the face of the recognized crisis willonly contribute to the vulnerability ofalready vulnerable people.

Reference

U.S. Department of Health and Human Services (January 2006). Thesupply of direct support professionals serving individuals with intellec-tual disabilities and other developmental disabilities: Report to Congress.Washington D.C.: Author. Retrieved 9/18/07 from http://aspe.hhs.gov/daltcp/reports/2006/DSPsupply.pdf.

Charlie Lakin is Director of the Researchand Training Center on Community Living,University of Minnesota, Minneapolis. Hemay be reached at 612/624-5005 or [email protected]. The full text of H.R.1279 can be found at http://thomas.loc.gov(enter H.R. 1279).

DSP Fairness and Security Act: ANCOR’s “You Need to Know Me” Campaign

When the 109th Congress closed in 2006, 86legislators had signed on as co-sponsors ofthe Direct Support Professionals Fairness andSecurity Act (H.R. 1264) , a historic first for thedevelopmental disabilities community. Bornof an arduous effort championed by theAmerican Network of Community Optionsand Resources (ANCOR) since 2001, its goal ispassage of federal legislation that wouldbring fairness to compensation levels thatwork to discourage people from seekingemployment as Direct Support Professionals(DSPs). The legislation received unparalleledattention last year thanks to more than30,000 advocates who sent more than 45,000letters to Capitol Hill. To draw additionalattention to the plight of the DSP workforce,ANCOR held briefings and constituent meet-ings with legislators, and put the Internet tocreative use. A cartoon centered on the needfor increased DSP wages was releasedthrough e-networks, drawing an audience ofmore than 50,000 viewers. The January 2007 arrival of the new 110th

Congress brought a dramatic turnover inlegislators, promising new opportunities andchallenges for the reintroduction of the DirectSupport Professionals Fairness and SecurityAct. In cooperation with ANCOR, Representa-tives Lois Capps (D-CA) and Lee Terry (R-NE)have reintroduced the legislation (H.R. 1279).ANCOR and its campaign partners, The Arc ofthe U.S., United Cerebral Palsy, and LutheranServices of America, are once again mobiliz-ing their grassroots to garner sponsorshipfrom legislators. The bill currently has 106 co-sponsors, and we are hoping that the 110thCongress will bring a hearing on the bill. Weare also actively working on the Senate sideto raise awareness of the issue with Senatestaff. This second wave of activity affords a newopportunity to address the lack of publicawareness of who a DSP is and provides theimpetus behind ANCOR’s new campaignslogan, “You Need to Know Me. I’m a DirectSupport Professional.” The slogan’s benefitsare twofold: It raises awareness of the

importance of DSPs, while providing flexibilityfor strong advocacy messages. “You Need toKnow Me. I’m a Direct Support Professional.You need to know that the current disabilitysupport system doesn’t work without me. Youneed to know that my job isn’t easy.” Thepotential for creative and hard-hittingmessages is abundant. ANCOR remains dedicated to its advocacygoals to obtain wage and benefit enhance-ments, advance a national policy to addressthe DSP workforce shortage, demonstrate thecritical role of DSPs in enhancing the lives ofAmericans with disabilities, secure incentivesfor solidifying a career path for DSPs, andbuild public awareness of the depth of privateprovider services. Simply put, you need toknow that ANCOR is hard at work for you. Get involved! To find out how, visitwww.YouNeedToKnowMe.org.

Overview

Contributed by Renee Pietrangelo, CEO, AmericanNetwork of Community Options and Resources,Alexandria, Virginia. She may be reached at 703/535-7850 or [email protected]. For moreinformation visit www.YouNeedToKnowMe.org.

Retrieved from the Web site of the Institute on Community Integration, University of Minnesota (http://ici.umn.edu/products/impact/202). Citation: Larson, S.A.,Hewitt, A., McCulloh, N., LaLiberte, T. & Gaylord, V. (Eds.). (Fall/Winter 2007/08). Impact: Feature Issue on Direct Support Workforce Development, 20(2). [Minneapolis:University of Minnesota, Institute on Community Integration].

4 Overview

Individual and Family Directed Services:Implications for the DSP Workforceby Jennifer Hall-Lande and Amy Hewitt

A quality, sustainable Direct Supportworkforce is an essential component inthe quality of life for individuals withdisabilities and their families. In fact,Direct Support Professionals (DSPs) area key ingredient in an effective supportmodel. The importance of developing ahigh quality, stable DSP workforce isclear, yet numerous challenges exist inthe traditional DSP workforce model.

Current workforce issues have re-sulted in significant concerns about thequality of care and outcomes for indi-viduals with disabilities. A significant

DSP shortage exists (Hewitt, Larson, &Lakin, 2000). Staff quality and inad-equate training are persistent concerns.Issues of distrust and maltreatment areoften directly related to lack of skills andpoor training of support staff. Staff turn-over rates have consistently averagedbetween 45 to 70% (Larson, Hewitt, &Knoblach, 2005). These complex prob-lems require creative solutions that con-sider alternative ways to find, recruit,and retain quality staff. Program optionsthat allow the flexibility for individualsand families to manage their individualbudgets and services, such as consumer-directed supports, are an example ofsuch a solution (Hewitt, 2004).

Benefits of Consumer Direction

Consumer-directed supports is a serviceoption in which individuals with disabili-ties and their families use individually-set and controlled budgets to select andpurchase their own supports. It offers amyriad of positive benefits to individu-als, families, Direct Support staff, andfunding agencies. Services are providedin a way that minimizes administrativecosts and maximizes services and sup-port. Consumer-directed models focusless on organization priorities and moreon individual and family needs. Theyempower individuals and families byproviding greater control and choice inrelation to their support services. Oneof the most promising aspects of theconsumer-directed supports option is itspotential to effectively address many sig-nificant DSP workforce challenges.

The active participation of individu-als with disabilities and their families inrecruitment and hiring helps to addressthe issue of staff shortages. Individualsand families are often best equipped tounderstand potential resources in theirlives as well as the type of employees thatare a good match for their individualizedneeds. The individual’s and family’sactive participation in recruiting andhiring staff provides an opportunity toincrease the pool of potential DSPs.Families and individuals often look be-yond traditional staffing options to theirnetworks of friends, family, and commu-nity members. This flexibility allows forthe inclusion of individuals who may nothave previously been involved in deliver-ing services to individuals with disabili-ties (Mellum & Heffernan, 2004).

Under the consumer-directedsupports model, staff training is oftentailored to the individual’s specific needs.Instead of learning generally aboutevacuation procedures the staff learnsthe specific evacuation procedures forthe individual they support. Instead of

learning from a provider organizationabout the importance of working withfamilies, the staff learns from the familyexactly what their expectations are andhow they want the DSP to interact withthem. For example, a DSP working witha family with a child with Autism canreceive training on the child’s uniqueAutism-related support needs.

Consumer-directed service optionsalso help to address staff quality. Fami-lies have a clear idea of the type of staffwho are successful in meeting their indi-vidual and family needs, and have theflexibility and opportunity to choosestaff and services aligned with thoseunique needs. This option draws fromexisting community supports, andbuilds on the power of relationships andpersonal connections. This influenceflows both ways. The quality of life of in-dividuals receiving supports is enriched,while at the same time the professionalexperience for the DSP is more meaning-ful. Individuals and families are able tochoose staff that they know and trust,and DSPs experience a greater sense ofprofessionalism, fulfillment, and connec-tion to the needs of the individual andfamily (Mellum & Heffernan, 2004).

Lastly, wages are consistently associ-ated with higher turnover rates (Hewitt,2006). Under consumer-directed sup-ports, families are able to compensatestaff more flexibly. The skill and diver-sity that DSPs bring to their work can bedirectly linked to incentives such asbonuses, increased pay, and raises. Theincreased compensation as well as pro-fessional acknowledgment results inpotentially greater job satisfaction andthus greater retention of staff.

Challenges in Consumer Direction

Consumer-directed programs presentsome new workforce challenges. Onechallenge is building a sense of commu-

Consumer-directed supports are an

important, innovative step toward

promoting meaningful, sustainable

change in the DSP workforce.

5Overview

nity and increasing professionalizationfor DSPs. The sometimes isolating na-ture of providing support for a family,without the larger community of profes-sionals, can be a challenge. AlthoughDSPs in consumer-directed services gaincloseness to the family and individual,they may lose the network of peers. Theinformality can lead to a lack of profes-sional identity.

An additional challenge is one ofboundaries. With greater individualcontrol comes increased responsibilityfor individuals and families. Both staffand families report that roles and boun-daries may be less clear. Further, somefamilies miss the support system of alarger organization to manage training,administrative tasks, and challengingstaff issues.

Overcoming the Challenges

Consumer-directed supports representsan innovative and creative way of look-ing at services. It also requires new ap-proaches for supporting staff. Althoughcompensation remains an importantfactor in keeping quality staff, a sense ofrespect and value remains among themost significant components in the re-tention equation. Families may need toimplement specific supports to facilitatea sense of professionalism and connec-tion for DSPs. Individuals and familiescan support DSP professionalism by en-couraging participation and subsidizingmembership in professional organiza-tions such as the National Alliance ofDirect Support Professionals (see www.nadsp.org) and professional confer-ences.

To build a sense of community itmay be helpful to have regular staffmeetings and appreciation events. Pro-fessional listservs can facilitate commu-nication and a sense of communityamong DSPs. Families may also find itbeneficial to assign another DSP as amentor. Some families have pooledresources for training and connectionsacross staff. Training such as the onlineCollege of Direct Support (see www.collegeofdirectsupport.com) and Realis-

tic Job Previews are helpful tools for pro-viding effective DSP training in indi-vidual and family settings.

While DSPs in the consumer-directedmodel often make higher wages thanwhen they work in traditional organiza-tion-driven services and supports, andindividuals and families can access ben-efits for their employees through fiscalsupport entities, it remains uncertainhow benefit utilization compares totraditional services. The University ofMinnesota is currently studying indi-viduals and families who use consumer-directed supports to gain more under-standing of wages, benefits, and reten-tion of DSPs who work in individually-directed services and supports.

Conclusion

Consumer-directed supports is animportant component of the workforcesolution. This model may not solveeverything, but it is an important, inno-vative step toward promoting meaning-ful, sustainable change in the DSPworkforce.

References

Hewitt, A. (2006). The direct care support workforce and individuallycontrolled budgets. New Directions 4(3), 1-4.

Hewitt, A. (2004). Finding, keeping and training staff when individualsand families control the budget. Impact: Feature Issue on Consumer-Controlled Budgets and Persons with Disabilities, 17(1), 8-9, 28-29.[Minneapolis: University of Minnesota, Institute on Community Inte-gration].

Hewitt, A., Larson., S.A. & Lakin, K.C. (2000). An independent evaluationof the quality of services and system performance of Minnesota’s Medic-aid Home and Community Based Services for persons with mental retar-dation and related conditions. Minneapolis: University of Minnesota,Research and Training Center on Community Living.

Larson, S.A., Hewitt, A., & Knoblach, B. (2005). Recruitment, retention,and training challenges in community human services: A review of theliterature. In S.A. Larson & A. Hewitt (Eds.), Staff recruitment, retentionand training for community human service organizations. Baltimore:Brookes Publishing Company.

Mellum, J. & Heffernan, K., (2004). Consumer-directed community sup-ports: A county perspective on a new service option. Impact: FeatureIssue on Consumer-Controlled Budgets and Persons with Disabilities,17(1), 18-19, 31. [Minneapolis: University of Minnesota, Institute onCommunity Integration].

Wages for DSPs working in the communityare derived almost entirely from a com-bination of Medicaid and state funds.Reimbursement rates – that include thecost of labor – are set by each individualstate or county within the state. His-torically, these governmental fundingstreams have not kept pace with generalmarket demands, nor have they kept pacewith state employees who are performingthe same job functions in state-operatedprograms and institutions. On an annualbasis DSPs earn an average of $17,950 incomparison with the $24,273 earned bytheir peers in state-operated programs.Due to Medicaid under-funding andsoaring general liability, workers compen-sation, and health care costs, many DSPsreceive limited benefits such as paidhealth insurance or paid time-off. Thechallenges faced by DSPs have led to highturnover and ongoing vacancies at thesame time that demand for communitysupports and services is increasing. In its Olmstead decision, the SupremeCourt affirmed the right of individualswith disabilities to receive community-based services as an alternative toinstitutional care. The Direct SupportProfessionals Fairness and Security Actwould help states meet their obligationsunder the Olmstead decision. Thelegislation would make a much needednational investment and create anincentive – all through a joint federal-state-private partnership – to address oneof our most pressing challenges in the21st century. To learn more about the Act, and a jointcampaign of United Cerebral Palsy (UCP)and ANCOR to advocate for its passage,visit WhoWillCare.net.

Excerpted and adapted with permission from the Web site www.WhoWillCare.net.

Why is Recruitmentand Retention of DSPsa Growing Crisis?


Jennifer Hall-Lande is a Research Assistantwith the Research and Training Center onCommunity Living (RTC), Institute onCommunity Integration, University ofMinnesota, Minneapolis. She may bereached at 612/626-1721 or [email protected]. Amy Hewitt is TrainingDirector and Senior Research Associatewith the RTC; she may be reached at612/625-1098 or [email protected].

6 Profile

After an adult lifetime of independentlycaring for my personal needs, a spinalcord injury forced me into a crash courseon finding and managing people to helpme with my most basic and personalactivities. The resources available to mewere (1) the money in my savings ac-count, which eventually would be supple-mented with Medicaid dollars; (2) aservice provider agency to assist me withthings like completing backgroundchecks on prospective DSPs and manag-ing payroll; and (3) a neighborhood andcommunity that I needed to trust wouldhold the social capital I needed to firstsurvive, and eventually have a life I trulyenjoyed. My most immediate need was tofind people to help me with essential ac-tivities, such as getting out of bed everymorning and having something to eat afew times each day. My two greatest fearswere losing my sense of control overactivities that I was asking for help with,

and depending on people who provednot to be dependable.

My DSPs have very difficult jobs. I askthat they come to work, usually early inthe morning or late in the evening, andwork shifts only 2-3 hours long (some-times less). I ask them to often get “upclose and personal,” to perform taskssuch as lifting me (which is not easy), andto help me with nearly every aspect ofmy personal life. Their jobs are not onesthat anyone can jump in and do well, afact that is sometimes forgotten. ThoughI sometimes forget it myself, the DSPs

who have been with me the longest andwho I trust the most have developed aunique set of skills, knowledge, and atti-tudes. They are the first to admit they arenot experts on providing personal care toall people with disabilities nor are theygourmet chefs. But they do have expertknowledge in providing personal carethat matches my needs and preferences,and in preparing the kind of meals Ienjoy the most. This is exactly why it isso important for me to recruit and hirequality people, and to make the job at-tractive enough for people to stay aroundonce they get the hang of it.

I need several hours of support eachweek. I have chosen to have severalpeople working for me part-time, insteadof having fewer people, or one person,covering most shifts. While this presentsthe challenge of managing several peopleand means that no one person feels asense of ultimate responsibility for mycare, I value the flexibility this provides inmanaging changing work schedules. Ialso like it because it assures I have ulti-mate responsibility and clear authority indeciding how things will be done in myhome. As I have grown to trust my DSPsI have become more comfortable withand appreciative of them trading hours

They Work for Meby John Smith

without my involvement so that all shiftsare covered, and with them providingideas about how to do things at home.Each of my DSPs has developed a workroutine of their own. My role has becometo listen to what they need from me to getthings done more efficiently. I see myincreased trust in each of my DSPs andtheir judgment as signs of my increasedmaturity as a supervisor. I have let go ofsome of my control over the small things,but maintain my influence in setting thetone and deciding what’s important inmy home.

Being responsible for managing myDSPs includes recruiting and hiringenough candidates to meet my supportneeds, and developing some ways to puntat times when I do not have enough ofthem. Recruiting DSPs has become easyfor me because I live on the edge of alarge university campus. I have usedclassified ads in the student newspaper,posted flyers, as well as word of mouthand personal contacts to find people in-terested in being a DSP for me. As themethod of recruitment moves closer tome, my chances of finding someone withstrong interest increase (i.e., a personalcontact is more likely to follow throughthan someone answering a newspaper

As their supervisor, I need to assure

that my relationship with my DSPs

is grounded in an environment of

respect, patience, and flexibility.

John, a Program Coordinator at the Institute on Community Integration, visits with one of his co-workers.

7Profile

ad). As I have lived in my current apart-ment longer and have gotten to knowmy neighbors, it has become easier tofind people to work as a DSP for me. Itry to pay a higher hourly wage thanother jobs in my area. Currently, all ofmy DSPs earn the same wage and I findways to give people bonuses when theydo exceptional work. In the future, I willprobably begin giving raises to people asthey stay with me.

