Year 1: Organization‐ wide Implementation Day 4 ... · Racial/Ethnic Diversity in MN Cultural Norms and Communications Cultural Norms Might Influence Communication in Many Ways,

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Year 1: Organization‐wide ImplementationDay 4: Organizational Culture & Workforce

Strategies

LIKE

• Time as group, flow of the day, at our own pace (11)

• Feedback and consultation with trainers (2) • Lil discussion in regard to incident reporting • Getting to understand colleagues needs • Our group is coming together and building

connections • Veggies, bagels, snacks (4)

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LEARN

• We are all at different pages and we work at our own pace • Developing goals and action plans • More of my team is using tools than I knew • Incident Data • Loved topic • More info about PBS facilitator• It is a slow process (but was everyone was great contributing)• Starting to see a vision – learning where this is taking us • There’s a lot of thought and implementation to change • Where CSS fits into PBS • Started thinking about PBS and how to build quality relationships and quality of life • Matrix and how to use it • Checklist • Implementation tools • How to move forward with more simple steps • Tools on website • MNPSP.org was helpful

CHANGE

• Nothing (9)• Everything so scattered • Unclear on PBS and CSS when to use • PBS information was confusing – would like more

background info • A lot of PBS info too high level for where we are at • Room temp (4) • Don’t need a full hour for lunch • Not having outside work on my mind • Actual donuts

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Today’s Purposes

• Better understand Organizational Workforce and Culture

• Think about strategies for increasing cultural awareness and humility

• Learn about Organizational Workforce Strategies

Coaches Connect

• Coaches and PBS Facilitators - Share New Learning

• Review Action Plans & Outcome Statements –Look at your Workforce Outcome, today you will develop action plans

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Organizational Workforce & Culture

Purpose: Better understand & support your organizational workforce

Organizational Workforce Development

Positive Behavior Support

Universal Stage• Align Policies to Person‐Centered Practices• Revise Job Descriptions, and Performance Evaluations• Integrate Practices into Onboarding & Ongoing Training• Use Data for Decision Making

Secondary Stage• Monitoring and Early Intervention • Training Targeted for Groups of Staff• Targeted Strategies to Improve Specific Settings• Simple Problem Solving for Challenging Situations

Tertiary Stage• Tailor Problem Solving for Specific Problematic Situations • Individualized Training and Mentoring in Unique Settings • Improve Supervision and Mentoring for Locations Experiencing Challenges

• Establish Matching/Hiring Tailored to Individualized Plans

Organizational Workforce

Implementing Multi‐Tiered Systems of Support

Person‐Centered Practices & Planning

Year 1

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Embedding Cultural Awareness

Universal Stage• Using a Cultural Lens When Developing Policies • Recognizing Culture When Developing/Completing Job Descriptions and Performance Evaluations• Offering Culturally Relevant Trainings in New Orientation and Ongoing Instruction• Meaningful Data Collection‐Collecting Data on Diversity to Guide Decision Making • Encourage Diverse Cultural Point of View• Encourage Self‐Assessment• Varying Perspective and Interpretation of Self‐Determination and Choice Making

Secondary Stage• Awareness of Cultural Bias and Norms when Monitoring and Early Intervention

• Training Targeted for Groups• Culturally Appropriate Targeted Strategies to Improve Specific Settings

• Simple Problem Solving for Challenging Situations That Occur in More Than One Situation

Tertiary Stage• Tailor Problem Solving for Specific Problematic Situations Which Incorporates Cultural Norms and Awareness

• Individualize Training and Mentoring to Address Unique Settings Where Problems Occur

• Improve Supervision and Mentoring for Locations Experiencing Challenges Which Include Cultural Responsiveness

Implementing Multi‐Tiered Systems of Support

“It is not possible to be truly sensitive to someone else’s culture until one is sensitive to one’s own culture and the impact that cultural customs, values, beliefs, and behaviors have on practice.”

(Lynch & Hanson, 1997)

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Culture

Culture

[Culture] is that complex whole which includes knowledge, beliefs, arts, morals, laws, customs, and any other capabilities and habits acquired by [a human] as a member of society (UNESCO).

