Direct Support Workforce Specialization Training

Louisiana MFP Rebalancing Demonstration

Presented by Faimon Roberts, Program ManagerFaimon.Roberts@la.gov Phone: 225-342-6718

Overcoming Challenges: Direct Service Workforce Opportunities for

Success

October 18, 2011

Joe BongiovanniNJ DHS DDD

Colleen McLaughlinBoggs Center/UCEDD

STATE OF NEW JERSEYDEPARTMENT OF HUMAN SERVICES

DIVISION OF DEVELOPMENTAL DISABILITIES

New Jersey Career PathDesigned to give DSPs the opportunity to

receive state issued certificates and be able to apply for national credentialing

though NADSP

• College of Direct Support• 7 Training Modules in each level

– 4 to 8 lessons in each module– At least an 80% on tests, can take up to

3X

• Skill Mentoring• Portfolio Development

College of Direct Support• State-of-the-Art Online Courses• Competency-Based Training• Lessons that Support Community

Life

• Developed by the University of Minnesota Research & Training Center (RTC) on Community Living with collaboration by national board of editors

Career Path Pilot (2007-2010)

• Funded by the NJCDD

• 8 NJ Provider Agencies

• 348 people enrolled in the CDS, 194 of these are DSPs participating in the Career Path– 107 Level 1 Certificate Recipients

– 73 Level 2 Certificate Recipients

Pilot Outcomes

NJ Community College Faculty Review

– Made recommendation that the Career Path be accepted as 9 credits toward an Associate’s Degree in Human/Social Services

– Currently available at one NJ community college

– Working with stakeholders to promote the availability at others

Pilot Outcomes• Agency Turnover Survey Results:

– Overall Agency reduction from 36% to 26% – Reduction from 38% to 12% in the part of the

agency where staff could voluntarily participate in the career path training.

– Only 16% of the people participating in the career path left their organizations. 

– Reduction in turnover leads to cost savings which maybe reinvested in the workforce and organization.

• 100% of responding DSPs strongly agreed/agreed that they would recommend that all DSPs participate in the Career Path and that as a result of the Career Path they are more likely to continue their careers as DSPs.

• Statewide Implementation of the College of Direct Support (CDS)

Money Follows the Person (MFP)

• College of Direct Support Funding – Pilot – Grant funded– Statewide implementation – one-time

state funding– Continued funding through MFP

Rebalancing Fund as stated in NJ’s operational protocol

Money Follows the Person (MFP)

Alignment w/MFP Benchmarks– Benchmark #1: Projected number of

individuals in each target group to be assisted in transitioning to the community• Increasing # of transitions from 305 – 2296

across sectors over the next five years (2011-2016)

• In DDD plan is for 827 transitions and closure of one DC

– Benchmark #3: Increase in an available and trained community workforce (i.e. direct interventions, undertaken by the State, to increase the quality, the quantity and empowerment of direct care workers).

“It’s about the Quality… of supports that a well-trained workforce provides.”

“It’s about the Value… of professionalism gained through the College of Direct Support state-of-the-art training”.

 “It’s about the Future… of Direct Support Professionals and the lives of people with developmental disabilities”

The NJ Partnership for Direct Support Professional Workforce

Development

“NJ Partnership”Stakeholder Involvement

• Department of Human Services, Division of Developmental Disabilities

• The Elizabeth M. Boggs Center on Developmental Disabilities/UCEDD

• New Jersey Council on Developmental Disabilities

• Provider Organizations:– Alliance for the Betterment of Citizens with Disabilities

(ABCD)– The Arc of New Jersey– New Jersey Association of Community Providers (NJACP)

• NJ Community Colleges: Consortium for Workforce and Economic

• Family Representation

• DSP Representation

Statewide Implementation of the CDS

• Each licensed day/residential provider supporting individuals funded through the HCBS have access to the CDS– Required to use system to track the 5

required NJ Pre-Service Trainings– Access to 30+ cutting edge courses– Access to courses in the CDS College of

Frontline Supervision & Management

Training & Technical Assistance

• CDS Agency Administrator Training• Technical Assistance: TA email address,

NJ CDS Agency Administrator Listserv• “Making the College of Direct Support

Work for Your Agency” Workshop• CDS Administrator Forums• Mentor Training• PowerPoint on applying for NADSP

uploaded onto the CDS• Ongoing evaluation/data analysis

What we’ve learned…• Existing research on best practice is

extremely useful• Need to “speak multiple languages” –

programmatic and funding• HR/Staff Development Departments

recognize the need for additional training and professional opportunities

• Providers need support to develop effective training plans

• Providers need to create buy-in across the agency

• Marketing and clear communication is key – from the state and organizational level

Developmental Center Training

Use of the CDS courses for training NJ Developmental Center Staff

• Enhances skills and knowledge need to support transition into the community.

• Provides an educational opportunity aimed at employment marketability at community providers

The Future...• Community Care Residences• Individualized Lessons • Self-Directed Services• Aging

• Enhanced Recruitment Strategies– Workforce Investment Boards– Vocational-Technical Schools– Community Colleges

Beyond the BasicsOffered to DSWs, supervisors, nurse consultants, agency

trainers, and natural supports/family supporting persons withSignificant behavioral/psychiatric support needsSignificant medical/nursing/physical support needs

Follows (and does not replace) both (1) the basic training required statewide for all DSWs and (2) in-servicing by professionals (e.g., psychologist, nurse, physician) on plan elements

Best delivered before the transition occursPilot shows time constraints after move, and having all shifts

present produces best outcomeDesigned to work for populations outside of DD (MI, elders,

adults with disabilities). Optional at this time.