When I started, someone with moreexperience advised me that my DSPscould not be my friends. Though con-fusing at times, I now consider my DSPscolleagues. When they come to myhouse, they are coming to work. As theirsupervisor, I need to assure all our rela-tionships are grounded in an environ-ment of respect, patience, and flexibil-ity. As I ask my DSPs to honor thesevalues, it is important that I model themin my relationships with each of them.For example, I need to show respect to

my DSPs and the work they do by beinghome and done with my activities eachnight when my DSP comes to help me goto bed. Similarly, I expect my DSP toarrive on time each evening so I’m notforced to bide my time waiting when Icould be doing other things. Being flex-ible means I sometimes go to bed a littleearlier or later if my DSP has specialplans. I am usually happy to accommo-date such requests because I know anevening will be coming when I will needto ask that DSP for a similar favor.Patience, of course means being under-standing if someone is occasionally lateand even honest when the tardinessdidn’t cause any real problems, andtrusting that as I give someone a break,that person or maybe someone else willsoon be giving me a similar break. Weare usually able to maintain an atmo-sphere of respect, flexibility, andpatience. I am amazed at the way somevery difficult situations do not turn into

catastrophes or interpersonal strugglesas my DSPs and I model these behaviorsfor each other. I shudder to think howquickly everything would unravel if Ibegan to ignore any of them.

My need for personal assistance hasthrust me into the role of a supervisorfor several people, as well as a recruiterwhen I need to be. After two years, Ihave learned a lot and still have more tolearn. I have been lucky enough to havea very solid group of DSPs, and worryabout the day that each will leave to geta “real job.” Though it is neither goodnor bad, the task of managing DSPs willbe a lifetime challenge for me. I wouldnot have it any other way.

John Smith is a Program Coordinator atthe Institute on Community Integration,University of Minnesota, Minneapolis. Hemay be reached at [email protected] or612/624-0219.

The Code of Ethics developed through theNational Alliance for Direct Support Pro-fessionals (NADSP) guides DSPs through theethical dilemmas they face daily andencourages the highest professional ideals.Direct support staff, agency leaders, policy-makers, and people receiving services areurged to read the code and to consider waysthat these ethical statements can be incor-porated into daily practice. This code is notthe handbook of the profession, but rather aroadmap to assist in staying the course ofsecuring freedom, justice, and equality for all.

1. Person-Centered Supports. As a DSP, myfirst allegiance is to the person I support;all other activities and functions I per-form flow from this allegiance.

2. Promoting Physical and EmotionalWell-Being. As a DSP, I am responsiblefor supporting the emotional, physical,and personal well-being of the individu-

NADSP Code of Ethics for Direct Support Professionals

als receiving support. I will encouragegrowth and recognize the autonomy ofthe individuals receiving support whilebeing attentive and energetic in reducingtheir risk of harm.

3. Integrity and Responsibility. As a DSP, Iwill support the mission and vitality ofmy profession to assist people in leadingself-directed lives and to foster a spirit ofpartnership with the people I support,other professionals, and the community.

4. Confidentiality. As a DSP, I will safeguardand respect the confidentiality and pri-vacy of the people I support.

5. Justice, Fairness and Equity. As a DSP, Iwill promote and practice justice, fairness,and equity for the people I support andthe community as a whole. I will affirmthe human rights, civil rights and respon-sibilities of the people I support.

6. Respect. As a DSP, I will respect thehuman dignity and uniqueness of thepeople I support. I will recognize eachperson I support as valuable and helpothers understand their value.

7. Relationships . As a DSP, I will assist thepeople I support to develop and maintainrelationships.

8. Self-Determination. As a DSP, I will assistthe people I support to direct the courseof their own lives.

9. Advocacy. As a DSP, I will advocate withthe people I support for justice, inclusion,and full community participation.

Reprinted with permission from the National Alliancefor Direct Support Professionals. For information on or-dering Code of Ethics brochures, wallet cards, and post-ers visit www.nadsp.org/library/code.asp or call theInstitute on Community Integration at 612/624-4512.


8

Five Things Families Can Do toFind and Keep Great DSPsby Nancy McCulloh

Finding and keeping great DSPs

can be challenging. Using these

simple strategies and techniques can

help to make the task easier.

Overview

Families caring for a loved one with adisability know first-hand that findingand keeping good Direct Support Pro-fessionals (DSPs) is not always easy.Many families struggle with the comingand going of DSPs. Some DSPs leave af-ter only a few days and others leave aftera few months. These constant changesaffect the family’s quality of life as wellas that of their family member. Familieswant good workers to show up, be on

time, and stay on the job for longer thana few months. They need and want DSPswho are qualified, caring, creative, andcompetent.

There are a number of things thatfamilies can do to increase their chancesof finding and keeping good DSPs. Theremainder of this article describes strat-egies for families in five key areas: find-ing a good match, using insiders, creat-ing and using a Realistic Job Preview,interviewing that works, and keepingnew staff.

Finding a Good Match

The overall hiring goal is to find some-one who is a good match for your needsand wants. There are a number of strat-egies that help you match the person’sskills and interests to your wants andneeds. For instance, make a list of yourwants and needs. Talk with DSPs whowork for you to find out what skills are

needed to do the job. Then figure outwhat is most important by ranking eachitem starting with the item that is mostimportant and ending with the least im-portant item. This will help you defineclearly who you are looking for and whatyour expectations are. A better matchmeans the needs and wants of your fam-ily member are more likely to be met bythe person you hire.

Using Insiders

Second, you must look in the right placesto find the right DSP. Some families useagencies to help them find DSPs whileothers advertise in local newspapers oruse Internet ads, fliers, and job postings.These outside recruitment sources are lesseffective, cost more, and can lead to ap-plicants who do not match well with yourneeds and wants. Outside sources oftendon’t work because people who respondto these approaches usually do not fullyunderstand what you expect.

A better strategy is to ask DSPs whoalready work for you or other people whoknow you well to help you find new DSPs.This is called inside recruitment sources.Someone who knows you and your familymember knows what it takes to do the joband can explain expectations to possibleapplicants. When DSPs understand whatis expected on the job they have fewerunmet expectations and are less likely toleave soon after they start.

Encourage “insiders” to recruit for youby offering recruitment bonuses such asmoney and other gifts. Recruitmentbonuses can be set up so the insider getspart of the bonus when the new DSPcompletes orientation and part after theyhave been on the job for six months. Helpinsiders recruit for you by providing call-ing cards; these are business cards thathelp insiders tell others about the job.Insiders can give these cards out to thepeople they know who are interested in

coming to work for you. Include a mini-job description (one or two statementsabout what you are looking for) and thename and number of the person theycan talk to about the job.

Creating and Using a RJP

Tell applicants about the job by doing aRealistic Job Preview (RJP). A RJP is arecruitment strategy used to give appli-cants detailed and balanced informationabout what is expected of them on thejob, what a typical day is like, your fam-ily as the employer, and the work set-ting. RJPs can be short videos, scrap-books or photo albums, slide showpresentations, or other formats thatdescribe and illustrate the daily work ofthe DSPs you employ. RJPs tell appli-cants about both the fun parts of the joband the challenging parts of the job. Besure to include what other DSPs whowork for you say about the job, alongwith favorite moments and importantduties. Share the RJP with an applicantbefore you offer them a job to help themmake a good decision about accepting ornot accepting a job offer. Applicantswho are not a good match often decidethey are not interested in the job afterthey’ve experienced a RJP.

Interviewing that Works

Interview applicants based on whetherthey can meet your needs. Reviewresumes and applications to make sureapplicants meet minimum require-ments. If they don’t, then don’t inter-view them. You do not have to interviewevery applicant.

Before an interview, prepare a list ofquestions based on what you need andwant DSPs to do on the job. Decide whattype of questions will help you find theinformation you need to make a gooddecision about who to hire. Asking ques-

9Overview

tions about past work behaviors (struc-tured behavioral questions) will provideinformation about what the applicantwill do on the job if you hire them. Askabout real situations and how the personhas handled them in the past. Situationalquestions ask what a person might do ina make-believe situation or what theywould do if given two equally desirable/undesirable outcomes. Asking fact-find-ing questions will give you a clear pictureabout the person’s work history, educa-tion, knowledge and values. Avoid askingillegal questions (such as age, religion,marital status) by sticking to questionsbased on what the person needs to beable to do on the job.

Make the process of deciding who tohire easy by setting up a scorecard andrating each person you interview. Ascorecard has a list of important thingsyou want and need in someone whoworks for you and your family member.Rate each applicant by how they an-swered the questions and decide who youwill hire based on their score.

Keeping Them Once You Hire Them

If you want new staff to stay on the jobfor a long time, make sure they feelwelcomed and are trained to do what youneed to have them do. Welcoming newDSPs helps them feel at ease on the job.Welcome them by showing them aroundand explaining any “house rules” on theirfirst day. Introduce the whole family andother DSPs who work for you and yourfamily member. Train them to do the jobthe way you would like it done. Learninga new job is not always easy. Your role isto teach the new DSP. This can be diffi-cult because different people learn in dif-ferent ways. Find out the best way toteach someone something by asking theperson how they learn best. When train-ing DSPs remember the following steps:(1) Tell them what they are expected todo, (2) show them what they are expectedto do, (3) have them do the job, (4) checkto make sure they are doing the job, and(5) give them feedback about their work.

Conclusion

Finding and keeping great DSPs can bechallenging. Using these simple strate-gies can help to make the task easier.Another resource that families and indi-viduals with disabilities may find usefulis Find, Choose, and Keep Great DSPs, twotoolkits designed for individuals withdisabilities and families that provideeasy-to-use tips and strategies to helppeople to find, choose and keep highquality DSPs. Anyone can download afree copy at www.ildspinitiative.com/.

Nancy McCulloh is a family member of aperson with a disability, and a ProgramCoordinator with the Research andTraining Center on Community Living,Institute on Community Integration,University of Minnesota, Minneapolis.She may be reached at [email protected] 612/626-7765.

The National Direct Service WorkforceResource Center offers information, resources,and assistance to state and local govern-ments, employers, Direct Support Profes-sionals (DSPs), people with disabilities,families, and researchers, with the goal ofimproving the quality, recruitment, andretention of the direct service workforcenationwide. It brings together in one placethe nation’s premier resources on the topic ofdirect support, offering the following:

• A comprehensive online searchable data-base of resources, current research, bestpractices, and policy briefs related toimproving recruitment and retention ofDSPs. Among the resources listed are pro-gram materials such as worker and super-visor training curricula, guidance on mea-

National Direct Support Workforce Resource Center

suring workforce outcomes, recruitmentmaterials, and peer mentorship programdesigns.

• “Find a Direct Support Professional/Caregiver” resource page providing linksto state worker registries around thecountry as well as Area Agencies onAging and the Centers for IndependentLiving nationwide.

• Access to information, resources, and ad-vice from a diverse and experienced teamof direct service workforce policy profes-sionals through a national toll-freetelephone number.

• Individualized, in-depth technical assis-tance for selected state Medicaid agen-cies awarded through an annual applica-tion process.

The center is funded and supported by theCenters for Medicare and Medicaid Services(CMS) under the U.S. Department of Healthand Human Services. The partnering organi-zations contributing their expertise include:

• The Lewin Group

• Paraprofessional Healthcare Institute

• Research and Training Center on Commu-nity Living, University of Minnesota

• The Westchester Consulting Group

• Institute for the Future of Aging Services

• The Annapolis Coalition

For more information about the NationalDirect Service Workforce Resource Center visitwww.dswresourcecenter.org or call toll-free877/822-2647.


10

Addressing DSP Workforce Challenges:Strategies for Agenciesby Sheryl A. Larson

Finding, hiring, training, and retainingDirect Support Professionals (DSPs) areenormous challenges for agencies andthe people they support. Thankfully,there are many research-based solutionsavailable to address these challenges.People may be wondering, “Whereshould I start? Where do we go fromhere?” The answers depend on preciselywhat challenges need to be addressed.

Assess the Situation

The first step toward addressing work-force challenges is to assess the situationto understand the precise nature of thechallenge. Is it a recruitment, retentionor training issue – or all three? What’sthe specific nature of the challenge?Assessing the situation may include ex-amining turnover rates, current vacancyrates, and the proportion of new hireswho left their jobs within six months ofhiring for both DSPs and frontline super-visors. It may involve assessment of staffdemographics, job satisfaction, job per-formance, consumer satisfaction, team-work, training needs, reasons for leaving,and other factors. It is most helpful toreview this information on a site-by-sitebasis. These assessments can clarifywhether the initial understanding of theproblem is accurate, and provide docu-mentation useful later in determiningthe effectiveness of interventions.

Implement Interventions

The next step is to work with an inter-vention team that includes representa-tives from each of the affected stake-holder groups (DSPs, supervisors,administrators, people with disabilities,and families) to select an approach anddevelop a plan to address the top prioritychallenge. The team should identify thegoal toward which it will work and selecta strategy to achieve it. The plan should

clearly identify: (1) the components ofthe strategy, (2) major barriers (the “yeahbuts”) and how those will be addressed,(3) strategies for measuring progress,and (4) a timeframe for implementingand evaluating the intervention. Manydifferent strategies could be selected toaddress challenges identified by the in-tervention team. The chart, “Challengesand Suggested Strategies to OvercomeThem” (see opposite page), shows com-mon recruitment, retention, and trainingchallenges and lists interventions thatcan be used for each. The interventionteam must become familiar with thestrategies that are most likely to be help-ful so that an informed decision can bemade about which one(s) to implement.

The intervention strategies fall intofour basic categories:• Finding and hiring employees. Includes

recruitment interventions designed toincrease the number of qualifiedpeople who apply for open positions,Realistic Job Preview interventionsthat help applicants make informeddecisions about whether the organiza-tion and job are a good fit for theirinterests and needs, and selectioninterventions designed to choosefrom among the qualified applicantsthe ones whose skills and characteris-tics best match the position.

• Welcoming and training employees. In-cludes orientation and socializationinterventions that welcome new em-ployees to the organization and helpthem understand “the way we dothings around here,” and traininginterventions to build competenciesneeded to perform the job well.

• Motivating and supporting employees.Includes supervision and manage-ment training interventions to buildskills and improve practices, team-building interventions to prevent andreduce conflict and improve team

functioning, recognition interven-tions to let employees know they areappreciated and to acknowledge ac-complishments, and career develop-ment interventions to help employeesmove along a career path.

• Changing systems. Includes networkinginterventions to build collaborationacross organizations and groups ofindividuals or families strugglingwith similar challenges, policy inter-ventions to reduce inequities andimprove systemic support for broaderinitiatives (e.g., wage and benefitissues), and professional developmentinterventions that build opportunitiesfor DSPs nationwide to be recognizedas professionals.

Plan for Success

Regardless of the intervention selected,there are several common keys to suc-cess. Having a local champion who valuesthe intervention and has the skill andpower within an organization to ensurethat it is carried out is essential. It is alsoimportant to have an inclusive planningprocess so that individuals with disabili-ties, family members, DSPs and supervi-sors are participants in the change pro-cess. In addition, successful interventionsare based on accurate assessments of thechallenge and well thought-out solutions.Finally, successful interventions includean evaluation component that measureswhether the intervention was imple-mented as designed, reviews progress onan ongoing basis so adjustments can bemade as needed, and measures whetherthe intervention actually produced thefinal outcome that was desired.

Sheryl A. Larson is Senior ResearchAssociate with the Research and TrainingCenter on Community Living, University ofMinnesota. She may be reached at 612/624-6024 or [email protected].

Overview

11

Challenge

• Few qualified applicants• Trouble finding new DSPs

• Turnover rates are too high• New hires quit in the first 3-6 months

• New staff are unsure of their job roles and functions

• Supervisors have difficulty finding time to coach and mentor new employees

• Lack of training opportunities

• Poor performance• Training doesn’t produce desired results

• Supervisors report being overwhelmed, don’t know how to do their job

• Morale problems

• Conflict between staff and supervisors or managers

• Co-workers don’t get along

• Long-term staff are dissatisfied

• Dissatisfied individuals with disabilities or family members

• Inadequate wages or benefits

Challenges and Suggested Strategies to Overcome Them

Strategies

• Expand recruitment sources• Use inside sources for recruitment• Implement recruitment bonuses• Advertise and implement hiring bonuses• Build regional recruitment consortia

• Use inside recruitment sources and bonuses• Give Realistic Job Previews• Improve selection practices• Conduct structured behavioral interviewing

• Conduct effective orientation• Establish peer mentoring programs

• Establish peer mentoring programs• Reduce turnover so there are fewer new employees to coach and mentor

• Use Web-based training or distance learning• Develop a training calendar• Collaborate with other organizations to share training resources

• Establish competency-based training• Use skills mentors to coach staff as they learn new skills

• Support and train supervisors• Mentor supervisors

• Implement participatory management• Offer recognition

• Use teams/team-building• Provide networking opportunities• Support and train supervisors

• Use teams/team building• Improve selection practices

• Enhance career development opportunities• Offer mentoring programs• Provide networking opportunities• Treat DSPs as professionals

• Conduct a job analysis• Implement competency-based training

• Investigate possible policy changes• Tie competency-based training to salary increases

• Build recruitment networks with schools and other community organizations• Market the organization• Implement internship programs for students

• Conduct effective orientation• Improve socialization practices• Establish peer mentoring programs• Improve training practices

• Improve coworker support for new hires

• Share training resources with other organizations so that the supervisor can focus on coaching and mentoring

• Create a staff development culture instead of offering only regulatory-driven training opportunities

• Create a staff development culture instead of offering only regulatory-driven training opportunities

• Give Realistic Job Previews for supervisors

• Create mentoring and other career advancement opportunities• Reward long-term employees

• Implement high performance supervision practices

• Provide supervisor training• Train on conflict resolution

• Allow competent staff to test-out of required training• Offer advanced training• Recognize tenure, reward years of service• Implement equitable wage/benefit plans

• Integrate code of ethics into socialization, orientation, and training practices

• Develop career paths• Professionalize direct support roles

Adapted with permission from Larson, S.A., Hewitt, A.S., & Anderson, L.L. (2005). Selecting and implementing strategies for change. In S.A. Larson & A.S. Hewitt (Eds.). Staff recruitment, retention and training strategies forcommunity human services organizations, pp. 321-342. Baltimore: Paul H. Brookes Publishing, Co.