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Racial/Ethnic Diversity in MN

Cultural Norms and Communications

Cultural Norms Might Influence Communication in Many Ways, Including:

– Greeting, Hand-Shaking– Eye Contact– Use of Gestures– Comfort with Silence– Turn-Taking

• Space –Comfort Zone • Topics of Conversation• Asking and Responding to Questions• Interruptions, Use of Humor

. Slide source:@2016 –University of MN, Institute on Community Integration, Research and Training Center on Community Living.

Source: American Speech‐Language‐Hearing Association. (2010). Cultural Competence Checklist: Personal reflection. Available from

www.asha.org/uploadedFiles/practice/multicultural/personalreflections.pdf.

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Activity

Critical Reflection as a Strategy for Improving Cultural Responsiveness

• Talking about race/racism is hard.• Talking about race/racism is beneficial.• If people work hard, they will be successful.

(White, Sandomierski, & Webster, 2019)

How much do you agree?

A little A lotWhy do you feel this

way?

How is this belief reflected in your organization’s policies or practices?

How might this belief impact equity at your organization?

1 2 3 4 5

MN Direct Support Worker Survey Racial/ethnic identification of direct support workers

(Pettingell, Kramme, & Hewitt, 2019)

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What do you notice about ethnic identities in the two graphs?

Minnesota Overall Direct Support Workforce

ADD Slide Re story from PBIS

• School story about diversity and office referrals intervention and discrepancy

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DSP Workforce. WorkforceKey to Quality

DSP recruitment and retention: A self-advocate perspective

• We want staff who show up on time and help us get the stuff done we need to get done

• We want people who are paid enough to stay so they like what they are doing

• We want people who respect us and are respected for what they do and the pay they earn

Cliff Poetz, Advocacy Leader Source: IMPACT 2008

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Who are we talking about?

• Direct Support Professionals– personal care attendant

– direct care worker

– direct support staff

– community living specialist

– job coach

– employment specialist

– ETC…..

Projected growth of workforce 2016-2026 (BLS)

1,970,900

603,700

1,863,300

4,437,900

3,003,900

607,900

2,169,700

5,781,500

HOME CARE

NURSING HOMES

OTHER INDUSTRIES

TOTAL

2016

2026

PHI. “Workforce Data Center.” Last modified November 10, 2017. https://phinational.org/policy‐research/workforce‐data‐center/.

52%

Percent change from 2016‐2026

1%

16%

30%

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Age of DSPs in U.S. and MN


Median Age in the U.S.: 41Median Age in MN: 34

U.S. Citizen Birth U.S. Citizen by Naturalization

Not a Citizen of the U.S.

75%

15% 10%

81%

11% 7%

US Minnesota

DSP Citizenship Status in the U.S. (2016)


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DSP educational attainment in U.S.


MN Direct Support Worker Survey –What did we learn about who our DSWs are?

• 77.5% women, Average age 43 years

• Average household size of 3• 58.5% average annual household

income < $40,000Statewide Cost of Living (OES Data Tool)

– $15.39 needed for family of 3 (2 FT adults, 1 child)

– $38.25 needed for family of 3 (1 adult, 2 children)

• 28.4% have another job• 63% have education beyond high

school – 17% have 4 year Bachelor’s

or graduate degree

DSW Reliance on Government Subsidies

(Hewitt, Pettingell, & Kramme, 2019)

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Is there a crisis?

This is NOT a new issue……for 25+ years…..

• Larson, S.A, Hewitt, A., & Lakin, K.C. (1994). Residential Services Personnel: Recruitment, Training and Retention. In M. Hayden & B. Abery (Eds.), Challenges for a Service System in Transition: Ensuring Quality Community Experiences for Persons with Developmental Disabilities. Baltimore: Paul H. Brookes.

• Hewitt, A., Larson, S.A., & Lakin, K.C. (1994). A guide to high quality direct service personnel training resources. Minneapolis: University of Minnesota, Research and Training Center on Residential Services and Community Living.

