Creating a Culture of Direct
Support Professional Competence
Statewide Conference
Grand Island, NE
October 15, 2014
Joseph M. Macbeth, Executive Director and John Raffaele, Training Consultant
National Alliance for Direct Support Professionals
“They got up this morning, early, and left their
families on this holiday Monday, to go out and make
this thing called 'community living' happen. Their
work, done well, doesn't look like labour. Their work,
done well, is, however, work. It's the kind of labour
that changes lives, changes families and changes
communities. It's the kind of labour that requires
dedication and self-discipline and determination. It's
the kind of labour, done well, that is exhausting".
- Dave Hingsburger, 2014
National Alliance for Direct
Support Professionals (NADSP)
A Thought from a Friend…
National Alliance for Direct
Support Professionals (NADSP)
Quick Introductions
Joe Macbeth
Executive Director
John Raffaele
Training Consultant & Facilitator
“Not Ready for Apartment Living”
A DSP with Good Intentions, the
absence of a Code of Ethics & the
understanding of Skills
National Alliance for Direct
Support Professionals (NADSP)
A Day In the Life of a DSP…
New Federal Requirements
441.301(c) (4) – Optimizes, but
does not regiment, individual
initiative, autonomy, and
independence in making life
choices, including but not limited
to: daily activities, physical
environment, and with whom to
interact.
Proposed State Transition Plan
Deliverables:
“Identify, develop, and distribute
training tools and policy updates
that are needed for compliance”
Direct Support Professional Must
Understand:
People will have the freedom and
support to control their own
schedules and activities, and have
access to food at any time.
People will be able to have visitors
of their choosing at any time.
People will have the freedom to
furnish and decorate their sleeping
or living units
ARE THEY PREPARED?
National Alliance for Direct
Support Professionals (NADSP)
Actions To Complete For
Compliance
Historically….
Now and in the Future….
• Primarily Seen as Caretaker
• Ambassador, Mentor &
Teacher
• Focus on Custodial Care
• Providing Companionship
• Culturally Competent
• Providing Coverage
• Close Interactions with
Families - often in Family
Settings
• Primarily Focused on Health &
Safety Issues
• Supporting Informed
Decisions – Assessing RISK
• Entry-Level Job
• Possession of Complex Skills
National Alliance for Direct
Support Professionals (NADSP)
The Emerging Role of Direct Support
Professionals
Historically….
Now and in the Future….
• Follow the Plan
• Creating plans with People
they support
• Filling shifts
• Building meaningful
friendships & relationships
• Rely on readily available
supervision
• Inclusion – not recreation
• Community Outings
• System-Centered
Identification
• Advocating WITH – not FOR
people with disabilities
• Person-Centered
Identification
National Alliance for Direct
Support Professionals (NADSP)
Raising the Expectations of the Direct
Support Workforce
National Alliance for Direct
Support Professionals (NADSP)
Building & Maintaining Friendships
National Alliance for Direct
Support Professionals (NADSP)
Speaking of Inclusion & Disabilities
Recent Trends in Direct Support
•
% change in employment (2012 – 2022): 48.8%
•
Number employed (2012): 1,190,600
•
Number employed (2022): 1,771,400
•
Median annual income: $19,190 ($9.23/hour)
•
Nationwide median of $34,750
•
The BLS expects that over 580,000 jobs for Personal Care Aides will be
created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
National Alliance for Direct
Support Professionals (NADSP)
The Second Fastest Growing Occupation:
Personal Care Aides
Recent Trends in Direct Support
•
% change in employment (2012 – 2022): 48.5%
•
Number employed (2012): 875,100
•
Number employed (2022): 1,299,300
•
Median annual income: $20,820 ($10.01/hour)
•
Nationwide median of $34,750
•
The BLS expects that over 424,000 jobs for Home Health Aides will be
created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
National Alliance for Direct
Support Professionals (NADSP)
The Third Fastest Growing Occupation:
Home Health Aides
• Cost per hire
• Long-term Supports and Services(2005):
$3,278 (UMN)
• Long-term Supports and Services(2011):
$6,000 (PHI)
Good Turnover? Bad Hiring…
National Alliance for Direct
Support Professionals (NADSP)
The Financial Cost of Turnover
“Decreasing turnover is about
sustaining quality”
The Other Costs of Turnover
• Services are fractured
Impact on Direct Support
Professional Workforce
• Forced overtime
• Personal growth is disrupted
• Activities and events are
canceled
• Increased medication errors and
other incidents
• Trusting relationships are broken
• Increased job stress
• Unsafe situations are created
impacting health & safety
• Reduced productivity
• Revolving door of strangers
performing the most intimate
interactions of daily life
• Deteriorating job satisfaction
• Burn Out
• Ultimately….More Turnover
National Alliance for Direct
Support Professionals (NADSP)
Impact on People with
Disabilities
“Preparing” Direct Support Professionals:
How Have We Done?