Overview


12

The Importance of Competency-BasedTraining for Direct Support Professionalsby Traci LaLiberte and Amy Hewitt

Competency-based training and

education have been among the

fastest growing and changing

elements in human services.

High quality supports result in a higherquality of life for individuals who usedirect support services. With the de-mand to fill open direct support posi-tions, and a shrinking labor pool skilledin direct support services, it is criticalthat staff be effectively trained so thatthey can deliver high quality supports.Currently, much of the training and edu-cation available to Direct Support Profes-sionals (DSPs) falls short of achievingthat desired quality. Too often trainingand education programs focus heavily onregulatory requirements such as pre-scribed topics and the number of hoursa DSP attends a training, rather than onthe development of knowledge, skills,and attitudes that enable them to effec-

tively support people with disabilities.Other ineffective training practices in-clude scheduling the majority of trainingin the earliest days of employment, offer-ing few opportunities for ongoing con-tinuing education and skill development,and failing to meet national certificationrequirements.

Today’s DSPs desire the opportunityto acquire the knowledge, skills, andattitudes necessary to perform at a levelof excellence in their jobs. They alsodesire the opportunity for professionaldevelopment and a career path that isanchored in a high quality training andeducation program.

Competency-Based Training

Competency-based training is an avenueto achieve a highly knowledgeable andskilled workforce. A systematic approachto training that is monitored and revisedin light of performance and outcomes isthe hallmark of a competency-basedtraining program. Clear and detailed out-comes or competency statements areused to develop the training curriculumand measure learners’ competence. Com-petency statements are derived from athorough job analysis of the learner’sduties, which contributes to the traininggoal of meeting individual learner needsas they master various skill levels.

In community human services, com-petency requirements and correspondingcompetency statements for DSPs have in-creased with the evolution of communitysupport and consumer-directed supportpractices. The Community Support SkillStandards (CSSS) serve as the nationalset of competencies for the field of directsupport. The CSSS were developed in1996 by the Human Services ResearchInstitute in collaboration with a multi-disciplinary advisory group. A compre-hensive job analysis was completedacross a variety of community humanservices settings resulting in the develop-ment of 12 broad competency areas withcorresponding detailed skill statements.The competency areas are as follows(Taylor, Bradley & Warren, 1996):• Participant Empowerment• Communication• Assessment• Community and Service Networking• Facilitation of Services• Community Living Skills and

Supports• Education, Training and Self-

Development• Advocacy

• Vocational, Educational and CareerSupport

• Crisis Prevention and Intervention• Organizational (employer) Participa-

tion• Documentation

Over the last decade, three additionalcompetency areas have emerged:• Relationships and Friendships• Person-Centered Goals and

Objectives• Supporting Health and Wellness

A national validation study conductedby the Research and Training Center onCommunity Living (RTC/CL) (Larson etal., 2007) validated the importance ofadding the Relationships and Friend-ships, and Supporting Health andWellness competency areas to the CSSS.

Training Models

Competency-based training is beingused increasingly in community humanservice settings. While there is more toaccomplish, there are many excitingadvances. For instance, several states, in-cluding California, Oklahoma, and Illi-nois, have moved toward statewide com-petency-based training programs wherea standardized curriculum is used to de-liver training during the initial period ofa DSP’s employment. Other states, suchas North Dakota, Indiana, Georgia, andMinnesota are using community col-leges and other postsecondary educa-tion systems to deliver competency-based training to DSPs.

The College of Direct Support(www.collegeofdirectsupport.com), anInternet-based, multimedia trainingprogram, has built its competency-basedtraining curriculum on the CSSS. It hasthe essential elements of a competency-based training curriculum, including a

Overview

13

comprehensive transfer of knowledgefrom classroom to workplace compo-nent. This competency-based, onlinetraining has resulted in more skilledDSPs throughout the world. The Collegeof Direct Support is currently used inthe United States by nearly 65,000 DSPswho cumulatively have been assignedover 2 million lessons. Australia has alsorecognized the need for the high qualitycompetency-based training and creden-tialing, and the College of Direct Sup-port is being incorporated into theAustralian credentialing program.

Staff development and training arewhat yield increased wages; withouthigh quality, competency-based train-ing, there will likely be little progresstoward adequate wages for DSPs. Thedirect support profession must learnfrom other professions such as nursing,social work, substance abuse, and childcare that have connected training, edu-cation, and credentialing to careeradvancement and wage increases. Tothat end, in July 2006 the National Alli-ance for Direct Support Professionals(NADSP) launched the first nationalvoluntary credential for Direct SupportProfessionals, with competency-basedtraining requirements based on theCSSS competencies as its cornerstone(see www.nadsp.org). This credentialingwill help ensure that people who pursuecareers in direct support share a com-mon knowledge base and skill set. It willfurther ensure that DSPs make a com-mitment to practice according to theNADSP Code of Ethics. In other words,

the job will no longer be left to chance.DSPs will be required to show masteryin the nationally-validated competencyareas through skill demonstration onthe job and through a portfolio of worksamples.

Conclusion

Direct Support Professionals have longbeen overlooked and undervalued. Yet,an individual with disabilities enjoys ahigher quality of life when supportedby competent, consistent, and reliableDSPs. Looking back over the pastdecade of advancements in workforcedevelopment, competency-based train-ing and education have been among thefastest growing and changing elementsin human services. With this recogni-tion, the field is both energized and chal-lenged to continue to move forward inan effort to provide all DSPs with com-petency-based professional developmentopportunities they need to become rec-ognized, appreciated, credentialed, andwell-paid professionals with a careerpath in community human services.

References

Larson, S.A., Doljanac, R., Nord, D. K., Salmi, P., Hewitt, A.S. & O’Nell, S.(2007). National validation study of competencies for front line supervi-sors and direct support professionals: Final report. Minneapolis, MN:University of Minnesota, Research and Training Center on CommunityIntegration.

Taylor, M., Bradley, V. & Warren, R. (1996). The community supportskill standards: Tools for managing change and achieving outcomes.Cambridge, MA: Human Services Research Institute.

Traci LaLiberte is Director with the Centerfor Advanced Studies in Child Welfare,University of Minnesota, Minneapolis. Shemay be reached at 612/624-2279 [email protected]. Amy Hewitt isTraining Director and Senior ResearchAssociate with the Research and TrainingCenter on Community Living, Institute onCommunity Integration,University ofMinnesota. She may be reached at 612/625-1098 or [email protected].

Overview

Today’s DSPs desire the

opportunity to acquire the

knowledge, skills, and attitudes

necessary to perform at a level of

excellence in their jobs.

Resources from Aroundthe Country

• The Right People for the Job (2002). Apublication for agencies and individualswith disabilities offering straightforwardinformation on how to recruit, assess, andselect direct care workers for home andcommunity-based care. Published by theParaprofessional Healthccare Instituteand MEDSTAT. Available online atwww.paraprofessional.org/publications/WorkforceTools_Vol1No1. pdf.

• The ToolBox (www.thetoolbox.org). AWeb site providing a variety of tools forDirect Support Professionals and theirsupervisors, including information aboutthe book “The New Supervisor: Strategiesfor Supporting and Managing FrontlineStaff” by Linda LaPointe.

• Responding to the Challenge of aChanging Workforce (2002). A journalarticle discussing recruitment strategiesfor use with non-traditional groups suchas Baby-Boomers, Generation Xers, andracial and ethnic minorities. Authored byDennis Doverspike, Marianne Taylor,Kenneth Shultz, and Patrick McKay andpublished in the journal Public PersonnelManagement, 2000, 29(4).

• American Society for Training andDevelopment (www.astd.org, 703/683-8100). Through its Web site and otherresources ASTD provides extensive infor-mation for training and staff develop-ment professionals in a variety of fields.Resources include its publication Infoline,a single-topic how-to reference thataddresses training questions. Among themany topics in Infoline are team-building,successful orientation programs, andidentifying core competencies for jobsuccess.


14

The Health and Higher Education ofDirect Support Workersby William Ebenstein

Overview

The developmental disabilities fieldneeds to develop a more comprehensiveapproach to the frontline workforce, anapproach that encompasses wages, healthinsurance, and educational benefits. Lowsalaries have barely kept pace with infla-tion while higher health care costs con-tinue to erode modest incomes. Access tohigher education is the only true way toprofessionalize the workforce and gain ameasure of economic security for dedi-cated, competent staff.

Health Insurance

With funding for community agencieslimited by reimbursement rates, it isinevitable that the need for modest wageincreases will conflict with efforts to con-tain health costs. Health expenditureshave increased dramatically and a grow-ing share of agency operating budgets isgoing toward health coverage. Responses,although expedient, may be counterpro-ductive. Wages are stagnant, while in-creases in health costs are passed alongas higher premiums. Inferior plans areoffered, with less coverage, more out-of-pocket expenses, and longer waiting peri-ods for new employees. Fewer directsupport workers are able to afford healthcoverage even if eligible.

Increasingly, agencies are replacingfull-time workers with part-timers orcontract employees who are not eligiblefor health benefits. In addition, more areshifting the health insurance burden topublic insurance by expanding “opt-out”bonuses to Medicaid-eligible workers,resulting in a further erosion of the em-ployer-sponsored system. Some workersare even turning down higher paying pro-motional opportunities to maintain theirincome eligibility for public insurance.At the same time, there is evidence thatemployer-provided health insurance is animportant factor in recruiting and retain-ing frontline staff. Increased job tenure

has been reported at agencies that havehigher rates of employer-sponsoredhealth coverage, and at agencies thatspend more per worker for health cover-age. Also, turnover may increase if quit-ting a job does not result in the loss ofhealth benefits. In surveys, many workerssay that employer-sponsored healthinsurance is an important factor in theirdecision to take or keep a job. Many em-ployers believe that insurance coverageenhances employee health, morale, andproductivity. Thus the value of employer-provided insurance for the health of anorganization far exceeds its direct cost.

Higher Education

Educational benefits that provide accessto higher education and opportunities forcareer advancement must be part of theeffort to strengthen the workforce. Thenew service paradigm requires an edu-cated workforce with increased responsi-bility, more autonomy, knowledge aboutthe disability field, a strong value base,and critical thinking and communicationskills. Many agencies now require somecollege or even a degree for the most chal-lenging direct support positions. For ex-ample, of the almost 2,000 direct supportstaff employed by the YAI/National Insti-tute for People with Disabilities, a largenon-profit provider in New York, morethan half have at least an associate’sdegree, and over 40 % hold a bachelor’sdegree. To support this trend moreemployers are providing partial tuitionassistance and/or paid educational re-lease time. Creative collaborations withpublic colleges have leveraged additionalresources. Compared to non-credit train-ings, educational attainment based oncollege credits and degrees is recognizednationally, portable to other employers,transferable to other colleges, and linkedto promotions and higher earnings.

Disability Studies is an emerging

multidisciplinary area of study that hasgained acceptance within academia. Thisdynamic field is rooted in the DisabilityRights Movement and starts with thepremise that the perspectives and experi-ences of people with disabilities are cen-tral. Increasingly it is playing a role in thegraduate education and daily practice ofclinicians, teachers and other profession-als. Many University Centers for Excel-lence in Developmental Disabilities arenow offering certificate or degree pro-grams in Disability Studies. It is equallyimportant that frontline staff becomesfamiliar with the core knowledge andshared values inherent in this approachand that it informs their daily practice.Enhancing access to college, and linkingDisability Studies coursework to careerladder opportunities, can transform theculture of our field. The incorporation ofDisability Studies within higher educa-tion, at both the undergraduate andgraduate level, is the key to professional-izing the frontline workforce.

Conclusion

The problems facing low-wage workers inour field are similar to those confrontingworkers in related health and human ser-vices occupations. We need to forge analliance with other stakeholders, includ-ing representatives of the long-term carefield and organized labor, in the effort toprovide a living wage, offer decent healthbenefits, and expand access to highereducation. All these elements must be inplay to achieve a stable, well-educated,professional frontline workforce.

William Ebenstein is University Dean forHealth and Human Services, and Directorof the JFK Jr. Institute for Worker Education,City University of New York. He can bereached at 646/344-7315 or [email protected].


15

Managing Diversity Within Human Servicesby Richard Oni

Many human service providers must

interact with staff and with people

receiving their services who are

culturally different from themselves.

Cultural diversity has been around a longtime, though we have perhaps not real-ized it. The old idea of the United Statesas a “melting pot” of different culturesall combining to form one has given wayto a new idea of a cultural “salad” or“quilt,” one where cultures still maintaintheir unique qualities and combine toform a large richer world. America isnow, and has been since its inception,the destination of choice for immigrants.Two-thirds of all global immigration is

into the United States, and most of theseimmigrants are from contrasting cul-tures that do not blend readily intoAmerican life.

Many human service providers mustinteract with staff and with people re-ceiving their services who are culturallydifferent from themselves. To foster anenvironment that positively supportsdiversity, administrators of providerorganizations must address a number ofareas. Managing diversity is to createand sustain an organizational environ-ment in which all workers of all kindscan perform well, have opportunities todevelop their full potential to contributeto the organization, and are equipped toprovide culturally appropriate services toindividuals with disabilities and families.The starting point for agencies seeking toeffectively manage diversity is in hiringpractices.

Agency administrators must make aconcerted effort to institute equal em-ployment opportunities and affirmative

action in the hiring process. The follow-ing suggestions should be considered:

• Eliminate discrimination by ensuringthat all selection devices are job re-lated (valid), and free of cultural bias.

• Institute aggressive recruitment fromgroups that are under-represented inthe agency.

• Provide training and sensitization todiversity and cultural differences forall managers involved in the hiringprocess.

• Establish realistic goals (not rigidquotas) for hiring a diverse workforceso that an agency can assess its pro-gress in the hiring and promotionprocesses.

• Appoint members of diverse groupsto committees of the company.

Diversity in hiring must be coupledwith training and a long-term commit-ment to managing diversity. Managingdiversity should include the following:

• Create opportunities for staff, indi-vidually and collectively, to discussissues related to ethnic, racial, cul-tural or gender differences in an hon-est and upfront manner, while pro-tecting each person’s sensitivities andnot invading his or her private life.

• Create opportunities for staff to ex-plore the values, perspectives, andcommunication methods of the dif-ferent groups represented within theagency and among those to whomthey provide services.

• Make explicit to all staff the unwrit-ten rules of the agency.

• Establish and regularly revisit theagency rules regarding anti-discrimi-nation and harassment.

• Develop a mentoring program tohelp DSPs from diverse cultures tosucceed on the job.

• Include managing diversity, under-standing cultural differences, and

problem-solving in a diverse work-force on the agenda at staff meetingsas well as in formal training.

• When training immigrant and minor-ity workers, use methods appropriatefor adult learners, especially adultlearners for whom English may be asecond language. Some suggestedstrategies are use extensive handouts;avoid jargon, slang, and idioms; pro-vide a glossary of necessary jargon;use visual aids; allow questions to beasked anonymously and in writing;and summarize and check for under-standing frequently.

Top management commitment ismandatory for successfully managingdiversity in human services. The explicitand implicit signals sent by top manage-ment through its support of diversity in

leadership, attendance at training pro-grams, promotion of high-visibilitydiversity projects, and swift and forcefulresponses to people and practices thatstand in the path of accomplishing truemulticulturalism in the workplace willdetermine whether agencies and theirstaff are successful in providing servicesfor individuals with disabilities in anincreasingly multicultural country.

Richard Oni is Director of ProgressiveIndividual Resources, Inc., an agency pro-viding culturally appropriate social servicesto recent African immigrant families, locatedin St. Paul, Minnesota. He may be reachedat 651/222-6567 or [email protected].

Overview

Top management commitment is

mandatory for successfully managing

diversity in human services.


16

The College of Direct Support: A Tool forTraining and Workforce Developmentby Susan O’Nell

Profile

The College of Direct Support (www.collegeofdirectsupport.com) is an onlinecurriculum for Direct Support Profes-sionals (DSPs) and Frontline Supervisors(FLS) nationwide. It is providing nearly65,000 learners with hundreds of thou-sands of hours of flexible, self-paced,multi-media training in areas critical toDSPs and FLS today. But being a tool fortraining is only one aspect of the powerof the College of Direct Support (CDS).

Most people who provide services topeople with intellectual or developmen-tal disabilities are familiar with training.Many states have a required number ofhours and topics or even specified cur-riculum that they mandate providers touse. However, too few are using theirtraining as a component of workforcedevelopment.