• Hewitt, A., Larson, S.A., & Lakin, K.C. (1994). Policy Research Brief: Training Issues for Direct Service Personnel Working in Community Residential Programs for Persons with Developmental Disabilities. Minneapolis: Institute on Community Integration (UAP), University of Minnesota (College of Education).

• Hewitt, A., O’Nell, S., & Larson, S.A. (1996). Overview of Direct Support Workforce Issues. In Jaskulski, T. & Ebenstein, W. (Eds.), Opportunities for Excellence: Supporting the Frontline Workforce. Washington, D.C.: President’s Committee on Mental Retardation, U.S. Department of Health and Human Services.

• Hewitt, A., Larson, S.A., & Lakin, K.C. (1997). Resource guide for high quality direct service training materials, 2nd Edition. Minneapolis: University of Minnesota, Center on Residential Services and Community Living.

• Larson, S.A., Sauer, J., Hewitt, A., O'Nell, S., & Sadlezky, L. (1998). SOS Training and Tutorial Assistance Project for Direct Support Professionals, Training, and Frontline Supervisors: Final Report. Minneapolis: Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota.

• Larson, S.A., Hewitt, A., & Anderson, L.L. (1999). Staff recruitment challenges and interventions in agencies supporting people with developmental disabilities. Mental Retardation, 37, 36-46.

• Test, D., Flowers, C., Hewitt, A., & Solow, J. (2003). A Statewide Survey of the Direct Support Workforce. Mental Retardation, 41, 276-285.

• Larson, S.A., Hewitt, A.S., & Lakin, K.C. (2004). A multi-perspective analysis of the effects of recruitment and retention challenges on outcomes for persons with intellectual and developmental disabilities and their families. American Journal on Mental Retardation, 109, 481-500.

• Larson, S.A. & Hewitt, A. (2005). Staff recruitment, retention and training for community human service organizations.Baltimore: Brookes Publishing Company.

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Root of DSP workforce challenges

• No good planning• Departments of Labor allowed “off the hook”• Changing demographics

– Aging of Americans– Fewer younger Americans

• Shifts in laws and expectations

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Other factors influencing reality

• Growth # of People with ID/DD Receive Services– 390% increase in last 2 decades

• People with IDD live longer (age 66)• Growing diversity• Economic stability and growth

– Impact of Great Recession on momentum– Competition with other fields

Activity: Do you know your numbers?

• Please fill it out if you do.• If you don’t, do you know

who you would ask for this information? Write down their name.

• What information would be helpful for your team to make decisions about your workforce?

• How would you collect this information, and who would be responsible for it?

• ACTION PLANNING.

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Lunch!

MN Direct Support Worker Survey –Top 10 reasons DSWs leave their job?

90% Found another job that pays more 1

64% Found another job that offered better benefits 2

43% Found another job with hours that worked better for their family 3

38% No opportunity for promotion 4

35.5% Supporting people is a difficult job 5

33% Not recognized for the work they did 6

33% Found another job closer to home 7

18% Could not get along with co-workers 8

17% Too little time with and/or poor quality from supervisors 9

16% Training and support were inadequate and/or poor10

And the number one reason why DSWs left their job?

(Hewitt, Pettingell, & Kramme, 2019)

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DSW Wages are Low

Statewide Cost of Living • $15.39 needed for family of 3 (2 FT adults, 1 child)• $38.25 needed for family of 3 (1 adult, 2 children)

(OES Data Tool, MN DEED)

DSP wages over time (2016 BLS)

WAGE INCREASE: PCA + $0.00HHA + $1.00 NA + $0.24

Total + $0.12


$11.11

$10.44

$11.11

$11.15

$11.72

$10.87

$12.15

$12.46

$11.64

$12.70

$11.91

$11.24

$12.03

$10.00

$10.50

$11.00

$11.50

$12.00

$12.50

$13.00

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Iowa

Personal care aidesHome health aidesNursing assistantsTotal (Average)

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Direct Care Worker Median Hourly Wage Comparison in the United States, 2017

U.S. Bureau of Labor Statistics, Occupational Employment Statistics: https://www.bls.gov/oes/

$18.76

$17.39

$13.23

$13.07

$12.45

$11.16

$11.11

$10.76

Parking Enforcement Workers

Refuse and Recyclable Material Collectors

Nursing Assistants

Orderlies

Other Personal Care and Service Workers

Home Health Aides

Personal Care Aides

Parking Lot Attendants

DSPs

Low wages: Correlation of entry wage to turnover

Source: 2009 DSP Wage Study, ANCOR

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Estimated replacement costs related to turnover – U.S.

