Frontline Initiative

Focusing on Outcomes Changes Relationships


Sandra Wessman is project coordinator at Nekton-Norhaven, Inc.,in St. Paul, Minnesota

The development of personal outcomes as a planning process for people with disabilities is an important alternative to the traditional developmental ⁄ behavior modification process. Traditionally, a person’s strengths and needs are assessed and then goals and objectives developed relating to deficit areas. Training and habilitation become the focus of the relationship between direct support professionals and the people they support. Outcomes, an alternative approach, looks at people as people first, with the understanding that each person is different and has different dreams and aspirations regardless of disability. Instead of trying to remedy a deficit, personal outcomes nurture achievement and accomplishment – an important shift in focus. Furthermore, we’re learning at Nekton-Norhaven that this shift has opened new potentials in thought and practice concerning the direct support professional.

Since we began looking at the achievement of personal outcomes as a hallmark of good services, our approach and attitude has changed toward the people we serve and also toward the direct support people we employ. Traditionally, our employee evaluations concentrate on observable, measurable criteria based on training and compliance with rules and regulations. This encouraged top-down relationships between the management and the DSP and also between the DSP and the consumer. 

An outcomes approach to services, however, results in many changes in direct support professionals’ responsibilities and roles. The primary responsibility of the DSP becomes assisting the person receiving services to achieve personal outcomes. The person receiving services chooses who is on his or her team (or support network), and this often includes one or more DSPs. The person’s plan is developed by those who know the person best – this is usually a direct service professional. When an organization moves toward an outcomes approach, power roles within the organization invert. The person who knows the person best is responsible for assisting the person to determine their outcomes and provides the follow-through necessary to realize these outcomes. Direct support professionals are the key to whether outcomes are achieved or not.

High turnover for DSPs is difficult for people who receive services because they have to work with new staff. They should have some input into the hiring process. When people receiving services have a choice about who works with them, DSPs focus on that person rather than on agency process. As an agency, we’ve traditionally filled openings; now we’re concerned about relationships and enhancing people’s lives.

Training DSPs also takes on a different form when personal outcomes are the primary focus. Competency switches from knowing and reciting rules to knowing and respecting the individual. Some important questions include: Does the direct support professional understand this person’s outcomes? Are they familiar with and can they communicate with others on the support network? Are they supportive and helpful rather than controlling and dogmatic? Does the organization encourage the direct support professional to be creative and imaginative? The answers to these questions become far more important in developing effective training programs than does compliance with rules and regulations.

With a personal outcomes model, satisfaction with services is an important issue. Is the person receiving services and his or her support network satisfied with the services? Are direct support professionals satisfied with the organization where they work? In outcomes, there must be an ongoing dialogue between the people providing direct support and the organization because if they’re satisfied with where they work and the support they receive, they will likely be in a better position to provide better services to consumers.

Employee evaluations are also looked at differently. In our agency, people receiving services are asked what they think of the DSP’s performance, and DSPs are asked to provide examples of their own “best practices.” Stories of how people receiving services worked toward or achieved personal outcomes become the basis for employee evaluations.

In an outcomes model, when we look at services provided by the organization, our primary focus is on the relationship between the direct support professional and the person receiving services – that’s where the action occurs. The desired outcome for our agency? Competent, creative, long-term professionals who understand their role in supporting others to achieve personal outcomes.