Workforce development is differentthan simply training people. It is a way ofbuilding and keeping a pool of qualifiedand committed workers. It is an effort tolearn about the number of workers in acommunity and increase the numberavailable to the industry. It is also anactive process of improving the qualityand preparation of those available work-ers. When workforce development effortsare successful, there is always a personwith basic or even advanced skills wait-ing to fill an open position.

Direct support workers are hard tofind. Industry leaders report feeling pres-sured to hire and retain workers who arelacking essential skills or aptitudes. A“warm-body” approach to hiring hasdeveloped that compromises the qualityof services. It also perpetuates discour-agement among high quality workersbecause under-qualified workers lackrespect for and understanding of thework. It also can make the day-to-dayrealities of work far more difficult. Leftunchecked, individual companies andthe industry as a whole can feel theeffects as qualified workers lose motiva-

tion. Or worse, they leave for jobs thatprovide more respect, prestige, andopportunities. This creates a downwardspiral in the workforce that can be hardto escape.

Training is one aspect of workforcedevelopment. Providing training that isrecognized outside of the individual em-ployer or state in which the person is em-ployed can be critical. This could meanthat workers earn college credits for com-pleting training. It could mean that itsmoothly transfers into “credit for priorlearning” from a college or university. Itcould mean that training is part of ameaningful credential. Meeting the edu-cational component of an establishedapprenticeship is another option. Theseoptions make training more valuable tothe employee. Because credit or creden-tials are portable, employees do not haveto repeat training in areas where theyalready have competence. Training timecan be spent on learning new skills andthus can lead to further opportunities.

Providing training that is credit-bear-ing or related to credential also increasesthe employee’s value to the community.

The pool of workers is more preparedwhen expectations in education andtraining are clearly defined and meaning-fully applied. Career paths are more eas-ily defined and rewarded. There is a cleardifference between entry-level and ad-vanced skills. The skills and educationhave a clear connection to the work. Thisnot only ensures individual workers areprepared; it also increases the positivevisibility of the work as a whole. This inturn makes it easier to find new workers.

When building the CDS, we werecareful to consider what needed to be inthe content and the structure to make ithelpful to people who needed good train-ing materials for current employees. The24/7/365 availability of the material andthe self-paced nature made it a new wayto deliver high-quality, consistent train-ing to employees. However, other impor-tant components were included in theCDS content and programming structureas well, to make it helpful to larger effortsin developing the workforce as a whole.

In particular, the material is carefullycrafted to ensure that it is in line withnational efforts to create portable, mean-

The home page of the online curriculum www.collegeofdirectsupport.com.

17Profile

ingful training. CDS content is based onseveral nationally validated skills setsand an accepted code of ethics for DSPs.These skill sets and ethics are also thefoundation of the educational compo-nents of the Apprenticeship Guidelinesdeveloped by the U.S. Department ofLabor (see http://rtc.umn.edu/docs/DOL-DSPApprenticeshipNotification.pdf ). They are a basis for the education,skills, and attitudes that are part of thecredentialing efforts of the National Alli-ance for Direct Support Professionals(see www.nadsp.org). Assessment meth-ods built into the CDS provide guidanceto learners in developing professionalportfolios that help establish their com-petence and ability to apply learning.

CDS content is available at the pre-service or entry level, as well as at special-ized and advanced levels. Some of thecurrent course offerings for DSPs are:

• Safety at Home and in theCommunity

• Maltreatment of Vulnerable Adultsand Children

• Supporting Healthy Lives• Individual Rights and Choice• Community Inclusion• Positive Behavior Support• Documentation• Cultural Competence• Personal Care• Medication Supports• Introduction to Developmental

Disabilities• Direct Support Professionalism• Introduction to Medication Support• Teaching People with Developmental

Disabilities• Person-Centered Planning and

Supports• Introduction to Employment

Supports• You’ve Got a Friend: Supporting

Family Connections, Friends and thePursuit of Happiness

Some of the current course offerings forsupervisors and managers are:

• Training and Orientation• Fueling High Performance• Recruitment and Selection• Developing an Intervention Plan

More courses bridging the move fromDSP to FLS and creating effective super-visors are coming. They offer more expe-rienced DSPs new and more challengingcontent, and also provide core contentfor advancement and career paths.

Finally, the programming behind theCDS content is helpful to workforcedevelopment. Training records are main-tained and can be transferred or recalledwhen needed. The CDS comes with thecapacity for building survey tools andreports. These let purchasers create anddistribute online surveys to help themunderstand key aspects of workforcedevelopment. A pre-made set of surveysis included to help understand thingslike turnover and vacancy rates, workerand customer satisfaction, and workercommitment to the field or organization.These tools and the automatic reportingare extremely helpful in understandingif recruitment, training, and retentionefforts are making a positive difference.

Taking on workforce issues as a wholecan seem overwhelming at times. Itrequires collaboration and cooperationbetween entities that have often seenthemselves as competitors. It requires astrong vision and long-term efforts.Fortunately, organizations have a toolthat can help them get on board withsome of the critical aspects of workforcedevelopment now. The College of DirectSupport provides answers to a lot ofinternal training needs. And, by usingthe CDS effectively in their own way,employers are becoming part of a criticaleffort to improve the entire workforce.

Susan O’Nell is Project Coordinator withthe Research and Training Center on Com-munity Living, University of Minnesota,Minneapolis. She may be reached at 612/624-0386 or [email protected]. For moreinformation about the CDS contact BillTapp, National Director, at 877/353-2767or visit www.collegeofdirectsupport.com.

Using CDS at Starkey, Inc.

The crisis of workforce developmentcontinues to be a challenge: the challengeof hiring the right people, training, nurtur-ing, celebrating and keeping them.Carolyn Risley Hill, CEO at Starkey Inc. inWichita, Kansas, and her staff are doingeverything they can do to make theCollege of Direct Support (CDS) a signifi-cant part of their workforce developmentefforts. Starkey has 265 employees tosupport approximately 400 persons withdisabilities. Judy Leiker, Starkey’s Trainingand Development Supervisor, says theCDS is a part of the recruiting andinterviewing process for prospectiveemployees. “We tell them about the CDSand our training and let them know upfront it will be available for them,” shesays. In 2006 Starkey introduced a newincentive program for employees – $25for completing the first half of thelearner’s assigned CDS lessons, $25 forcompleting the second half, and entry intoa drawing for $20 upon completing amodule in a calendar month. Theworkforce is responding. “We reallyhaven’t formally announced this andpeople are already signing up for thetraining,” Leiker says. “We are currentlynot restricting the amount of overtimeDSPs work in order to encourage them tocomplete assigned lessons.” In addition,Starkey is working to institute hourly payincreases and bonuses in the next fiscalyear as incentives for more and moreemployees to complete the CDS trainingas well as the training in the College ofFrontline Management and Supervision.“We’re proud to have the CDS and itcontinues to make a difference for us,”says Leiker. “A trained workforce is a morestable workforce.”

Contributed by Tom King, CDS, and Judy Leiker,Starkey, Inc. Tom can be reached at [email protected] and toll free at 877/353-2767. Judy can be reached at [email protected] and at 316/512-4161.


18

Training Frontline Supervisors in WorkforceDevelopment: The NTIFFS Projectby Nancy McCulloh

Profile

In 2003, the University of Minnesota’sResearch and Training Center on Com-munity Living (RTC/CL) began a three-year project to train community humanservice employer “change agents” inworkforce development practices andstrategies to improve recruitment, reten-tion, and training of Direct Support Pro-fessionals (DSPs) and Frontline Supervi-sors (FLSs). The purpose of the project –titled the National Training Institute forFrontline Supervisors (NTIFFS) – was torefine, test, and deliver to participatingagencies a national train-the-trainer andtechnical assistance model on DSPworkforce development interventions.

Project Approach and Activities

This project shared workforce strategiesand interventions employers and FLSscan use to improve DSP retention andlower vacancies rates. Training was basedon the College of Direct Support and theCollege of Frontline Supervision andManagement online curricula (www.collegeofdirectsupport.com), the Remov-ing the Revolving Door curriculum devel-oped at the RTC/CL, and the book StaffRecruitment, Retention, and Training Strat-egies for Community Human Services Orga-nizations (Larson & Hewitt, 2005) writtenby RTC/CL staff.

More than 200 applications werereceived from organizations around theUnited States for five spots in the project.Participants had to commit to the projectfully by providing information regardingturnover and vacancy rates at the begin-ning of the project and annually for itsduration. In addition, they had to submitdocumentation of support and commit-ment of resources with their applicationin order to be considered. The organiza-tions selected to participate were:• New Horizons Resources of New York• Orange Grove Center of Tennessee

• Potomac Center of West Virginia• A partnership of Bancroft Neuro-

Health and Devereux, both fromNew Jersey

• A Wyoming partnership of the South-west Wyoming Rehabilitation Center,Community Entry Services, and Reha-bilitation Enterprises of NortheasternWyoming

The project trained a cadre of “changeagents” to help the participating commu-nity human service employers improvetheir DSP workforce outcomes. Seven-

teen participants attended two one-weekintensive train-the-trainer sessions inMinneapolis during 2004 and 2005; theyleft equipped with the information theyneeded to train the FLSs in their agencies.These change agents received training inproven workforce development interven-tion strategies that help employers findand keep high quality DSPs. In return,the participants committed time andpeople willing to learn new skills, sharetheir expertise, implement changes, andprovide feedback to the project advisorycommittee on how to make these changes

NTIFFS Profile #1: Orange Grove Center

Despite being the key to the delivery of quality care in the community, Frontline Supervisors havehistorically been under-appreciated and underdeveloped. Orange Grove Center, an agency with

over a half a century of distinguished leadership in the support of individuals with develop-mental disabilities, recently seized an opportunity to strengthen its Frontline Supervisors.

Selected as one of five organizations in the country to participate in NTIFFS, Orange Grove madea commitment to address its problems with staff recruitment and retention. At the core of our

commitment was a self-appraisal that questioned our commitment, our mission, and the depthof our skill sets. With the realization that our Frontline Supervisors, house managers, and

supported living companions were overwhelmed, over-burdened, and over-extended wewelcomed the practical programmatic tools provided by the “Removing the Revolving Door”

curriculum used in the project. Supervisors were groomed in methods of providing ownership toscores of DSPs, the true “delivery king pins” in any human service organization. The DSPs were

motivated to see firsthand how their actions, methods, and strategies affected the lives of thepeople they supported. The supervisors began to support, not intimidate, the staff, encouraging

true working partnerships and providing environments that encouraged and invited DSP inputand viewpoints. Supervisor use of Realistic Job Previews, participatory house meetings, and

opportunities for meaningful contributions to individual support plans reinvigorated, re-motivated and re-energized the DSPs. The need for rewarding staff diligence and achievement

was realized through the adoption of the Tier Program, a board-supported approach to merit payincentives based on mastery of needed skills. The creation of the novel DSP Games, an Olympic-

like event allowing staff to compete in games designed to highlight their skills was the icing onthe cake. Our outcomes testify to our success – we have finally tamed the beasts of retention,

recruitment and staff esteem. We believe that we have begun to create an environment thatencourages dedication and commitment, and that provides an opportunity for individuals to be

engaged in a profession that clearly makes a “difference.”

Contributed by Jenny Foster, Director of Compliance and Training, Orange Grove Center, Chattanooga, TN. She maybe reached at 423/493-2919 or [email protected].


19

work best across the country. The projectprovided specific technical assistance toparticipants on assessing their workforcechallenges and developing long-termplans to address these challenges. Techni-cal assistance was provided through on-site and remote contacts with the changeagents in each participating agency. Dur-ing the last year of the project partici-pants developed sustainability plans andprovided technical assistance to otherorganizations eager to learn what theyhad learned about improving DSP andFLS recruitment, retention, and training.

Project Accomplishments

Overall, 4,617 DSPs, FLS and other staffparticipated in the following:• 317 supervisors or managers com-

pleted 3,075 College of FrontlineSupervision and Management lessonsonline.

• 590 supervisors or managers attendedRemoving the Revolving Door training. [McCulloh, continued on page 34]

Profile

When Bancroft NeuroHealth was chosen to participate in the NTIFFS project, our DSP turnover

rate was 36%, costing our organization $1.4 million the previous year. That is an estimated costof $3,500 per terminated employee, which only reflects the financial loss. Turnover takes a toll on

staff morale, productivity, and subsequently the quality of care, as well. The organization made staff retention its highest priority for its NTIFFS participation, and

mandated that all Frontline Supervisors (FLSs) participate in the “Removing the Revolving Door”curriculum training. Ninety percent of our FLSs completed the training. The main point of the

training was to prepare FLSs to do the following in relation to DSPs: (1) develop a realistic site-specific job preview, (2) utilize behavioral-based interviewing techniques (picking the right

candidate), (3) standardize the on-boarding process (training), and (4) give staff recognition.Since beginning this process, policies and procedures have been changed to facilitate program

and organizational goals. Now candidates who apply for a position are interviewed by two FLSsusing behavioral-based interviewing. Once a candidate is hired, his or her on-site orientation is

more extensive. The hope is that if we pick the right candidate, train better, provide more support,and give appropriate recognition, the chances of retaining that staff member will increase.

While we continue to struggle with reimbursement rates and the resulting low wages, the“Removing the Revolving Door” training has had a tremendous impact on the organization.

Bancroft NeuroHealth has seen a 5% reduction in our turnover rate in the last year. While thenumbers are showing promising signs, there are other benefits. For example, FLSs are more

confident when hiring people, and just as importantly, are taking a pass on candidates who

would not be a good fit.

Contributed by Brian Horsmon, Staff Education Specialist, Bancroft NeuroHealth, Haddonfield, NJ. He may bereached at 856/348-1157 or [email protected].

NTIFFS Profile #3:The Potomac CenterThose of us who have long been in the

business of serving and supporting peoplewith developmental disabilities know that

one of the major challenges is the perfor-mance of DSPs. The quality of their work is

affected by many factors, but a primary oneis the effectiveness of support and super-

vision they receive. In short, if we want goodDSPs, we need great Frontline Supervisors.

Faced by this challenge, we were happy toparticipate in NTIFFS. That training was

stimulating and hectic, but fun, and itintroduced us to the “Removing the Revolving

Door” curriculum. That exposed us to awealth of research-based materials, but

more importantly allowed us to interact withits authors, and to learn with people from

other states who shared similar problemsbut maybe had different solutions. Together

there was a synergy that strengthened ourdetermination to improve supervision.

Returning from train-the-trainer sessions, wetrained our Frontline Supervisors using the

curriculum. Not only did they benefit from it,but training revealed strengths and skills we

didn’t know they had. It became a realcatalyst for change.

While we looked at many potential areasfor improvement, we settled on three:

Realistic Job Previews (RJP), changes in newemployee orientation, and development of a

mentoring program. The RJP is used to screenjob applicants, and also to set some expec-

tations concerning the work we do. Orien-tation was changed from just covering the

mind-numbing regulatory requirements tofocus on welcoming and acclimating new

employees into our organizational culture.Mentoring pairs a new DSP with a more

seasoned staff member who assists the newemployee in learning their responsibilities.

NTIFFS has been a good beginning on thepath to quality we must continue to take. The

people we support deserve no less.

Contributed by David Plowright, Executive Director,Potomac Center, Romney, WV. He may be reached at304/822-3861 or [email protected].

• 238 supervisors or managersattended other supervisory training.

• 2,090 DSPs saw a Realistic JobPreview.

• 409 DSPs participated in a recruit-ment or hiring bonus program.

• 101 DSPs received training throughthe College of Direct Support.

• 552 DSP applicants were interviewedusing a structured behavioral inter-view.

• 194 DSPs were recruited usingmarketing and recruitment materialsfrom the training.

• 521 DSPs were oriented using revisedprocedures based on the training.

• 505 DSPs were welcomed to theirorganizations in a new way.

Additionally, in other organizations inthe participating states 49 FLSs receivedtechnical assistance from the partici-pants, and 19 legislators were contacted

NTIFFS Profile #2: Bancroft NeuroHealth

20

Embracing an Immigrant Workforce:The SOREO Perspectiveby Wendy Sokol

SOREO is a Tucson, Arizona based com-pany that provides in-home supports toapproximately 650 people with disabili-ties. One-third of the people we supporthave a preferred language other thanEnglish, including 26% whose preferredlanguage is Spanish and 7% whose pre-ferred language is Russian. To supportthe needs and preferences of these indi-viduals and their families we employ alarge immigrant workforce, with more

than half of our Direct Support Profes-sional (DSP), manager, and administra-tor positions held by people who haveimmigrated to the United States. Howhave we successfully grown our ability toprovide services in this culturally andlinguistically diverse environment? Theremainder of this article will describesome of our challenges and celebrations.

Our Setting

Tucson is 45 minutes from the Mexicanborder. Prior to the Gadsden Purchase in1853 Tucson was part of Mexico. Basedon the 2000 U.S. Census, 36% of the Tuc-son metropolitan population is Hispanicor Latino. Arizona was the fastest grow-

ing state in 2006, and has the seventhlargest Hispanic population (U.S. Bu-reau of Labor Statistics, 2002). Between2000 and 2020 the population of WhiteArizonans will grow 5% while the popu-lation of Hispanics/Latinos will grow68% (Latino Perspectives Magazine,2007). In addition, we have a significantRussian refugee population. We havefound that people receiving in-home ser-vices and supports prefer to have DSPswho are not only well trained, honest,reliable, empathetic and have solid inde-pendent problem-solving skills, but whoare also linguistically and culturallycompetent.