• Estimated costs to replace each DSP $4,073

• Calculating costs of turnover:– https://ici.umn.edu/products/docs/Turnover

Calculator.pdf

Source: PCPID, 2018

Workforce conditions that deter entry into the profession

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Many solutions to consider

There is not a single solution!

Recruitment & Selection

Targeted Marketing

Realistic Job Previews

Structured Interviewing

Status and Awareness (PSAs)

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Targeted Marketing

Customizable marketing materials

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Selecting the best candidates

The process used to assure a good match between

• The APPLICANT…with the right • Competencies and Skills• Attitudes and Values• Interest in and Commitment to do the job

• The ORGANIZATION…with its• Job Requirements and Expectations• Culture and Climate• Investment with employees

Know your stayers

• What does the data you gather tell you about who stays longest in your organization?

• Who are your best employees?• Where can you gain access to more people

with similar characteristics?• How are you marketing and recruiting to find

their clones?

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Use inside recruitment sources

Inside sources:• current employees

• Referral bonuses

• people receiving services and their families or friends

• volunteers

• social media networks that are existing “friends” of the organization

• staff friends

• service coordinators or case managers

• board members

• others…..

Outside sources:• newspaper advertisements

• internet ads• Craig’s list

• Linked in

• fliers regarding open positions

• job boards and placement offices in high schools and colleges

• others?

Expanded workforce pipeline

• High school students– CP30 http://www.opra.org/workforce-initiatives/c3po/

• Immigrants and expanded cultural, ethnic and linguistic diversity

• Retirees

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Who• Potential Recruits• Job Candidates

When• Early in interview Process

Why• Reduced early turnover• Increases met expectations


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Present non-distorted information to job applicants • about the job • and the

organization/family/individual(s)

• before a job offer has been made

Candidates understand job expectations before they start the job

Candidates make informed decision Candidates can self-select out

Benefits of Realistic Job Previews

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Realistic Job Preview

ANCOR RJP -http://www.nationaladvocacycampaign.org/newsroom/news/new‐ancorrtc‐realistic‐job‐preview‐available‐now

NYSACRA RJP –http://www.directsupportprofessional.org/


Structured Interviewing

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• The best predictor of future behavioris past behavior in similarcircumstances that was recent or thatreflected long-standing behaviorpatterns

• Ask candidates to describe situationsthey have faced and how theyhandled them

• Situation, Behavior, Outcome

• Based on NADSP Competency Areas

Use structured behavioral interviews

Sample Questions:

Competency area 1: PARTICIPANT EMPOWERMENTDescribe a situation when you assisted an individual to recognize that he or she had several choices in how to handle a difficult problem. What was the situation, what did you do, and what was the final outcome?

Competency area 4: COMMUNITY & SERVICE NETWORKINGPlease describe some community resources you have had contact with in your own neighborhood. How might those resources be used by a person with a disability?

Structured behavioral interviews

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Structured behavioral interviews


Status and Awareness (PSAs)

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DSP scope of practice - multidisciplinary

Changing our messages

• Why DSPs matter – Chumie Twerski• The ultimate goal of direct support – John

Raffaele

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Turn and Talk

• Are there any of these strategies that you would like to learn more about?

• Why strategy(s) and why?• Which data will you need to look at to

determine if they are successful?

