HCBS Training

The following story describes how one team used the fidelity of implementation process to stay focused when they faced challenges related to staff turnover.

An organization supporting people with Intellectual and Developmental Disabilities in a medium-size city had been implementing the person-centered practices framework described in these modules for four years. In 2016, this organization joined up with three other providers and a county team from the same region. Teams came together for a one-day training that occurred four times a year. The teams used this event to organize their action plan. Trainers with a background in person-centered practices, positive behavior support, cultural responsiveness, and organizational workforce issues provided mentoring by introducing content, tools, and resources that the teams used to build action plans for moving forward.

One or more trainers visited each team, both in person and by video connection, to complete a fidelity of implementation tool that is used to assess both person-centered practices and positive behavior support. Positive behavior support is a framework for improving quality of life and social interactions; it can be implemented using a tiered model. This positive support was included with person-centered practices because these two approaches work well together. For more information about positive behavior support across the lifespan, please visit the Module 7 Resource Page . 

The team from this organization did well during 2016-2018 and worked hard on the items on the Minnesota Team Checklist. However, during 2019, the organization experienced a lot of staff turnover making it difficult to continue attending planning days. Some team members were no longer working at the organization. The remaining team members, with their director, decided to withdraw from the regional training for awhile. 

However, a year later the biggest challenges in turnover had been addressed. The team returned to the regional training. Several of the managers and supervisors who participated in the early years of the training were still on teh team. The experienced team members explained the process to their new team members. This helped everyone know what to expect when they returned to action planning. 

One of the first things they did after returning to regional training was to complete an external evaluation. This helped the team regroup and assess their progress in becoming a more person-centered organization. The team used the Tiered Onsite Evaluation Tool (TOET) as their external assessment.  The TOET has a total of 27 items, and trainers scored each item based on different types of qualitative and quantitative evidence that the team made available to the evaluator. Each TOET item contains tailored criteria for scoring teams zero, one or two points per item. The evaluator then counted the number scored on each item and divided this sum by the total number of items to get a percentage. 

Types of Evidence Reviewed Using TOET

• Interviews
• Team meeting minutes/agendas
• Visual reviews (e.g., posters on the wall, artwork)
• Direct observations
• Summaries of incident report data
• Staff retention data
• Change in vision and mission statements

You can see the graph on this page shows the work done up to 2018. The percentage scores completed are reported for each subscale of the TOET.  Each year appears as a different shade of black or grey. The scores for 2020 show that even though this organization faced many challenges, the team process helped sustain the work that took place. This team made progress even though they could not attend trainings during 2019. A key part of the team’s success may have been the meeting routines that the team used (e.g., meeting regularly, using the fidelity of implementation tool to guide progress, reviewing the evaluation plan).  You can see from the list below that the TOET is very similar to the Minnesota Team Checklist. The only difference is that two practices are included as subscales so that teams can assess two types of practices: person-centered practices and positive behavior support.

TOET Subscales

• Team Action Plan
• Person-Centered Practices
• Positive Behavior Support
• Cultural Awareness and Competence
• Monitoring and Evaluation
• Staff Development and Learning
• Visibility 
• Overall Total TOET Score

Please visit the Implementation Story #6 to learn more about the data this organization collected as part of their person-centered and positive behavior support work. Also visit the Module 7 Resource page to view a webinar describing how to complete the TOET.