Recruiting, Training and SupportingOur Immigrant Workforce

SOREO contracts with the State ofArizona’s Medicaid agency to supportpeople with developmental disabilities,and also contracts with two counties tosupport people with physical disabilitiesand seniors. SOREO is the preferredprovider in the Tucson area for peoplerequesting a DSP who is linguisticallyand culturally competent for the His-panic/Latino population. Twenty-sixpercent of the families we support pre-fer to communicate in Spanish. Fifty-four percent of all our DSPs are His-panic as are 42% of our managementand administrative personnel. In addi-tion, Tucson supports a significant Rus-sian refuge population and 6.5% of thepeople we support prefer to speak inRussian. Among our employees, 12% ofDSPs and 10% of our management andadministrative team are immigrantsfrom Russia or the Ukraine. It is notcoincidental that the percent of peoplewho need supports and have a preferredlanguage of English, Spanish, or Russianmatches SOREO’s complement of directsupport, management, and administra-tive staff (see Tables 1-3 on page 33).

This is the crux of embracing an immi-grant workforce.

In communities with an immigrantworkforce that has limited opportunitiesfor advancement in other labor markets,agencies prepared to train and supportthe workforce in their language and attheir pace will find that workforce to behard-working, motivated, and honest.Most immigrant workers chose to cometo the United States, giving up the secu-rity of their homes because they believedin the “American dream” and wanted abetter future for themselves and theirfamilies. Immigrant workers who legallyreside in the United States have had theirbackgrounds scrutinized by the UnitedStates government before they enteredthis country. They come with a “greencard,” “Resident Alien Card” or as a“Naturalized Citizen.” Those who havenot yet become Naturalized Citizens areconcerned that they not break any lawsbecause a felony charge could result intheir deportation.

Recruitment of immigrant workers tosatisfy the demand for trained DSPs hasnot been an issue for SOREO. We rarelyadvertise to recruit applicants for DSPpositions, do not have vacancies, and ourstaff typically does not work overtime.We offer a competitive wage, company-sponsored health care and life insurance,401K, as well as paid time off and paidholidays to full-time employees. SOREOdoes not require applicants to have a highschool diploma or speak English. Weoffer accommodations to support animmigrant worker during training and asthey slowly develop proficient skills inEnglish. Because of these things, SOREOhas a reputation in Tucson as an em-ployer of choice.

Training and supporting a non-English speaking immigrant workforcehas unique challenges created by boththe language barrier and cultural differ-ences. Providers who launch recruitment

It is not coincidental that the

percent of people who need supports

and have a preferred language of

English, Spanish, or Russian

matches SOREO’s complement of

direct support, management, and

administrative staff.

Profile

21Profile

My name is Araceli Rivera. I emigrated to theUnited States of America in 2001 from Mexico.I am a single mother with three children. Myhusband and I came to America because wewanted to work hard to create a better futurefor ourselves and our children. My husbanddid not like the USA and he returned to Mexicowithin three years. I chose to stay with mychildren without his support. In 2001 I started working as a directsupport aide with an agency in Tucson,Arizona. I liked working with families,especially the children. I liked helping andseeing them grow and learn. There were manythings I did not like about my first employer,however. My interview lasted five minutes. I

was required to work seven days per week; Iwould leave home at 6:00 a.m. and not gethome until 7:30 p.m. I received no formaltraining when I started (except First Aid andCPR), and this training was in English. Thecompany provided services to many peoplewith developmental disabilities. I do notunderstand why they did not properly traintheir staff. I decided I had to leave. I knew Ihad to spend more time with my children. Amother should be able to see her children offto school. In late 2001 I interviewed with SOREO. Itwas a long interview and my sister trans-lated. I was drawn to SOREO because I likedthe philosophy. Wendy Sokol, CEO, spokeabout choice and dignity. She referred to thepeople they supported as “our families” andto the staff as “my staff.” There was a feelingof caring and belonging. I worked as a DSP with SOREO for twoyears. When I started, SOREO had just begunto translate all their training and forms intoSpanish. I would help with the translation sothat it made sense to employees from Mexico.SOREO always offered information in Spanishor through the help of translators. Theycreated an environment where you couldlearn and you felt comfortable to ask ques-tions. My questions were always respondedto in a positive way. I was matched withfamilies where I felt comfortable. Some of thefamilies spoke Spanish and English. Theywould teach me English and I would teach

My American Dream

them Spanish. My schedule worked for meand my family. SOREO was sensitive to myneeds and understood when I needed to bewith my children or to return to Mexico to bewith my family. As my English improvedSOREO offered me hours in the office to helptranslate for and train other DSPs. Wendywas my mentor. She gave me opportunitiesto learn and advance. She had faith in myskills. God brought me to SOREO so that ourlives might cross-over. In 2003, I became a Service Coordinator.SOREO paid for me to attend college toimprove my English. The classes made mefeel more confident. Today I am one ofSOREO’s top Service Coordinators. I am proudof what I do. I know I make a difference in thelives of people with disabilities. I have grownmy referrals so that I now have an assistantwho I am training so that she can have thesame opportunities that I had. With hardwork she will one day become a ServiceCoordinator. In July 2006, I bought my ownhome. I have worked hard to achieveeverything that I have, but I always believedthat through hard work I could make adifference and also achieve the Americandream.

Contributed by Araceli Rivera, Service Coordinator,SOREO, Tucson, Arizona.

[Sokol, continued on page 33]

initiatives to embrace an immigrantworkforce must be prepared to offeraccommodations to support that work-force. Agencies with an immigrant work-force must offer bilingual supportsthroughout the agency, including havingbilingual administrative and clericalstaff available in all departments, andbilingual supervisors. All supervisors atSOREO were promoted from the posi-

tion of DSP, and while 50% did notspeak English when they were hired,100% of current supervisors are bilin-gual. Supervisors are available 24 hoursa day as no single supervisor could speakall the languages spoken within theagency. The standard rotating roster foran on-call person was not effective. Anagency that wishes to support an immi-grant workforce must have an accessible

bilingual team of supervisors availableto help DSPs solve problems and to actas a role model.

SOREO also offers other supports toour immigrant workforce. All trainingmaterials, forms, newsletters, applica-tions, and job descriptions are trans-lated into Russian and Spanish. SOREOprovides 40 hours of mandated training


22

State Initiatives to Strengthen theDirect Support Workforceby Steve Edelstein and Carrie Blakeway

As states strive to rebalance their long-term care service systems and improveaccess to home and community-basedservices for individuals with disabilities,they have found that access to commu-nity services depends on the availabilityof a well-trained, stable, and sizabledirect support workforce. Obstacles toachieving such a workforce include lowwages, poor benefits, lack of training andprofessional development opportunities,lack of respect and appreciation from su-pervisors, lack of control over their jobs,and limited opportunities for advance-ment. Recognizing that the quality of theworkforce has a direct and immediateimpact on the quality of long-term ser-vices, states are intensifying their effortsto find innovative solutions to theseworkforce challenges.

Several national grant programs andinitiatives have supported states inimplementing significant workforceimprovement activities, including:• The Centers for Medicare and Medicaid

Services (CMS): Real Choice SystemsChange, Direct Service Workforce(DSW) Demonstration, and DirectService Workforce Resource CenterTechnical Assistance grant projects

• The Robert Wood Johnson Foundationand Atlantic Philanthropies: BetterJobs, Better Care grants

• The U.S. Department of Labor: HighGrowth Job Training Initiatives

States are drawing from a growing set ofbest practices in pursuing a range ofstrategies within these programs to im-prove the recruitment and retention oftheir direct support workforce, such as:• Offering better employee benefits,

including health care.• Providing enhanced training for Direct

Support Professionals (DSPs) andsupervisors.

• Creating opportunities for profes-sional development and advancement.

• Recognizing and rewarding perfor-mance of individual workers and ofemployer agencies.

• Implementing more effective recruit-ment and selection strategies.

Twenty-eight states are participating inat least one of these initiatives and manyare participating in several. Four stateswith particularly innovative initiativesunderway are featured here:

• Kentucky. DSW Demonstration (CMS)and Real Choice Systems Change (CMS)

• North Carolina. Real Choice SystemsChange (CMS), DSW Demonstration(CMS), DSW Resource Center Inten-sive TA (CMS), and Better Jobs, BetterCare (Robert Wood Johnson andAtlantic Philanthropies)

• Pennsylvania. Better Jobs, Better Care(Robert Wood Johnson and AtlanticPhilanthropies), and High GrowthJob Training Initiative (U.S. Depart-ment of Labor)

• Washington. DSW Demonstration(CMS)

Details of these efforts are provided inthe remainder of this article.

Kentucky

Through a DSW Demonstration grantawarded in 2004, eight provider agenciesin the metro-Louisville region estab-lished the Support Providing Employees’Association of Kentucky (SPEAK).SPEAK (www.dspspeak.org/) providesprofessional development opportunitiesand bonus payments for DSPs employedby its provider agency members. One ofSPEAK’s most successful initiatives is apreservice orientation they provide toprospective job candidates – a RealisticJob Preview (RJP) that occurs before an

individual is hired. Once a memberagency finds a prospect, the agency doesan initial interview. If the agency is stillinterested in the job candidate after theinitial interview, they refer that indi-vidual to SPEAK to participate in the RJP.The RJP is delivered in-person by theSPEAK project coordinator, an employeeof one of the lead organizations in theproject. The session lasts up to five hoursand includes three components: an initialvisit with the SPEAK coordinator, a sitevisit, and a family visit. The session is ex-tremely informal and casual by design, toincrease the comfort level of the prospec-tive employee. Prospective employees aregiven a $50 cash payment at the comple-tion of the session. Because of this prac-tice, as well as the other activities ofSPEAK, turnover in partnering organiza-tions has dropped from 62% to 27% inthree years. All of the SPEAK partnersplan to continue using the preservice ori-entation as a selection tool beyond thegrant period.

In 2001, Kentucky was awarded a RealChoice Systems Change grant to developa Direct Support Work Certificate pro-gram offered through the state’s commu-nity and technical college system. Thecertificate prepares people to work in avariety of community programs. The out-comes are currently being evaluated andit is hoped that increased education willresult in better wages for direct supportworkers and lead to lower turnover foremployers.

North Carolina

In the past five years, North Carolina hasreceived several grants resulting in aflurry of activity aimed at improving therecruitment and retention of a qualitydirect support workforce. Through a2001 Real Choice Systems Change grant,the state created a career ladder for directsupport workers by recognizing two

Profile

23

advanced practice job categories – medi-cation aide and geriatric nurse aide. Thestate also created the Direct Care WorkerAssociation of North Carolina to supportthe professional development of directsupport workers and to promote publicawareness of the importance of the pro-fession, and trained a cadre of trainers tohelp providers implement a more sup-portive, coaching style of supervision.

With a Better Jobs, Better Care grant,the state created the North CarolinaNew Organizational Vision Award (NCNOVA), a special licensure designationthat recognizes long-term care providerswho demonstrate their commitment totheir direct support workforce throughsupportive workplace practices and lead-ership and career development opportu-nities. With the pilot phase near comple-tion and the full implementation stagegetting underway, the state is measuringspecific outcomes such as reductions inturnover, decreases in job vacancies, andincreases in job satisfaction in order tomake the case to state policymakers to tiefinancial incentives to the special licen-sure.

In 2004, a group of agencies in thewestern part of the state received a DSWDemonstration grant to explore theimpact of providing health insurancecoverage to home care workers on theworkers’ decision to stay in direct sup-port. Although the project encountereddifficulty finding affordable comprehen-sive coverage, it did have a positive im-pact on retention and turnover from thecoverage it was able to offer. Based on thestudy, the grantee hopes to interest otheragencies in the state in creating a biggerpool of workers that would improve cov-erage and lower costs.

Pennsylvania

In Pennsylvania, the State WorkforceInvestment Board and the Governor’sOffice of Health Care Reform convened agroup of over 100 stakeholders represent-ing providers, labor representatives,people with disabilities, and other advo-cates across all service sectors to addressits workforce crisis. Through this unique

high-level collaboration between theState’s workforce development andhealth care systems, the group laid out acomprehensive vision for improvingdirect support job quality and buildingadequate workforce capacity to meetfuture long-term care needs. The group’skey recommendations included a systemfor training, credentialing, and careeradvancement for direct support workers;creation of statewide quality standards toencourage supportive workplace prac-tices; exploration of options for afford-able health insurance; and an analysis ofrate setting and reimbursement practicesto ensure that policies are consistent withworkforce goals.

The signature achievement of thePennsylvania Better Jobs, Better Careproject was the development of a univer-sal core curriculum to provide initialtraining to all direct support workers,regardless of setting. Project leaders areseeking to promote the curriculum inconnection with the Commonwealth’s ef-forts to create a competency-based train-ing program for direct support workers.Through a U.S. Department of LaborHigh Growth Initiative grant to the Para-professional Healthcare Institute, Penn-sylvania also served as a pilot site for anew apprenticeship for home care work-ers. The apprenticeship is also using acompetency-based training model andcreates a structured career ladder fordirect support workers in home andcommunity-based settings.

Washington

Washington State has a consumer-directed in-home services workforcecomposed of 23,500 workers, calledIndividual Providers (IPs). In 2002, thisworkforce unionized and bargained withthe state for wage increases and healthinsurance benefits. Today, IPs who workat least 86 hours a month and meet othereligibility requirements can enroll ineither of two comprehensive healthinsurance plans.

Washington’s Home Care QualityAuthority (HCQA) received a DSW Dem-onstration grant in 2004. With this grant,

HCQA has marketed and promoted thenew health benefit to IPs across the stateand implemented several other interven-tions designed to improve staff recruit-ment and retention. The grantee pilotedHome Care Referral and Registry Centers(HCRRs) in four regions of the state, andthe number of sites has now expanded to14. The HCRRs provide worker orienta-tion, training, and peer mentorship. Casemanagers at the HCRRs help to matchworkers with people with disabilitiesneeding services in the community.HCQA developed a Web-based workerreferral registry that matches workerskills, training, and abilities with con-sumer needs and preferences. Potentialworkers can visit the registry’s Web site(www.hcqa.wa.gov/) to find out aboutjobs in home care, and people with dis-abilities looking for workers can searchthe registry to find qualified IPs to inter-view.

Future Trends: Evaluation

With so many different strategies andinitiatives underway, states are turningtheir attention to evaluation and out-comes measurement. State policy-makers need to know which strategieswork and which have the greatestimpact. However, many states do notconsistently or systematically collectworkforce data, such as retention andturnover rates, worker wages, benefits,and training. States will have to investconsiderably in evaluation and make anenduring commitment to data collection,so that they can monitor their progress,learn from their experiences, and con-tinue to develop good workforce policygoing forward.

Steve Edelstein is National Policy Director,Paraprofessional Healthcare Institute, NewYork, NY. He may be reached at [email protected] or 718/402-7413.Carrie Blakeway is Direct Service WorkforceResource Center Manager, The Lewin Group,Falls Church, VA. She may be reached [email protected] or 703/269-5711.

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Kansans Mobilizing for Change:Award-Winning Systems Changeby Kathy Olson and Kathy Stiffler

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People with developmental disabilitiesoften rely on Direct Support Profession-als (DSPs) to assist them with dailyactivities ranging from self-care andhomemaking to employment and com-munity participation. DSPs influence thequality of life for the people they sup-port. Nationwide, low wages, limitedopportunities for training and careeradvancement, as well as a lack of recog-nition for the essential work they do haveresulted in high turnover among DSPs.In Kansas, these aspects of the DSPworkforce crisis are being addressed bythe award-winning systems changeeffort, Kansans Mobilizing for DirectSupport Workforce Change (KMFC).

KMFC Overview

Kansans Mobilizing for Direct SupportWorkforce Change focuses on enhancingeducational opportunities for and thestatus of DSPs. Its overall goal is improv-ing recruitment and retention rates, lead-ing to improved quality of services. Twoyears of initial funding (2002-2004) fromthe Kansas Council on DevelopmentalDisabilities united stakeholders in theproject, which still continues today withother funding. The participants in KMFCare service providers, self-advocates,families, state policymakers (representa-tives from the Kansas Departments ofCommerce, Health and Environment,and Social and Rehabilitation Services),representatives from the U.S. Depart-ment of Labor, and other Kansas DSPworkforce development stakeholdersalong with researchers from the Uni-versity of Kansas (additional researchersfrom the University of Minnesota par-ticipated in the initial project). Amongthe key areas on which project partnershave focused are education of FrontlineSupervisors and DSPs, as well as devel-opment of a recognized direct servicecareer path.

