Transforming Lives

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Trillium 2020 Vision: DirectCourse Launch

Overview of Launch

Welcome Introductions Trillium’s Vision Details about DirectCourse and our network Next steps Questions and Answers

Project Vision Statement

Cardinal Innovations Healthcare, Smoky Mountain MCO and Trillium Health Resources are committed to a collaborative, cost‐effective investment in the development of a committed, direct support professional workforce that demonstrates the 

competencies and values necessary to assure that people receive high quality services and achieve 

meaningful outcomes.

Quality and Direct Support Professionals

“Quality… is defined at the point of interaction between the staff member and the individual with a developmental disability.” 

~John F. Kennedy, Jr., Chair, PCMR, 1995

“A highly competent DSW is critical to the wellbeing and safety of individuals who need support to live in the community. The achievement of optimal outcomes among service participants is dependent on the delivery of quality direct services and supports.”

~The Centers for Medicare & Medicaid Services (CMS)Preamble to the Final Competency Set for the Direct  Service 

Workforce, Dec. 2, 2014                      

What is a Direct Support Professional (DSP)?

DSPs support people with I/DD, older adults, people with physical health care needs, people with physical disabilities, people with mental illness, and people with substance use disorders in settings such as: a person’s home residential treatment facilities nursing homes job training group homes hospitals

What is a Direct Support Professional (DSP)?

DSPs provide person-to-person assistance to people in need of daily support in: activities of daily living household tasks personal health and safety community access and inclusion relationships/support with recovery work peer support

DSPs Have Diverse Occupational Titles

Home Health Aides Direct Support Professionals in residential,

vocational services, day programs, treatment centers or community support programs

Certified Nursing Assistants (CNAs) Homemaker services Personal Attendants/Personal Care Aides Paraprofessionals

This list is not exhaustive

Person-centeredCulturally competent

Support ChoiceMaintain health

Document Comply with rules and regulations

Teach

Specialized knowledge End Shift Neat & Tidy

Work well with others Medical Support

Respect rightsSafety Problem-solve

~ICI, 2015

Expectations of DSPs

Policy Drivers

HCBS Final Rule on Community Settings-DSPs will need to make more decisions with less oversight

Recognition that most people live at home with families-Families need to know what to expect from a DSP-As participant-direction grows, so will families’ and individuals’ needs around how to assess the performance of DSPs

Challenges to Developing the Workforce

A significant increase in the demand for DSPs (“care gap”)

The need for comprehensive training to ensure knowledge, skills and competence in the provision of services/supports

Increasing diversity in the workforce – and the community at large

Challenges Lead to HIGH TURNOVER

High Turnover:

National Data on Turnover

• Nationally, the separation rate averages 38% (ANCOR, 2010) with most DSPs leaving in the first six months of being hired.

• Fiscal impacts are staggering - estimated by ANCOR in 2010 to be $4,872 each time a DSP leaves and has to be replaced.

• Annual cost of turnover, nationwide and across sectors, is $784 million (Hewitt & Larson, 2007)

• Estimated in NC, for I/DD alone, in 2007, at $42 million a year

Competency-Based Training: It Works!

Research Conducted by the University of Minnesota  ‐Institute for Community Integration (ICI) encompassed:

• 11 provider organizations • 112 service locations (day & residential)• 824 DSPs• 333 people receiving services• College of Direct Support (CDS) curriculum

~NASDDDS, Vol. 22,  No. 1,  January 2015

Competency-Based Training: It Works!

Results of the Research

• Turnover was lower by 16.3% (vs. control group)• Staff gained knowledge and skill at twice the amount of 

control group• People who used services had better outcomes

– Higher community inclusion– More likely to see family when they chose– More likely to exercise choice in daily living– Higher scores when describing relationships with friends and others

~NASDDDS, Vol. 22,  No. 1,  January 2015

CMS Response

• CMS‐funded research began in 2011 to develop and validate a common set of core competencies, through the National Direct Service Workforce Resource Center

• CMS funded development of the Road Map of Core Competencies for the Direct Service Workforce (December 2014)

The CMS Roadmap Addresses

Four community–based, long-term services and supports (LTSS) sectors:AgingBehavioral health (mental health,

substance use disorders)Intellectual disabilitiesPhysical disabilities

Competencies Support CMS’s Goal

• A “coordinated, inclusive and person‐driven system” in which people with disabilities  have “choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health and quality of life.”