Retention

DSW Competencies

Education and Training

Credentialing and Career Paths

Recognition

Membership and Networking

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Retention

DSW Competencies

Education and Training

Credentialing and Career Paths

Recognition

NADSP competency set

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Outcomes Associated with Competency-Based Training

Scales are tipped severely in the wrong direction

240+ hours minimally needed to meet basics

40+ hours provided

Balance is achieved whenTraining competence

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KnowledgeKnowledgeSkills & AbilitiesSkills & Abilities

BehaviorsBehaviorsApplication & TransferApplication & Transfer

Focus on what’s needed to be successful – outcomes.

What do I need to know? What theories or ideas?

What do I need to be able to do?

What dispositions must I display?

Where must I be able to apply these KSAs, and at what level?

Competency-based training and education

Source: Charla Long, 2017

Align training with outcomes

Direct Support Professional : MODULE Individual with Disability: OUTCOME

Professionalism Satisfaction with Staff

Community InclusionPerson Centered Planning

Community Inclusion

Individual Rights and ChoiceCivil Rights and Advocacy

Choices & Rights

Safety at Home and in the CommunitySupporting Healthy LivesPersonal Care

Health & Safety

You’ve Got a Friend Friends & Family

Employment SupportsHome and Community LivingPersonal Care

Work, Day, and Home

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Intervention: training approach

• Online training: College of Direct Support 35 lessons over 12 months 6 modules address different topics Pre/post‐test measures

• Mentoring Supervisor or advanced DSP Mentoring on each module topic

• Group discussion With peers and supervisors Provided for each module

Nancy McCulloh, MS

[email protected]

320‐253‐5661

DirectCourse ‐ MinnesotaDirector of Statewide Implementation

Lead Learning Administrator

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DSP training + education + careers

• Competency Based Training

• Credentialing and Career Paths

NADSP E‐Badge Academy

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Retention

Membership and Networking

NADSP

Source: retrieved from OADSP.com

VISION STATEMENTA world with a highly qualified and

professional direct support workforce that partners with, supports and empowers

people with disabilities to lead a life of their choosing.

MISSION STATEMENTTo elevate the status of direct support professionals by improving practice

standards, promoting system reform, and advancing their knowledge, skills and values.

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Implementation Levels

Organization

Systems

Societal

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Organizational culture

• Intentional learning• Leader who knows the direct line staff by

name• Goes out of their way to engage• Periodically practices direct support• Celebrates DSPs

• Individual story-driven • Data-driven

• Makes data driven decisions regarding workforce

• Monitoring is routine• Engages DSPs at all levels

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Where do I find solutions?

“When I am facing the most difficult challenges, I turn to the factory and I always find solutions

there.”- Hamdi Ulukaya

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Know who your workforce is and support it

Importance of DATA

• Legislative advocacy• Accuracy in separating information DSP who

with certain populations or types of services• Make informed policy and practice decisions• Create wage scales within organizations• Other reasons?.......

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Can you answer these key questions (for your site, org or state)?

• What is your DSP turnover rate (crude separation)? • What is your vacancy rate for DSPs? # of vacancies?• What 3 issues most influence your retention rates?• What specific recruitment and selection interventions do you use and what

changes have they made in your data?• What percentage of you DSP are fired and why? • What are reasons DSPs leave?• What are the FLS turnover rates (crude separation)? What is your vacancy rate

for DSPs? # of vacancies?• How much are you spending each month in overtime expenses (extra 50%

only)?• What is the average number of hours of training your DSPs receive during

orientation? Annually thereafter?• What are three characteristics of your most successful DSPs?• What are your best and worst performing sites related to DSP turnover and

vacancy rates?• What are the best things about your organizational culture and the most toxic?