Enhancing EducationalOpportunities and Career Status

Educational opportunities addressingthe essential functions of the direct ser-vice profession are critical to providingquality services and to DSP career devel-opment. Online training through theCollege of Direct Support (CDS) and theCollege of Frontline Supervision andManagement, a nationally available com-petency-based training curriculum devel-oped at the University of Minnesota, wasintroduced during the initial KMFCproject (see www.collegeofdirectsupport.com). The online curriculum was cus-tomized with Kansas-specific contentand used to transition from face-to-facetraining to computer-based training withpersonal follow-up. CDS provided in-creased flexibility and availability ofhigh-quality training, and when grantfunding ended KMFC members contin-ued to meet and explore ways to fundthis training option. Purchase of theCDS by a pool of employers was muchmore affordable than individual pur-chase, so KMFC pursued this option.Member advocacy resulted in CDS beingidentified as an immediate priority in theState’s Social and Rehabilitation ServicesStrategic Plan 2005-2010. When CDSwas not included in the final budget re-quest, KMFC was successful in gettingthe legislature to add funding for FY2007. Ongoing advocacy resulted infunding being included in base Socialand Rehabilitation Services current bud-get request.

CDS is now available statewide, andin the first 10 months of this expansionover 90 service providers have takenadvantage of this training opportunity.KMFC members are sharing their CDSimplementation strategies and successstories with others across the state. DSPswho work for individuals who self-directservices, for small providers who supportonly a few individuals or for larger ser-

vice providers are now all accessing thesame training. Several employers are alsolinking wage increases to training.

To help build a career ladder KMFCdeveloped a credentialing and appren-ticeship program for Kansas DSPs. TheAd Astra Direct Support RegisteredApprenticeship Program promotes afundamental shift from direct support as“just another job” to a conscious careerchoice. It provides coherent, step-by-step, multi-level staff training built onnationally recognized Community Sup-port Skills Standards (HSRI, 1997) thatdefine the skills a DSP needs to know toprovide high quality support for peoplewith developmental disabilities. AdAstra provides employers with a coach-ing protocol involving both mentors/journeyworkers (highly skilled currentemployees) and Ad Astra apprentices(candidates). The Kansas ApprenticeshipCouncil has registered this voluntarycredentialing program leading tojourneyworker status.

Outcomes

Outcomes of the initial two-year projectshow that the strategies used hold prom-ise for addressing the need for enhancededucational opportunities and status forDSPs, as well as reducing turnover. Out-comes include the following:• Overall in the 12 organizations that

completed the project interventions,there was a 15% reduction in DSPturnover from their baseline assess-ments in 2002 through projectcompletion in 2004. Turnover forfrontline supervisors declined 29%from the baseline level, suggestingthat the project’s activities had thegreatest impact initially on supervi-sors, but by the end of the secondyear a healthy decline in DSP turn-over was also evident.

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• At the start of the project 40% ofagency participants reported that theylimited provision of services to newindividuals with disabilities due totheir workforce crisis. In the final yearof the project only 15.4% reportedtheir workforce challenges forcedthem to limit new services.As mentioned earlier, over 90 Kansas

service providers are now making CDStraining available to their staff. In addi-tion, two agencies are participating in theapprenticeship program. KMFC partici-pants have also created a number ofworkforce initiatives to continue theefforts of KMFC beyond the initial grant,including establishing a Kansas Chapterof the National Alliance of Direct Sup-port Professionals, and advocating at the

state level for increased wages and ben-efits for DSPs.

In 2005, KMFC received the MovingMountains Award (see below) for itswork in direct support workforce sys-tems change. Despite the promising suc-cess of the initial two-year project, addi-tional work must be done to address DSPchallenges in Kansas. Toward that endKMFC members continue to meet face-to-face quarterly and collaborate withothers in their local communities andacross the state to build on the earlierwork – especially in the areas of trainingthrough the CDS and credentialing –bringing about continued systemschange to resolve the direct supportworkforce crisis in Kansas.

Reference

Human Services Research Institute (HSRI) (1997). Analysis of the con-tent of the community support skill standards and the national standardsfor human services educational programs. Cambridge MA: Author.

Kathy Olson is Associate Research Professorwith the Kansas University Center onDevelopmental Disabilities, Parsons. Shemay be reached at 620/421-6550, ext. 1771or [email protected]. Kathy Stiffler is Co-Founder and Chief Executive Officer withIndividual Support Systems, Inc., Topeka.She may be reached at 785/228-9443, ext.12 or [email protected]. For moreinformation on KMFC and its reports andresources, see www.workforce.lsi.ku.edu.

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The following 15 organizations are recipients of

the Moving Mountains Awards, presentedannually to organizations and agencies that

demonstrate best practice in direct supportworkforce development. Awards are given by

the Research and Training Center on Com-munity Living, University of Minnesota, in

partnership with the National Alliance forDirect Support Professionals (NADSP). Nomi-

nations are solicited through NADSP memberorganizations and reviewed by a panel of

NADSP members using selection criteria basedon the mission and goals of the NADSP. For

more details on the award and profiles of therecipients see www.nadsp.org/training.

2007 Award Winners

• Support Providing Employees’ Association of

Kentucky (SPEAK): For excellence in preservice

orientation, mentoring of new hires, inservice

training, and promoting DSP recognition and

professionalism.

• Alaska Alliance for Direct Service Careers: For

excellence in developing ongoing statewide

initiatives that build DSP careers.

2005-2006 Award Winners

• Ark Regional Services (WY): For excellence in

competency-based training for DSPs.

• Community Supports for People with Disabili-

ties Program, South Central College (Minne-

sota): For excellence in promoting DSP career

development through credit-bearing

coursework.

• Kansans Mobilizing for Workforce Change: For

excellence in creating and sustaining mean-

ingful direct support workforce change at the

systems level.

• The Arc Northern Chesapeake Region Stars

Program (MD): For excellence in creating a ca-

reer track to raise the value and status of DSPs.

2004 Award Winners

• PATHS (Ohio Alliance of Direct Support Profes-

sionals): For excellence in DSP career develop-

ment through apprenticeship and credentialing.

• Everyday Heroes Leadership Initiative (NY): For

excellence in building DSP leadership for com-

munity inclusion.

• Direct Support Professionals Association of

Tennessee (D-SPAT): For excellence in building a

statewide DSP association that promotes net-

working, training, and recognition programs.

2003 Award Winners

• Elm Homes (MN): For excellence in redesign-

ing human resource practices for DSPs.

• Mid-Hudson Coalition Inc. (NY): For excellence

in DSP education, training and development.

• SPIN (PA): For excellence in DSP training, lead-

ership development and career development.

2002 Award Winners

• Dakota Communities, Inc. (MN): For excellence

in DSP training for their Advocating Continuing

Education Program.

• Vinfen (MA): For excellence in creating, devel-

oping, and nurturing Self-Managed Work

Teams (SMTs) with DSPs as team leaders and

members.

• OHI (ME): For excellence in supporting DSPs.

NADSP Moving Mountains Award Winners by Year


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Improving Recruitment, Retention andTraining in California: CDSNby Carol Zabin

California, like many other states, faces astaffing crisis due to poor conditions ofemployment for workers who provide di-rect support to individuals with disabili-ties in community settings. A reliable,committed, and professional direct sup-port staff is critical to developing “per-son-centered” services that help peopleto lead self-directed lives in integratedsettings of their own choosing. This ar-ticle addresses the specific roots of thestaffing crisis in California and a newinitiative to overcome it. The initiativeincludes the creation of a new non-profitsocial enterprise, called the ConsumerDirected Services Network (CDSN),designed to provide a comprehensivepackage of recruitment and training sup-ports to multiple provider agencies. Inaddition, the new initiative has put fortha policy proposal to improve compensa-tion for workers in agencies that meetspecific training benchmarks. The initia-tive supports building a political partner-ship among organized labor and parts ofthe provider and advocacy community tosupport policy reform.

The Workforce Crisis in California’sCommunity System

California’s community services systemassists more than 200,000 people withdevelopmental disabilities, employsapproximately 90,000 workers, and costsover $3 billion per year. Developmentalservices in California have undergone adramatic transformation since the 1969Lanterman Developmental DisabilitiesServices Act recognized the civil right ofpeople with developmental disabilitiesto determine their own life plans, placesof residence, and service providers. TheLanterman Act created an entitlement toservices, and established a community-based system operating under the prin-ciples of decentralization and localcommunity control. Over time, a steady

progression of federal and state legisla-tion, court decisions, and MedicaidHome and Community Based Services(HCBS) waivers have facilitated thedevelopment of flexible and innovativeprograms in the community system.

As a result of this transformation,services that once were delivered bylarge, segregated public institutions nowoperate through private nonprofit andfor-profit community-based agencies.This dramatic change in the type ofentity that provides services has hadenormous and often unforeseen conse-quences for the direct support work-force, for employee-employer relations,for the level of training and profession-alization of the workforce, and for otheraspects of the direct support labor mar-ket. Four consequences are of particularimportance:• Poor wages and benefits. Dismantling

the state system of institutional careturned public-sector, unionized jobswith health insurance, pensions,training, and career ladders intopoorly paid jobs with fewer benefitsand even fewer opportunities forcareer advancement. The labor stan-dards that exist in public sector and/or unionized jobs do not exist inprivate labor markets, and agencyreimbursement rates are determinedbased on the going wage for low-skilled workers. Simple mechanismssuch as cost of living adjustmentsthat are built into public sector con-tracts or collective bargaining agree-ments are absent, as is access to state-administered health insurance andretirement benefits. Poor compensation is recognizedas a main cause of the extremely highrates of turnover. High turnoverforces providers to struggle to findqualified workers, undermines train-ing, continually disturbs relationshipsbetween workers and people with

disabilities, and ultimately under-mines quality of care.

• Changing job descriptions and lack oftraining support. DSPs providing per-son-centered services designed tomaximize self-determination havevery different job responsibilitiesthan workers in institutions andtraditional services. While the latterwork under the direction of on-sitesupervisors in structured and routin-ized programs, workers providingperson-centered services perform abroad array of tasks autonomouslyas they help people with disabilitieslead self-directed lives. For example,they provide medication supports;implement behavioral plans; teachnew self-care skills; assist people withdisabilities in navigating relation-ships with family, neighbors, co-workers and others; advocate fortheir rights; teach self-advocacy; andinteract in many different work,home, and social environments.Workers in person-centered servicesare accountable not only to their em-ployers but to people with disabilitiesand families, who play a significantrole in hiring, supervision, andpossible termination. California’s community-baseddevelopmental services system hasnot invested in training for directsupport workers in these new ser-vices. Moreover, it has not tappedinto the state’s workforce investmentsystem nor its community collegesystem, the two major sources offunding for workforce training andeducation. Instead, community agen-cies are held responsible for provid-ing training to their direct supportstaff, but they have limited capacityto design or deliver this training.

• Proliferation of employers. The shift toa decentralized community-based

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system resulted in the creation of8,000 community-provider agencies,with an estimated average employ-ment of fewer than eight full-time-equivalent workers. In many cases,agency directors value small agencysize because they associate it with ahigher quality of personalized serviceand responsiveness to local needs. Infact, decentralization and communitycontrol are core values of California’sservice system. The proliferation ofsmall agencies also has some draw-backs, however. Small agencies oftenlack business expertise and face highadministrative costs. Healthcare in-surance, which is one of the keys toretaining workers in this industry, ischeaper with a greater number ofworkers in the health insurance pool.In addition, the smaller agencies pro-vide only minimal on-the-job trainingfor their workers and are unable toprovide career advancement opportu-nities. These inefficiencies absorb re-sources that could otherwise be usedfor service provision. Decentralizationin California has meant that the staff-ing crisis, which must be addressedon a multi-employer or sector-widebasis, has been severely neglected.

• Families as employers. In California,more than 30,000 families now di-rectly hire workers to provide respite,daycare, and other services, and an-other 9,000 people with disabilitieswill be eligible for self-directed servicevouchers over the next three years.Evaluations have shown that peoplewith disabilities who are able tochoose and arrange their own servicesand personnel have shown an overallincrease in measures of satisfactionand quality of life because of theirincreased flexibility and choice.Although increased choice has hadpositive results for the families in-volved, it can create difficulties forworkers, who experience greater diffi-culty finding work, often receive noWorkers’ Compensation insurancecoverage, and rarely have access tohealth insurance, training, or careeradvancement. Although many of the

people who provide these services arefamily and friends who may not needthis level of workforce supports, oth-ers are trying to make a living doingthis work and want to stay in the field.

A Strategy for Change

Absent state action to address the staff-ing crisis on a sector-wide basis, creativ-ity and innovation have emerged fromthe bottom-up. The Consumer DirectedServices Network (CDSN) has initiated anew strategy that combines the creationof infrastructure to help agencies recruitand train workers, a legislative proposalthat creates funding for compensationincreases tied to training, and outreachto promote positive relationships amongstakeholders, including organized labor,for policy reform. Components includethe following:• CDSN: Creating the infrastructure for

workforce development. The CDSN is anon-profit organization that offersservices to agencies providing person-centered services to people with devel-opmental disabilities in California.Incorporated in 2006, CDSN is nowpoised to launch as a financially self-sufficient enterprise. CDSN is de-signed to help small and medium-sizeagencies address their workforce is-sues by providing administrative andworkforce development services whilepreserving the autonomy of agenciesand people with disabilities over allaspects of service delivery. TheCDSN’s services include payroll, taxcompliance, recruitment, and stafftraining. This investment in a multi-employer training infrastructure ismade possible through foundationgrants, agency fee for service, and willeventually tap into public trainingand education funds that have notbeen previously used in this sector.

• Legislative reform: Using rate reform tocreate incentives for stabilizing andprofessionalizing the workforce. CDSNsponsored legislation (AB 1427) in2007 to allocate funds for rate in-creases for agencies that met specified

benchmarks for training theirworkforce. The bill was passed by thelegislature, but was vetoed by Gover-nor Schwarzenneger. The bill gar-nered the support of major consumeradvocacy groups and SEIU, and setsthe stage for future efforts to fundtraining linked to improvements inworker compensation.

• Partnerships for power: Uniting the po-litical voices of people with disabilities,families and advocates, agency provid-ers, and labor organizations. CDSNseeks cooperative relationships withall stakeholders, including organizedlabor, because convincing policy-makers of the importance of passingthis type of legislation will requirejoint stakeholder advocacy. In thepast, the voice of workers has beenabsent in policy debates in this sector,which has weakened the potential forrate reform significantly. Since CDSNseeks to promote a worker voice inthis industry, it requires that agenciesreceiving its services remain neutral iftheir workers seek representationfrom a labor union.

Conclusion

The disability rights movement calls forservices that promote self-determina-tion, community inclusion, choice, andindependence. Achieving this goal willrequire continuing commitment andinnovation. The CDSN initiative is acomprehensive strategy for stabilizingand professionalizing the direct supportworkforce that has great promise to notonly improve the lives of the direct sup-port workforce, but also the lives of thepeople with disabilities it supports.

Carol Zabin is Senior Labor PolicySpecialist, Center for Labor Research andEducation, University of California,Berkeley. She may be reached at [email protected].

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One Strong, Caring Voice: DSPs Band Togetherby Gail Abbott

We are Direct Support Professionals(DSPs). Our job is to support, notaccomplish. How well we do our job isreflected in the lives of the individuals wesupport. The thanks we receive is in theshining face of someone who has justgotten their first apartment, or in theprofound joy of a person who hasapplied for many jobs and after monthsof searching has just been gainfully em-ployed. Our joy is in the realization ofanother’s life-long dream. Our jobs and

our goals are to treat everyone with therespect and dignity they deserve, whilesupporting them to accomplish theirgoals in the workplaces and communitiesand encouraging them to express them-selves through leisure activities of theirown choosing. This is who we are.

Although professional caregivers havealways shouldered a multitude of respon-sibilities directly related to individuals’health and immediate safety, the hourlypay has always been low. Along with in-sufficient training, limited educationaland career opportunities, and low socialstatus for caregivers this has been an im-mediate threat to our DSP workforce aswell as to the people with disabilities wesupport. In Tennessee and across thecountry we are organizing to addressthese threats and ensure that our DSPworkforce can meet the needs of thosewe support today and in the future.

At the national level, DSPs and their

allies formed the National Alliance forDirect Support Professionals (NADSP)in 1996 to address issues relating to pro-fessional caregivers. NADSP is a coali-tion of organizations and individualscommitted to strengthening the qualityof human service support by strengthen-ing the direct support workforce. We areproud to report that the times indeed arechanging. With the establishment of theNADSP, a chain reaction of sorts began.DSPs around the country began to bandtogether. NADSP affiliate organizationsformed in Arizona, Arkansas, California,Connecticut, Florida, Georgia, Kansas,Illinois, Louisiana, Maine, Massachu-setts, Michigan, Minnesota, Mississippi,Missouri, Nebraska, New Hampshire,New Mexico, New York, Ohio, Pennsyl-vania, and Tennessee.

In Tennessee where I live, the DirectSupport Professional Association ofTennessee (DSPAT) works in conjunctionwith the NADSP on a national level, andlocal chapters have also formed to assistwith communication and unity. TheDSPAT motto is: “Many Caring People,One Strong Voice.” We have a voice, andthat voice is growing steadily louder. Forexample, in 2005 the Tennessee Depart-ment of Mental Retardation Services(DMRS) in conjunction with DSPATbegan examining the DSP rate of pay,and realized that it was decidedly lack-ing. DMRS recognized the need for well-trained professional caregivers, and ap-proved a pay increase for providers. Thisincrease was meant solely for DSPs, andcould not be used for any other purpose.In March 2006, providers began receiv-ing increased payments to fund DSPbonuses. This gave our Tennessee DSPsa much-needed raise at the state level.