• CMS’s Bottom Line:  “Education and competency‐based training programs based on…these core skills have the potential to strengthen the quality of the DSW and thereby improve service delivery.”

~CMS, 2014

What is Happening in North Carolina?

Trillium Health Resources, Cardinal Innovations Healthcare and Smoky Mountain MCOs are funding Direct Course for providers in each of their catchment areas.

Although the implementation methods may differ, the outcome is the same: to professionalize DSPs and consequently offer people who use services a path to better lives.

Expected Outcomes

Based on the University of Minnesota research, these are some expected Outcomes of DirectCourse:

Decrease in incidents

Increase in staff satisfaction

Increase in community inclusion for people supported

Increase in staff confidence

Increase in family involvement and satisfaction

What is DirectCourse?

• A dynamic competency-based, on-line curriculum offering comprehensive training for DSPs, based on analysis of the knowledge, skills, and attitudes required of DSPs.

• Direct Course helps users understand and apply competencies and ethical practices through timely, innovative, and engaging training.

• Direct Course includes:– College of Direct Supports (CDS)– College of Recovery and Community Inclusion (CRCI)– College of Employment Services (CES)– College of Personal Assistance and Caregiving (CPAC)

What is DirectCourse?

• All courses are self‐directed, offering the finest educational resources to help staff get the education they need on‐line, at their convenience, to then apply the skills and help the people they support achieve the best possible life.

Provider Agency & DSP Benefits

Providers who participate in this project may realize positive results such as:• Reduction of training cost• Reduction of Direct Support Professional staff turnover• Increase in the quality of services for people • Incentives through rate increases  as specific staff benchmarks are achieved 

• A stipend paid to direct support professionals for completion

Role of Lewin Consultants

Support Trillium’s efforts to professionalize the network’s DSPs by engaging people who use services, people who provide and manage those services and senior leadership.

Build internal capacity for sustainability by sharing learning and best practices between learners.

Ensure that each segment of the organization has designated time to work on new skills shared learning, feedback and evaluation.

Support the paradigm shift from direct support worker to direct support professional.

Role of Lewin Consultants

Face-to-face coaching and mentoring of skills and competencies during and after completion of Direct Course courses supports DSPs to be:

-successful in their work -more satisfied with their jobs-and more likely to stay in their positions

Elevated job satisfaction motivates staff to participate in training that also provides a pathway to earn incentives such as:

-Increased pay-Recognition-Credentials-Career advancement

Role of Lewin Consultants

• Provide face-to-face support for DSP supervisors (mid-level managers or QPs) whose role is to support the learning and implementation of skills by DSPs.

• Provide training and support to leadership around organization and culture change practices resulting from implementation of Direct Course learning.

• Facilitate with management, opportunities to share stories, highlight changes and develop action plans.

Role of Lewin Consultants

• Coaching sessions are designed to address knowledge and skill gaps and build competencies directly linked to the course(s) completed.

• Staff arrive at coaching sessions with their questions and examples of practical application based on their current jobs.

Role of Lewin Consultants

• Each coaching session facilitates learning through 4 methods of engagement:– Inviting staff to share key concepts learned with each other in their own words to reinforce learning.

– Addressing questions staff have about the  Direct Course materials.

– Linking concepts to practice by using real life situations.

– Assigning “homework” to practice and build confidence and competency.

How Can a Provider Agency Enroll?

Request for Application will be posted on Trillium’s website on April 22, 2016.

Request for Application will close at 5:00pm on May 13, 2016

Provider Agency Responsibilities

Use DirectCourse in ways that represent a “best fit” within the organization

Assist with gathering data for the evaluation of DirectCourse

Enroll staff in training with MAHEC (administrator for DirectCourse) within one month of contract award

Identify/assign a sub-administrator Work with consultants from The Lewin Group to

assist with implementation, coaching and mentoring

Questions?

For more information, please contact Kisha Darden at kisha.darden@trilliumnc.org

Be sure to sign up to get the RFA on the date of release.