Teach me and I might remember.
Involve me and I will learn”.
- Chinese Proverb
National Alliance for Direct
Support Professionals (NADSP)
“Tell me and I will forget.
National Alliance for Direct
Support Professionals (NADSP)
Invest in Direct Support Professionals
“It is defined at the point of interaction
between the staff member and the individual
with a developmental disability.”
John F. Kennedy, Jr. (1995)
Chair, President’s Committee on Mental Retardation
Developmental Disabilities
Where are those at the point of interaction of service delivery
typically found on organizational charts?
National Alliance for Direct
Support Professionals (NADSP)
Where is Quality Defined?
Future Organizational Chart
Executive
& Admin
Staff
Direct
Support
Professionals
Clinical,
Middle
Management
& Other
Support Staff
Clinical,
Middle
Management
& Other
Support Staff
Direct
Support
Professionals
Executive
& Admin
Staff
National Alliance for Direct
Support Professionals (NADSP)
Typical Organizational Chart
Quality
Intersection
(Training Based on Research)
Ineffective
Practice
Values
(Code of Ethics)
Unethical
Practice
Quality
Support
Uninformed
of Best
Practice
Skills
(Universal Competencies)
National Alliance for Direct
Support Professionals (NADSP)
Knowledge
NADSP Monitors the News…
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals
and the Media
“Caregiver who stole from
disabled men gets prison
time”
The Chicago Tribune, Illinois
January 11, 2013
National Alliance for Direct
Support Professionals (NADSP)
In the News….
“Report: State ignoring
abuse at group homes”
The Seattle Times, Washington
December 17, 2012
National Alliance for Direct
Support Professionals (NADSP)
In the News….
“Fragile Lives; Needless
Deaths”
(Multi-Part Series)
Hartford Courant , Connecticut
March 6, 2013
National Alliance for Direct
Support Professionals (NADSP)
In the News….
“Sex crimes alleged at care
facilities”
The San Francisco Chronicle,
California
November 29, 2012
National Alliance for Direct
Support Professionals (NADSP)
In the News….
“Caregiver arrested for
abusing disabled man in
Columbia group home”
The Baltimore Sun, Maryland.
February 5, 2013
National Alliance for Direct
Support Professionals (NADSP)
In the News….
“Senator Seeks Federal
Probe Of Group Homes”
Disability Scoop
March 6, 2013
National Alliance for Direct
Support Professionals (NADSP)
In the News….
And finally, the big one…
“At state-run homes,
abuse and impunity”
The New York Times, New York
March 13, 2011
National Alliance for Direct Support
Professionals (NADSP)
Which led to…..
“Legislative Leaders Announce Agreement on Legislation to
(New York Times, June 18, 2012)
Legislation Establishes Justice Center for the Protection
of People with Special Needs to Prevent, Investigate and
Prosecute Abuse and Neglect of Vulnerable New Yorkers
National Alliance for Direct
Support Professionals (NADSP)
Protect People with Special Needs and Disabilities”
Closing the Barn Door after the
horse has bolted.
Legislation that focuses on
Prosecution is NOT considering
Prevention & Building Excellence
National Alliance for Direct
Support Professionals (NADSP)
Which is sort of like…
“Direct Support jobs are compensated poorly, with
many workers living at or near the poverty level or
forced to work multiple jobs to make ends meet. One
might summarize the job description of the direct
support worker as requiring the wisdom of Solomon, the
patience of Job and the caring of Florence Nightingale…
While much is said about the value of these direct
support jobs, the traditional hallmarks of value are often
missing – qualifying credentials, adequate pay, career
ladders, attention to working conditions, adequate
training, managerial and supervisory support and so
on…”
The Measure of a Society: Protection of Vulnerable Persons in
Residential Facilities Against Abuse & Neglect . Clarence J. Sundram,
National Alliance for Direct Support
2012
Professionals
National Alliance for Direct
Support Professionals (NADSP)
But it also led to this….
“Take Me Out to the Ball
Game”
A Nice Afternoon
National Alliance for Direct
Support Professionals (NADSP)
A Day In the Life of a DSP…
The Five Elements of a Profession
Body
of
Knowledge
Code
of
Ethics
Universal
Skill
Standards
1.35 Million in
US
License,
Certificate or
Credential
Affiliation with
Professional
Organization
Approximately 4 Million Cross-Sector
PHI, 2012
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals
Pediatricians Back
in the Day
Kanner &
Bettleheim
Journals, Studies
Evidence-Based
Practices
Becoming a MD
College of
Direct Support
and other
curricula
National Alliance for Direct
Support Professionals (NADSP)
A Body of Knowledge that is based on sound
research and provides practitioners with a
universally accepted skills base.