At the local level, the AndersonCounty DSPAT chapter is a wonderfulexample of how a NADSP affiliate hashelped bring the concept of pride andstrength in numbers to individual DSPs.Anderson County has added to theDSPAT motto the line “Every Voice

Counts.” The strength this motto repre-sents demonstrates the camaraderie andpride that now exists between these orga-nizations and the importance we as awhole place on listening to our members.This chapter holds monthly potluckdinners to promote membership growth,and bake sales to raise money to supportthe chapter. It can now afford to publishits own newsletters and mail them to itsmembers in East Tennessee. Monthlyaward winners receive DSPAT award cer-tificates and cash prizes at chapter meet-ings to promote peer recognition, andpictures are taken for a chapter scrap-book, to post on the DSPAT Web site,and to send to local papers. The mem-bers take care of each other by starting afund for and donating money to DSPswho need a helping hand with groceries,shelter, or clothing.

These efforts in Tennessee have pro-duced wonderful results. For example,Meredith Zirkel joined the DSP work-force at Emory Valley Center in OakRidge three years ago. She has a degree incriminal justice. Her son has Autism, andwhen faced with the choice of how toprovide him with the best opportunities,she felt that she needed to see what hislife would be like as a consumer with aprovider agency. She now continues as aDSP because she wants to be part of themovement toward better education andtraining for professional caregivers. Shehas a large stake in the DSP workforceand its potential.

Teresa Luke is another wonderfulDSP. She has a Bachelor’s degree inhuman services and works as a job coachat Emory Valley Center. When asked whyshe chose this profession she says shefeels that a Higher Power called her tothis field. She could have chosen manyfields with her degree, but chooses to staywhere she feels she is truly needed. Thededication she feels to the people shesupports is commendable, and this atti-tude is one of the many reasons that wecannot, and will not, fail in our efforts.

The Direct Support Association

of Tennessee motto is: “Many

Caring People, One Strong Voice.”

We have a voice, and that voice is

growing steadily louder.

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The dedication of Meredith andTeresa and other DSPs with the samespirit will ultimately promote our suc-cess on all levels. The NADSP, DSPAT,and other local chapters must workcollectively to provide the support thatDSPs such as Meredith and Teresa needto do their jobs. DSPs need support fromthe national, state, and local levels to bethe professionals they need to be for thepeople they support. In the words ofDSPAT’s Executive Director, Earl Foxx Jr.,“The greatest benefit and honor of being

a NADSP affiliate is the idea of being apart of the nationwide movement toequip our workforce with the resourcesneeded to instill character and ethics thatare required to responsibly perform theirjob duties. I foresee the future of theNADSP as a growing organization, withestablishment of affiliates that will even-tually encompass our nation.”

Direct Support Professionals have be-gun to educate others that ours is a truecareer choice, and not “just a job.” MartinLuther King Jr. said: “All labor that uplifts

The NADSP Credential: HowBeing a DSP-R Affects My Life

September 30, 1981 was a day that changedmy life, more so than I would have imaginedback then. That was the day my son Jonathanwas born. I have learned so much over theyears not only by caring for my son, but alsoby going through the school systems in theplaces we have lived, the different testing thathas been done to determine his placement inthe classes, and the different physicians hehas seen for his neurological disorder and hisbehavior issues. I guess I should explain a littlemore: Jonathan has intellectual disabilities,and speech and behavior issues. I've alwaysbeen his primary caregiver – taking him to thedoctor, dentist, psychiatrist, and school. I've

always been the main brunt of his behaviorswhen he had them – I've been hit, bit, kickedand scratched. When it got real bad he wasadmitted to a hospital for a time. Now you're probably wondering what thathas to do with being a Registered DirectSupport Professional (DSP-R). Well, when Ithink about it, I've done Direct Support worksince my son was born. I don't consider caringfor my son “work” mind you, but I don't careany less for the women I've supported in theComet Trail group home for the last eightyears, or for the other women and men I'vesupported in other residential houses whereI've worked as a substitute DSP. Taking care ofmy son gave me the experience to work in thisfield. It also gave me the confidence and theincentive to learn as much as I can so I can doa better job supporting every individual inwhose home I have the privilege of working. When I first read about the NationalAlliance for Direct Support Professional’s(NADSP) credentialing program I was veryinterested and excited. Having DSP credentialscould not only assist us when we apply for ajob, but we have the chance for advancementin the credentialing process. The best thing tome, though, was the fact that we get recogni-tion for the work we do. The credentialingprogram will show government officials,employers, and even the families of the peoplewe support that we are willing and committed

to do the best we can to provide the qualitysupport our individuals deserve. I have recently transferred to the Trainingand Compliance Department of Orange GroveCenter. The fact that I went the extra step andgot my DSP-R credentials was a plus for myresume. I have also completed the AmericanHeart Association CPR Instructor course andteach CPR classes here with another instructor,and have been attending Department ofMental Retardation Services classes so I willbe able to teach our core training classes, too.Knowing I am doing my best to train qualityDSPs and letting them know that we have avoluntary credentialing process out there issomething I would have never thought Iwould be doing when I first began working inthe group homes. To be honest, I'm proud ofmyself. My children and my husband have toldme they are proud of me, too. I get a feeling ofsatisfaction when I look at my certificatehanging on the wall by my desk in the office. Regardless of where I end up in my career,I'll always be a DSP-R and eventually I hope tobe a DSP-Specialist in Supervision andMentoring. I will also continue to work in thegroup homes as much as I can, and do my bestto enrich the lives of the people I support.

Contributed by Laura Pittman, DSP-R, AdministrativeAssistant Training and Compliance, Orange GroveCenter, Chattanooga, Tennessee. In the photo are Lauraand her son Jonathan at the Tennessee DisabilityMegaconference.

humanity has dignity and importanceand should be undertaken with pains-taking excellence.” We are proud of whowe are and what we do. The happinessand the very lives of the people we sup-port depend on our excellence. We areDirect Support Professionals.

Gail Abbott is Secretary for the DSPATState Advisory Board. She may be reachedat [email protected]. For moreinformation visit www.nadsp.org andwww.dspat.org.


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In 2004, the Illinois Council on Develop-mental Disabilities made a three-year,$900,000 investment to facilitate state-wide systems change to address Illinois’direct support workforce issues. Theproject, titled the Illinois Direct SupportProfessional (DSP) Workforce Initiative,created a partnership between the Coun-cil; the University of Minnesota’s Re-search and Training Center on Commu-nity Living; the Institute in Disability andHuman Development at the Universityof Illinois at Chicago; the Human ServiceResearch Institute from Cambridge,Massachusetts; and Illinois organiza-tions, families, and individuals with dis-abilities concerned about improvingworkforce outcomes.

The project vision is that people withdevelopmental disabilities, and theirfamilies and support networks, havetrained, valued, and creative DSPs toassist them in living quality lives andfully participating in their communities.Toward that end, the main activities ofthe initiative include the following:• Establishing a statewide Steering and

Advisory Committee (SAC) chargedwith the responsibility of directingand guiding the work of the projectthrough, among other tasks, (1) iden-tifying and prioritizing the primaryand persistent statewide workforcechallenges; (2) selecting project par-ticipants from among community hu-man services organizations, as well asindividuals and families who directtheir own supports; and (3) develop-ing and disseminating a comprehen-sive, statewide workforce develop-ment plan.

• Providing training and technical assis-tance to 14 participating organiza-tions and 4 alternate organizations toassess organizational workforce chal-lenges and implement an organiza-tional workforce development plan topositively impact those challenges.

Investing in DSPs:The Illinois DSP Workforce Initiativeby John Sauer

• Providing training and technical assis-tance to 10 individuals or familieswho direct their own supports toassess key workforce challenges andselect workforce intervention strate-gies to make their lives less compli-cated with regard to finding, choos-ing, and keeping good DSPs.

SAC created the following work groups toimplement specific action plans :• The Recruitment and Retention Strat-

egies Work Group, which identifiedstrategies and activities to attract andretain qualified DSPs in the Illinoisworkforce.

• The Education, Training and CareerDevelopment Work Group, whichdeveloped intermediate and advancededucation opportunities that couldyield college credit and lead to volun-tary specialized credentialing pro-grams.

• The Workforce Data and StatisticsWork Group, which developed sys-temic strategies to identify and priori-tize statewide data needs; establish auniform set of and methods to gatherpertinent data; and monitor DSPwages, benefits, and workforce out-comes.

• The Status and Awareness WorkGroup, which organized a set of ac-tions to elevate the awareness, under-standing, status, and respect for thedirect support profession.

• The Mentoring and SupervisionWork Group, which supported DSPsby creating strategies to help developskillful and effective supervisors andmentors.The accomplishments of this initia-

tive have been numerous. The 14 partici-pating organizations made changes tohelp them move toward the initiativevision. Their activities included revisingtraining for DSPs (including using the

College of Direct Support), customizingand using Realistic Job Previews, provid-ing competency-based training for super-visors and managers, using structuredbehavioral interviews, improving orien-tation and socialization practices, usingparticipatory management techniques,measuring workforce outcomes, improv-ing employee recognition, creating anIllinois Chapter of the National AllianceforDirect Support Professionals (theIllinois Direct Support ProfessionalAssociation), and establishing mentoringprograms. In addition, a number ofresources were developed through theinitiative, including:• A video, Direct Support: A Realistic Job

Preview, distributed to members ofthe SAC and to the participating orga-nizations to use in recruitment. Threeorganizations received a customizedversion specific to their organization.

• The College of Direct Support, a na-tional competency-based training cur-riculum for DSPs on the Web was cus-tomized with Illinois-specific content.

• A comprehensive DSP WorkforceDevelopment Plan was developed anddisseminated statewide by the SACstakeholders.

• A toolkit of strategies, processes, andactivities to find, choose, and keepgreat DSPs was developed for the par-ticipating individuals with disabilitiesand another for families.

John Sauer is Program Coordinator with theproject at the Research and Training Centeron Community Living, Institute onCommunity Integration, University ofMinnesota, Minneapolis. He may bereached at 612/626-0535 or [email protected].


31

Resources from the Institute’s Research andTraining Center on Community Living

Resources

• Frontline Initiative. A newsletterthat provides practical informationfor Direct Support Professionals andshares professional successes. Pub-lished by the National Alliance forDirect Support Professionals withsupport from the Institute’s Researchand Training Center on CommunityLiving. To subscribe visit www.nadsp.org/pdf/orderform.pdf or call 612/624-0060. Back issues are also avail-able for downloading at http://rtc.umn.edu/dsp/pub1.asp.

• Removing the Revolving Door:Strategies to Address Recruitmentand Retention Challenges. A cur-riculum designed to train FrontlineSupervisors to be active and effectivein recruiting, retaining, and trainingDirect Support Professionals withintheir agencies. Available in print andonline. For ordering information visithttp://ici.umn.edu/products/curricula.html or call 612/624-4512.To download the curriculum visithttp://rtc.umn.edu/publications/#training.

• The Power of Diversity: Support-ing the Immigrant Workforce. Acurriculum to assist Frontline Supervi-sors to develop the knowledge andskills necessary to manage and sup-port a diverse workforce that includesrecent immigrants. Available in printand online. For ordering informationvisit http://ici.umn.edu/products/curricula.html or call 612/624-4512.To download the curriculum visithttp://rtc.umn.edu/publications/#training.

• The Peer Empowerment Program:A Complete Toolkit for Planningand Implementing Mentoring Pro-grams Within Community-BasedHuman Services Organizations. Aplanning guide and curriculum foruse by supervisors desiring guidancein starting a peer-to-peer mentoringprogram among Direct Support staff.

Available in print and online. Forordering information visit http://ici.umn.edu/products/curricula.htmlor call 612/624-4512. To downloadthe curriculum visit http://rtc.umn.edu/publications/#training.

• Research and Training Center onCommunity Living Direct SupportProfessional Workforce Develop-ment Web Site (rtc.umn.edu/dsp).This Web site of the Institute’sResearch and Training Center carriesover 70 newsletter issues, research-based reports, multimedia tools, andother resources of use to Direct Sup-port Professionals, Frontline Supervi-sors, managers, individuals with dis-abilities, families, researchers, policy-makers, and others.

• Higher Ground: The Dedicationof Direct Support ProfessionalsDuring and After HurricanesKatrina and Rita. A documentaryon DVD telling the stories of some ofthe heroic Direct Support Profession-als from New Orleans who, despitelong hours, low pay, and tremendousstress and trauma, continued to pro-vide support services during and afterthe storms while often not knowingthe fate of their own families. Pro-duced by the Institute’s Research andTraining Center in conjunction withVolunteers of America of GreaterNew Orleans. To order visit www.highergroundthemovie.org or call612/625-1566.

• Find, Choose & Keep Great DSPs:Toolkits for Families and Peoplewith Disabilities. A pair of easy-to-use toolkits designed to help familiesand people with disabilities find qual-ity, caring, committed Direct SupportProfessionals. Two versions of thetoolkit are available: one for individu-als with disabilities, and one for fam-ily members and support providers.Available for downloading at http://rtc.umn.edu/ildspworkforce/docs/

ToolkitforFamilies.pdf, and http://rtc.umn.edu/ildspworkforce/docs/ToolkitforPeoplewithDisabilities.pdf.Also available in print; for orderinginformation call 612/625-1566.

• Direct Support: A Realistic JobPreview. A video package illustratingthe everyday work of Direct SupportProfessionals. In it, DSPs offer adviceabout this important career choice.Customized versions for individualagencies are available. For more infor-mation visit http://rtc.umn.edu/wddsp/rjp.html or call 612/625-1566.

• Direct Support ProfessionalRecruitment Toolkit. A resource tohelp employers recruit and retainquality Direct Support Professionals.It provides tools to create an exciting,dynamic recruitment plan, resultingin a large pool of qualified applicants.Designed for agencies, individuals,families, and organizations. For order-ing information visit http://ici.umn.edu/products/multimedia.html orcall 612/624-4512.

• QualityMall (www.qualitymall.org). A Web site sharing informationfrom around the country useful inpromoting quality of life for personswith disabilities. It especially focuseson promising person-centered prac-tices, and includes over 75 resourcesrelated to direct support.

• You Know That It’s Got to BeDedication That I am Still Here:The Experiences of Direct SupportProfessionals During HurricanesKatrina and Rita, and Aftermath.A report describing the experiencesof Direct Support Professionals whoworked for Volunteers of America ofGreater New Orleans before, duringand after Hurricanes Katrina and Rita.Published by the Institute’s Researchand Training Center in conjunctionwith the Volunteers of America. Avail-able online at http://rtc.umn.edu/docs/NOLAFinalReport.pdf.


32

[Hastings, continued from page 1]wooden cabinet, and a juke box wereaccessible only by staff. The few per-sonal possessions a person owned couldbe stored in a small wooden cubby witha curtain in front of it. Staff were thekeepers of the keys. My job was to makesure people ate, assist with personalhygiene, and give pills.

Training? Well, that was eight days atthe main regional center (they werecalled state hospitals). I remember sit-ting in a dark room watching individualafter individual dressed in their under-wear paraded onto a stage while a voicein the background droned on abouttheir diagnoses. No names, no human-ity, just a diagnosis, a medical label you

wore for life that defined who you wereand how you were to be treated by staff.I had more training on how to make theperfect square corners on flat sheetsthan I did on the effects of the medica-tion I gave or teaching life skills. Thepeople I worked for back then weredivided into two categories. They wereeither individuals who were capable ofreceiving training, or those who werenot. The criterion for this was set by apsychologist who came in to test peoplehe met for the day without any inputfrom the staff who interacted with themon an ongoing basis. Once given thislabel it was theirs for life. People werecategorized by their disabilities, not anyabilities they might have. Of course, the

staff members were not encouraged toteach life skills nor were they trained todo so. There was no effort put intochanging the staff ’s knowledge base.Every day was much like the one before.In that extremely dismal place, whatcould ever have been right?

What was right was the spirit of thepeople I supported and their families.They created a community and changesthat had a ripple effect on the attitudesof politicians in Washington who lis-tened because they had family memberswith developmental disabilities. How-ever, without families, self-advocates,and advocates pushing nothing wouldhave changed. The change that began inthe late 1960s and early 1970s meantmany things, like the downsizing andclosing of state regional centers and indi-viduals having the right to live wherethey wished. Today, people with disabili-ties are active participants in their com-munities. The people I support expectthat any discussion I have with them isjust that, a discussion. The direction theywant their lives to go is determined bythem.

These changes have brought a needfor a workforce with improved educa-tion, training, and resources to assist thepeople we support. DSPs need a deepunderstanding of how to support thepeople with whom we work, and a codeof ethics to promote their true indepen-dence so that we are advocates for theirrights. The days of eight days of trainingare gone. DSPs need both formal educa-tion and ongoing training. Dependingon who you are supporting you may needextensive medical training, or training inoccupational therapy, body mechanics,or life skill development. This is nolonger a job anyone can walk into andexpect to coast through the work. On anygiven day I might have to use training Ihave received in medication supports toassess how a person is reacting to a newmedication, use body mechanics to pro-vide range of motion for someone whohas physical disabilities or be able toturn a desire that an individual has ex-pressed into steps they will take to meettheir goal. I need to understand the

needs of the individual I work withwhether that person has the ability tocommunicate with words or uses non-verbal communication. I may need toknow how to use a variety of orthodicdevices, assist with mobility challenges,or help someone with eating and special-ized diets. I might work with someonewhose medication and nutritional needsare met through a gastrostomy tube. OrI might be working with someone whoseanxiety is expressed indirectly and it ismy job to interpret this and help thatperson work through what is upsettingthem.