Two CurriculaPositive Behavior Supports

See content listing Requires an experienced trainer Didactic, competency based, includes a number of required exercises

and skill presentations. Competency is scored as total for entire program.

Nursing/Medical/ Physical Supports See content listing Requires a nurse (RN or LPN). Dietician, OT , ST and PT are optional. Didactic, competency based, modules include written evaluation or

written evaluation and extensive skills demonstration. Competency is scored by module.

Competency results are shared with DSWs and with the provider agency.

Some service recipient needs may touch both areas.

Nursing/Medical/Physical Supports Specialization Training

The first day of training (left) consists primarily of didactic elements, teaching DSWs about signs and symptoms of illness, common medical problems that result in hospitalization or death (UTI, decubitus, aspiration), and how to communicate health status information.

The second day of training (right) begins intensive hands-on learning with emphasis on supporting people with more intensive medical/allied health needs.

Trainees learn to maneuver wheelchairs in home and public environments and to use tie downs common to public transportation (left).

Above, a trainee learns to empty a catheter bag. Specialty classes are offered on catheter, g-tube, tracheotomy, and seizures. Cerebral Palsy and TBI are also being added.

Choice of Topics/ContentThe two focus areas were chosen after

careful evaluation of system barriers to successful transition and continued rebalancingRisk Management Process for waiver

recipients at risk of community placement failure 91% of cases reviewed impacted by one or both

focus areasCrisis Referral Process for DD Placement

90 % juvenile referrals psychiatric/behavioral, 10% medical

97% adult referrals psychiatric/behavioral, 3% medical

No other significant causes of crisis

Choice of Topics/ContentSince the start of the demonstration

Implementation Period, Louisiana transitioned 927 people from large public centers in a rebalancing effort less costly private facilities or to waiver services.

Crisis cases continued to result in admissions, thus challenging rebalancing.

Placement post crisis in 2011:

Juveniles Adults

Institution 56% 63%

Community 20% 24%

Pending 17% 11%

Not Eligible 7% 2%

Building Blocks for SuccessBuild a training program that addresses gaps and

systems failures that result in institutionalizationMarketed initially through the Demonstration.

Evaluate demand and feedback to improve/expand as rebalancing tool

Make it a win/win for providers and DSWs to participate in optional trainingTrainee salary match (50/50 provider/demonstration)Travel paymentsSupplies providedSustainability bonus of $500 for one year with

recipient inclusive of support to achieve plan goals

Building Blocks for SuccessFrom the start, focus on utility in the private

sector and sustainabilityTrain the trainer program to equip experienced

private sector agency staff to act as trainersUse upcoming changes in provider licensing

regarding presence of a nurse consultant in all ACS/SIL agencies to act as trainers

Equip OCDD Resource Centers with both trainers and the equipment/supplies necessary for the nursing/medical/ physical supports training, which is the most resource-intensive to deliver (Equipment paid by Demonstration)

Building Blocks for SuccessDo not be afraid to make big changes if things are

not working out.PBS was rewritten and shortened after the first pilot

with dramatic improvement in feedbackNursing/Medical/Physical supports was cut by at

least half, and is still in pilotOur end goals are keeping people who transition

through the demonstration in the community AND reducing the number of crisis referrals resulting in institutional placement.If we are not achieving results, we will keep

improving the program.

Is Training Enough? Organizational Shift

Provider agencies accepting multiple transitions of high-needs persons

Piloting Person-Centered Organization training and quality management support in limited agencies to evaluate if produces improved and/or longer-lasting outcomes (Begins Oct 11, 2011. Paid by Demonstration.)

Individualized In-Home Follow-UpWhen classroom learning is not translating to

home/community implementation as evidenced by post-move follow-up visits

In home/community direct training is offered (Demonstration or state funds)

Using to improve the overall curriculum

Stakeholders involvedOCDD Resource CentersOCDD Clinical ServicesOCDD Quality Management Committees

Risk Management Clinical Review CommitteeMortality Review

Coordinating Committee members -- DD Council, Advocacy Center, Governor’s Office for Elderly Affairs, Governor’s Office for Disabilities Affairs, Downs Syndrome Association, Families Helping Families, Mental Health Consumer, AARP Consumer, LA Nursing Home Association, New Orleans PACE, SWLA Independence Center, Office of Behavioral Health, LA Assistive Technology Access Network

Funding Sources Curriculum Development and Pilot

Staff and contracted professionals from OCDD Stakeholder time in-kind Printing, pilot supplies, and one consulting contract from demonstration DSW salary match, travel, and sustainability award from demonstration

Implementation Printing and supplies from demonstration, inclusive of stocking 4 sites for

statewide use Trainers for Train the Trainer from OCDD state funds or demonstration DSW salary match, travel, and sustainability award from demonstration

Sustainability Private agencies build trainer competency and are provided certification

to train the curriculum by OCDD OCDD Resource Centers (state funds) continue to offer curriculum on

sliding scale and/or free of charge OCDD will publish electronically for distribution

Demonstration budget for entire term is $2.75 million

Plans for FutureRoll out PBS statewide (2011)Finalize Nursing/Medical/ Physical Supports (2011)

and roll out statewide (2012)Expand use in the general risk management program,

starting with PBS (2011). Clinical Review Committee has already made recommendations for training participants.

Implement PBS with Office of Behavioral Health when they enter the demonstration in 2012.

Evaluate options for family caregiver training in nursing/medical/physical support for elder/adult disabled population following finalized training (2012).