Airplane
Pilots…
Becoming a MD
(continued)
The Community
Support Skill
Standards
State’s Developing
Core Competencies
The NADSP
Competency Set –
US DOL Adopted
National Alliance for Direct
Support Professionals (NADSP)
Universal Skill Standards or Competency Areas
for the Consistency of Professional Practice
Area 1: Participant
Empowerment
Area 2: Communication
Area 3: Assessment
Area 4: Community and
Service Networking
Area 5: Facilitation of
Services
Area 6: Community Living
Skills & Supports
Area 7: Education, Training
& Self-Development
Area 8: Advocacy
Area 9: Vocational, Educational
& Career Support
Area 10: Crisis Prevention and
Intervention
Area 11: Organizational
Participation
Area 12: Documentation
Area 13: Building and
Maintaining Friendships
and Relationships
Area 14: Person Centered
Supports
Area 15: Supporting Health and
Wellness
National Alliance for Direct
Support Professionals (NADSP)
NADSP Universal Competency Areas
NADSP Competency Area
Skill Statements
• The competent DSP assists and supports the participant to develop strategies,
make informed choices, follow through on responsibilities, and take risks.
• The competent DSP promotes participant partnership in the design of support
services, consulting the person and involving him or her in the support process.
• The competent DSP provides opportunities for the participant to be a selfadvocate by increasing awareness of self-advocacy methods and techniques,
encouraging and assisting the participant to speak on his or her own behalf, and
providing information on peer support and self-advocacy groups.
• The competent DSP provides information about human, legal, civil rights and
other resources, facilitates access to such information and assists the
participant to use information for self-advocacy and decision making about
living, work, and social relationships.
National Alliance for Direct
Support Professionals (NADSP)
Area 1: Participant Empowerment
The Direct Support Professional enhances the ability of the participant to lead a
self-determining life by providing the support and information necessary to build
self-esteem, and assertiveness; and to make decisions.
Nail Techs and
Jiffy Lube Guys
Becoming a MD
(continued)
Using the
Knowledge
Demonstrating the
Competencies
Recognition by an
Authority as a
Profession
National Alliance for Direct
Support Professionals (NADSP)
A License, Certificate or Credential to Practice
NASW, AMA,
ANCOR, AIEJI
Become part of
something larger
Participate in
Training & Networking
Opportunities
Recognition of
the Profession’s
Best Practices
Professional
Empowerment &
Status
National Alliance for Direct
Support Professionals (NADSP)
Affiliation with a Professional Membership Organization
Person-Centered
Supports
Confidentiality
Relationships
Promoting Physical
& Emotional
Well-Being
Justice, Fairness
& Equity
Self-Determination
Integrity &
Responsibility
Respect
Advocacy
National Alliance for Direct
Support Professionals (NADSP)
A Code of Ethics that provides
practitioners with a
universally accepted values base.
The NADSP Code of Ethics
Adopted by New
York in 2012
Adopted by New
Hampshire in
2014
Universally
Accepted
National Alliance for Direct
Support Professionals( NADSP)
Developed by
NADSP in 2001
National Alliance for Direct
Support Professionals (NADSP)
Code of Ethics Word Cloud
“Disney Isn’t for Me”
A Great Life
National Alliance for Direct
Support Professionals (NADSP)
A Day In the Life of a DSP…
“Disney Isn’t For Me”
Deconstructed with Skills & Values
• Participant
Empowerment
• Communication
• Assessment
• Community Living &
Supports
• Education, Training &
Self Development
• Advocacy
• Organizational
Participation
• Documentation
• Providing Person
Centered Supports
Values:
• Person Centered
Supports
• Integrity and
Responsibility
• Respect
• Self-Determination
• Advocacy
National Alliance for Direct
Support Professionals (NADSP)
Skills:
C -Citizen
H -Harm/Risk
O -Opportunities
I -Informed Decision
C -Community
E -Experience
National Alliance for Direct
Support Professionals (NADSP)
CHOICE
National Alliance for Direct
Support Professionals (NADSP)
CHOICE
Working on writing his
autobiography
Getting tattoos
Jumping out of
airplanes
Living his life, on his
terms
“The System opens the door to community; direct
support professionals help people go through that door”.
National Alliance for Direct
Support Professionals (NADSP)
Ed: Nearly 25 Years Later
Customized Trainings, One-Day Workshops and
Culture of Direct Support Competency Technical
Assistance
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jmacbeth@nadsp.org
National Alliance for Direct
Support Professionals (NADSP)
Join Our Membership at www.nadsp.org!