Direct support has become a profes-sion requiring not only ongoing train-ing, but an extensive complicated skillset. The training and educational needsof DSPs change as the needs of thepeople we support change. Ten years agowe knew little about Alzheimer’s; todayit is a challenge for many of the peoplewe support. Autism was something weknew little about; now DSPs have agrowing need for education and trainingon supporting people with Autism andtheir families. What once was a one-size-fits-all criteria for assisting people withdevelopmental disabilities has growninto a career requiring an extensiveknowledge base to help the individualswe support in their daily lives.

This is not a job, it is a profession.The people in the field now and who willenter the field in the future will be calledupon to do more and know more. Unfor-tunately, the ability to attract and retainthose individuals is becoming more andmore of a struggle. Low wages and ris-ing medical costs create constant turn-over. Families, self-advocates, and pro-vider agencies face an ongoing challengeto find qualified individuals whose com-mitment and knowledge will add topeople’s lives.

Rita McAninch-Hastings is a DirectSupport Professional living in Crystal,Minnesota.

Continuation

Today, people with disabilities are

active participants in their

communities. The people I support

expect that any discussion I have

with them is just that, a discussion.

The direction they want their lives to

go is determined by them.

33

[Sokol, continued from page 21]

Continuation

before a DSP is allowed to work directlywith an individual or family. This train-ing is offered in English, Spanish andRussian. SOREO has also taught it, withthe assistance of translators, in Korean,Japanese, Chinese and Vietnamese. DSPswho are not proficient in English are en-couraged to attend ESL classes. Duringthe time that they’re learning English,they are trained to complete their paper-work and tracking documents in theirnative language; once the documentcomes to the office it is translated intoEnglish by the supervisor. SOREO man-dates competency-based DSP trainingthrough the online College of Direct Sup-port (CDS) for all English speaking DSPs.If the DSP is not proficient in Englishthey complete their training in a stan-dard classroom in their native language.SOREO also sponsors DSPs who wish topursue credentials from the National Al-liance for Direct Support Professionals.

It was challenging to find competenttranslators to translate all our training

materials into multiple languages. Thedevelopment of training materials forpeople who had emigrated from Mexicowas the most difficult. Expert profes-sional translators either attempted totranslate literally or they translated into“formal” or “proper” Castilian Spanish.Some translators were offended whenwe insisted that training materials wereto be translated into the Mexican dia-lect. Translation of training materialinto Russian was also challenging. TheRussian language does not use anEnglish alphabet so we had to purchasespecial software and a different key-board so we could physically producethe documents that we needed. The useof translators is expensive, slow andchallenging. We have to screen and testtranslators carefully. The simplestmethod is to have them translate a pageof information that is pertinent to aDSP’s job and then ask a bilingual super-visor and a DSP to read the translatedmaterials and see if they can understandwhat is being said. We have learned thatwe cannot assume because someonesays they are a translator or they have anadvanced degree that they can translatematerial so that it is meaningful to ourworkforce.

Finally, we match the DSP applicantsto the preferences and needs of the indi-vidual and families they will support.Some people have a specific preferenceregarding language and/or culture. Fail-ure to honor that preference will result

in the failure of the DSP to satisfy theneeds of that person. To support effec-tive matching SOREO has a policy thatthe family/individual may choose theirDSP and may terminate services from aDSP for no reason at all. A DSP who isnot comfortable providing supports toan individual or family may also requesta change and may terminate their ser-vices to that person or family. This

accommodation supports the choices ofthe people we support and of the DSP.

Conclusion

Currently 650 individuals and theirfamilies receive services from SOREO.During 2006 we experienced a 78%growth in services. Our families, fundingentities, and DSPs choose SOREO. Asagencies face tougher competition to re-cruit, hire and retain a trained workforceperhaps they may consider the path thatSOREO has pioneered and embrace animmigrant workforce.

References

N.A. (February 2007). AZ Hispanic market profile. Latino PerspectivesMagazine. Retrieved 11/26/07 from www.latinopm.com/Latino-Perspectives-Magazine/February-2007/AZ-Hispanic-market-profile.

U.S. Bureau of Labor Statistics (2002). Employment situation. Washing-ton, D.C: Author. Retrieved 11/26/07 from www.bls.gov/new.release/empsit.nr0.htm.

Wendy Sokol is CEO and Co-Owner ofSOREO, Tucson, Arizona. She may bereached at 520/881-4477 or [email protected].

Table 2: Ethnicity of SOREO DSPs

Ethnicity Non-Immigrant Immigrant All DSPs

Caucasian 76.0% 12.5% 38.6%Black 4.0% 2.5% 3.0%Hispanic/Latino 16.0% 81.0% 54.4%Asian 1.0% 4.0% 3.0%Native American 3.0% 0.0% 1.0%

Table 3: Ethnicity of SOREO Managers and Administrators

Ethnicity Non-Immigrant Immigrant All Managers/Administrators

Caucasian 56.0% 20.0% 37.0%Black 11.0% 0.0% 5.0%Hispanic/Latino 22.0% 60.0% 42.0%Asian 11.0% 20.0% 16.0%Native American 0.0% 0.0% 0.0%

As agencies face tougher competition

to recruit, hire and retain a trained

workforce perhaps they may

consider the path that SOREO

has pioneered and embrace an

immigrant workforce.

Table 1: Geographic Origin of SOREOImmigrant Employees

Geographic Origin DSPs Managers/ Administrators

Mexico, Central & S. America 81.0% 60.0%Russia/Ukraine 11.5% 10.0%Asia 4.0% 20.0%Haiti 2.5% 0.0%British Commonwealth 1.0% 10.0%

34 Continuation

[McCulloh, continued from page 19]about DSP workforce challenges andsolutions.

The six partners from five states whofinished the project saw significant de-creases in DSP turnover by the end ofthe project. Across the partners, DSPturnover was reduced from 40% in 2004to 23% in 2006. In addition, each partici-pating organization had its own suc-cesses and challenges in relation to thetraining. Some of the specific experi-ences of the participating agencies, andtheir views of the training, are high-

lighted in the six agency profiles accom-panying this article.

Conclusion

The NTIFFS project is important be-cause it creates a model for trainingfrontline supervisors and organizationalleaders on workforce development inter-vention strategies. It demonstrates thatwhen frontline supervisors and leadersimplement these intervention strategiesin a thoughtful, planned way, they reap

the benefits of increased retention anddecreased turnover of DSPs.

Note: The training project was funded by a Field Initiative Developmentgrant #H133G030058 from the National Institute on Disability andRehabilitation Research (NIDRR). U.S. Department of Education.

Reference

Larson, S.A. & Hewitt, A. (2005). Staff recruitment, retention and trainingstrategies for community human services organizations. Baltimore:Paul H. Brookes Publishing.

Nancy McCulloh is Project Coordinator withthe Research and Training Center on Com-munity Living, University of Minnesota,Minneapolis. She may be reached at 612/626-7765 or [email protected].

NTIFFS Profile #4: Devereux

“Give a man a fish and he will eat for a day.Teach that man to fish and he will eat forever”.

With that in mind we wanted to teach ourresidential management staff to become

effective managers. Prior to participating in the“Removing the Revolving Door” curriculum

through the NTIFFS project, our turnover was54%, with DSPs representing 92% of that

number. Given our turnover rate we were anideal candidate for the project.

With the support of our National TrainingDirector, Mary Imbornone, we embarked on the

journey of implementing the curriculum withinDevereux New Jersey. It was not difficult to sell

it to our senior management. Our Director,Maureen Walsh, became a key advocate for its

implementation. With our National TrainingDirector and Executive Director’s support, we

had the major ingredients for a successful kick-off. We also had to sell it to our residential

management staff who were very protective oftheir staff’s work schedule. It was not uncom-

mon for them to feel that training merely tookaway valuable service delivery time. The task

was to put together a marketing plan to getthem on board with the training. Since turnover

was their challenge, the marketing plan was toeducate them on the cost of turnover. We pre-

sented turnover rates and their cost and impacton the operation. At the kickoff meeting, our

Executive Director, Corporate Vice PresidentSara Ellen Lenahan, senior staff members, and

National Training Director were there in full

force promoting the program. It was a winner!We captured the attention of the directors,

managers and program supervisors in ourresidential operations. They understood we

were giving them tools to do their job. The racewas on! We conducted six training sessions per

month, which covered the entire “Removing theRevolving Door” curriculum. Because we did not

have a facility large enough to accommodate aclass of 30, we rotated training classrooms

between public libraries throughout the state.We trained the entire direct support manage-

ment staff. In addition to classroom modules,everyone was required to complete one online

module. We used additional online modules asmake-up sessions for participants who missed

the live classes. The participants were engagedin learning application exercises that included:

• Calculating turnover statistics and costs.

• Creating new recruitment materials.

• Critiquing ads and developing new formats.

• Assessing effectiveness of Realistic Job Pre-

views (RJPs) and developing RJPs for eachprogram (e.g., film, scrapbooks).

• Re-evaluating our structured interview pro-cess and developing new behavior-based

questions.

• Revising our orientation checklist.

• Re-evaluating and rewriting our structuredobservation process and forms.

• Practicing aligning the mission, values andvision of Devereux with common coaching

statements.

It was an exhilarating experience that culmi-

nated in a graduation ceremony with 28graduates. Within six months of adopting theprogram, we had an 11% decrease in turnover

with a 13% reduction in the proportion of staffleaving within 12 months of hire. Since the

inception of the program we have continued tosee a downward trend in our turnover. We

ended the fiscal year in June 2006 with a 38%turnover rate.

Today we offer bi-annual “Removing theRevolving Door” training to our new residential

management and potential managers. Wehave linked elements of the curriculum to

specific competencies within our managers’role descriptions. Our corporate operation has

embraced the program and it has beenadopted with all our operations throughout the

United States. Our formula for success was toplevel commitment; a strong working partner-

ship between training, human resources, andoperations areas; and an openness to change.

The adoption of the program has made adifference in our organization, but most of all

in the lives of those we support.

For more information about Devereux’s residentialmanager training contact Mary Imbornone, NationalDirector of Training and Development, at [email protected].

35Continuation

Providers of services and supports for people

with developmental disabilities know in theirhearts that the fragility and vulnerability of

our work lies not in our clientele, but in ourworkforce. The nature of our work is relation-

ships and the quality of our work is defined atthe point of service. NTIFFS has given our

organization one very important tool to use toencourage the retention of competent and

dedicated direct support staff and also torecruit effectively. It helped us understand that,

vagaries of the economy aside, organizationscan increase the attractiveness of their

cultures, the competency of their management,and the motivation and performance of their

workforce. We also learned that turnover isdirectly related to one’s experiences with co-

workers and with immediate supervisors. In 2003, New Horizons led 10 Mid-Hudson

Coalition agencies in the NTIFFS training

Training supervisors who may be as far apart as350 miles is always a challenge. Through the

NTIFFS project 23 of our 24 supervisors hadaccess to online training through the College of

Frontline Supervision and Management,helping them learn to evaluate turnover and

retention statistics, improve DSP teamwork,support new DSPs, and recognize long-term

efforts of other DSPs. While we wanted to try allof the intervention strategies to fix all the

problems at once, in the end we developedsmall teams of participants to implement

several new strategies. Among the changes weimplemented were the following:

• Revised job descriptions and duties toinclude skill sets from the community resi-

dential core competencies in the curriculum.This provided staff with a clearer picture of

their responsibilities.

• Completed a written Realistic Job Preview

(RJP) that is now required reading for

NTIFFS Profile #5: New Horizons Resources

program to improve direct support staffretention and recruitment issues through a

comprehensive frontline supervisor trainingcurriculum and organization development

interventions. The program used the curriculum“Removing the Revolving Door,” the online

College of Frontline Supervision and Manage-ment curriculum, and the book “Staff Recruit-

ment, Retention and Training Strategies.” As aresult, the following changes have been imple-

mented by New Horizons and other agencies ofthe coalition:

• Using a realistic job preview in the hiringprocess.

• Bridging mission/orientation/training/evaluation of staff.

• Employing strategies of recruiting direct sup-port staff, such as replacing newspaper ads

with internal referral bonuses equivalent tothe cost of a media ad.

• Using structured behavior-based interview

questions.

• Distinguishing training from orientation.

• Setting up a strategic welcoming program.

• Focusing on reducing turnover in the first six

months of employment.

New Horizons closely tracks recruitment and

retention rates of direct support staff as oneimportant measure of quality services. As a

result of our participation in NTIFFS, our DSPturnover rates declined from 26% in 2003 to

10% in 2006, and we reduced turnover in thefirst six months of employment from 26% in

2003 to 13% in 2006.

Contributed by Regis Obijiski, Executive Director, NewHorizons Resources Inc., Poughkeepsie, NY. He may bereached at 845/473-3000, x304 or [email protected].

NTIFFS Profile #6: Community Entry Services

people interviewing for positions. This re-

sulted in some people not completing inter-views, relieving our organization of high

training costs for people who would haveleft within the first couple of weeks. This RJP

is also used as a recruiting tool at job fairs.

• Developed a mentoring program. Upon

completion of the pilot project, where 10DSPs acted as mentors, a mentoring pro-

gram was implemented for all new DSPs.Both mentors and mentees agree that this

helps in building co-worker relationshipsand learning new job duties. We discovered

we needed to make certain that mentorswork the same shift and possibly even at the

same site. This makes accessibility to thementor possible when the questions arise.

Mentoring has allowed us to recognize long-term DSPs who are dedicated to the job and

can help others learn the job.

The one challenge I was unable to overcome

was finding an individual at each of the otherorganizations from Wyoming who would be the

driving force behind “Removing the RevolvingDoor” training at their organizations. One

organization started to implement training andall Frontline Supervisors were excited, but when

that key person left the organization thetraining ended.

Based on our experience with NTIFFS, I wouldsay to others that if you find your organization

at a plateau, provide training for your FrontlineSupervisors. When they feel important enough

to receive more education, they will use thetraining to help their DSPs feel important. When

DSPs are important enough to have the supportof their supervisors, the services provided to

those we support can only be called excellent.

Contributed by Emily Howery, Staff Development Coordi-nator, Community Entry Services, Riverton, WY. She maybe reached at 307/856-5576, x224 or [email protected].

You May be Wondering Why...you’ve received Impact. We mail each issue to our regularsubscribers plus others whom we think might be interested. If you’d like to receive every issueof Impact at no charge, call 612/624-4512 or e-mail us at [email protected]; give us yourname, address, e-mail and phone number and we’ll add you to the mailing list. Impact isalso published on the Web at http://ici.umn.edu/products/newsletters.html.

Institute on Community Integration109 Pattee Hall150 Pillsbury Drive se

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Permit No. 155

In This Issue...• Direct Support Then and Now:

Reflections on 35 Years in the Profession

• Congress Recognizes Crisis in Direct Support: Remedial Legislation Proposed

• Individual and Family Directed Services: Implications for the DSP Workforce

• Five Things Families Can Do to Find and Keep Great DSPs

• Addressing DSP Workforce Challenges: Strategies for Agencies

• Managing Diversity Within Human Services

• The Importance of Competency-Based Training for Direct Support Professionals

• Stories and strategies from around the country

• And more...

Feature Issue onDirect Support Workforce Development

Volume 20 · Number 2 · Fall/Winter 2007/08Managing Editor: Vicki Gaylord

Issue Editors:Sheryl A. Larson, Research and Training Center onCommunity Living, Institute on CommunityIntegration, University of Minnesota, Minneapolis

Amy Hewitt, Research and Training Center onCommunity Living

Nancy McCulloh, Research and Training Center onCommunity Living

Traci LaLiberte, Center for Advanced Studiesin Child Welfare, University of Minnesota

Impact is published quarterly by the Instituteon Community Integration (UCEDD), and theResearch and Training Center on Community Living,College of Education and Human Development,University of Minnesota.

This issue was supported, in part, by Grant#90DD0579 from the Administration on Develop-mental Disabilities, US Department of Health andHuman Services; and Grant #H133B031116 from theNational Institute on Disability and RehabilitationResearch (NIDRR), US Department of Education.Additional support was provided from Grant#H133G030058 from NIDRR, and US Department ofHealth and Human Services, Centers on Medicaidand Medicare Services, Contract #TLG05-034-2967.06 to The Lewin Group.

The opinions expressed are those of the authorsand do not necessarily reflect the views of theInstitute, Center, University, or their funding sources.

For additional copies or information contact:Institute on Community Integration, University ofMinnesota, 109 Pattee Hall, 150 Pillsbury Dr. SE,Minneapolis, MN 55455 • 612/[email protected] • http://ici.umn.edu.

Impact is available in alternative formats uponrequest. The University of Minnesota is an equalopportunity employer and educator.

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