Service model redesign

• Shared living• Independent contractors• DSP worker cooperatives• Self-directed service expansion

– Direct Support Workforce Registries and Matching Services

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Community and family as focus of interventions and services

• Putting faith to work• Social inclusion: A community intervention• Retirement• Targeted focused work with diverse communities

– Community liaisons • Direct support professionals providing direct

intervention and support with communities – Businesses– faith communities– recreational programs– adult education)

Technology first approaches

• Sensors• Remote Monitoring • Computer-Assisted Devices (Tablets, Smartphones) • Transportation Technologies • Electronic Medication Dispensers• Smart Homes • Personal Robots and Assistants

https://www.youtube.com/watch?v=SrO8ksow8Bo

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Marketing and public relations campaigns

• Coalition for a living wage (NJ)– njdspcoalition.org

• Fix the crisis (PA)– Fixthedspcrisis.com

• We are DSPs – Raise the Wage (IL)– Wearedsps.com

• The Case for DSP Wage Increases (IN)– Stonebelt.org/direct-support-professional-wages-need-to-

increase• National advocacy campaign (ANCOR)

– Nationaladvocacycampaign.org

https://z.umn.edu/bfair2directcare

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• Component of recruitment campaign• Raise community awareness of DSPs• Celebrate profession• Combine with annual DSP national week

ANCOR PSAs –http://www.nationaladvocacycampaign.org/toolkit/future‐dsps

NYSACRA PSAs –http://www.directsupportprofessional.org/

PSA – public service announcements

Workforce development toolkits

• ANCOR – http://www.nationaladvocacycampaign.org/wel

come• The Arc of the United States

– https://www.thearc.org/for-chapters/dsp-toolkit

• Find, Choose and Keep Great DSPs (self-direction)– https://rtc.umn.edu/rtc/index.php?product

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Know what your DSPs see and think

• Ask them, be on the pulse– Informal talking sessions with leadership– Engagement survey– Focused conversation at staff meeting with

supervisors– Text with simple question

Focus on frontline supervisors

• DSP turnover is lower when• DSPs feel valued

• DSPs feel they are treated fairly

• Reasons DSPs leave• issues with co-workers• issues with supervisors

Source: Larson, 1997

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FLS wages are not great and turnover is high

• FLS wages– Average starting salary was $34,956.06 ($16.80/hr)– Average FLS salary was $40,253.54 ($19.35/hr)– Average highest FLS salary was $52,183.12

($25.08/hr)• FLS turnover

– Average FLS turnover rate was 13.0% (ranged from 0 to 50%)

– Average FLS vacancy rate for the entire sample was 5.3% (range from 0 to 33.3%).

(Hewitt et. al., 2015)

New York data

Where are FLS new hires recruited?

• 42% promotion of existing employees• 17% websites such as Craig’s List• 10% referrals given by current employees• 9% newspaper or circular ads• 1% private employment or temporary staffing

agencies• 1% school or training placement programs• 1% social media such as LinkedIn and Facebook• 5% came from other sources• (14% did not track this information)

(Hewitt et. al., 2015)

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National frontline supervisor competencies

1. Direct Support2. Health, Wellness, & Safety3. Individual Support Plan Development,

Monitoring, and Assessment4. Facilitating Community Inclusion

Across the Lifespan5. Promoting Professional Relations and

Teamwork6. Staff Recruitment, Selection, and

Hiring7. Staff Supervision, Training and

Development8. Quality Assurance9. Advocacy & Public Relations10. Leadership, Professionalism, & Self-

Development11. Cultural Responsiveness & Awareness

Supporting frontline supervisors

• Use evidence based Frontline Supervisor Competencies that reflect best practice in current service system.

• Use on-line workforce development tools utilizing these competencies, including: • candidate assessment tool • peer assessment• selection tool • training and development tool • performance evaluation

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Implement strategies to increase effectiveness of remote supervision

• Communicate frequently and listen– Use technology– Staff –centered communication approach

• Phone, text, e-mail• Communicate accountabilities and follow up often• Use animated gifs and emoticons to convey emotion• Provide right tools• Insist on some face-to-face that is not all business (not staff

meetings)– Network focused– Relationship building

• Make time weekly for one-to-one• Small talk is key• Use video

– Skype– Google Hangouts– Sqwiggle

Action/Outcome Planning:

• Which strategies here do you want to learn more about? Why?

• Discuss with your team any ideas you want to add to your action plan.

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We must do something radically different

If we want change…..

Documents

Year 1: Organization‐ wide Implementation Day 4 ... · Racial/Ethnic Diversity in MN Cultural Norms and Communications Cultural Norms Might Influence Communication in Many Ways,