Frontline Initiative Change

Coping with Change:
From Walking Upright to Supported Living


Rick Rader, M.D. is Director of the M.J. Kent Habilitation Center in Orange Grove Center, Chattanooga, Tennessee and is a Fellow of the American Institute of Stress

The caregivers’ world is running amok! New policies, new focus, new thinking, and new expectations are affecting every aspect of providing supportive care to individuals with special needs. There’s no place to hide. The changes (e.g. outcome-based quality assurance, person-centered planning, natural supports, etc.) are affecting every avenue of care from residential settings to vocational settings, from classrooms to community centers. Adopt, adapt, or adios. To the long term Direct Support Professional (DSP), it can seem like just the ongoing fashion and fad of a discipline perpetually in search of itself. During this century they have seen the shift from family homes to state facilities, and now another shift back to community homes. And they’ve been asked to weather the storm, see the light, and get in step with change once more.

Change doesn’t come easily to humans. Sure we’re a resilient bunch, capable of learning new skills, even – if need be – of changing our posture (upright walking was a major change that some of us still struggle with). But the price of all this change can be high. When the unexpected becomes routine, something has to give. The stress of life affects us in the same way, whether it comes from providing care in a group home, or from listening to the sound of a lurking saber-toothed tiger from the scant shelter of a cave. Both churn up your insides and ruin your concentration, communication skills, focus, joy, and health.

DSPs already have more than their share of stresses: mounds of regulations, varied family expectations, a skeptical community, murky job descriptions, compartmentalized professionals, inadequate training, and financial hardship.

When you add the dynamics of change to the cauldron, you begin to stir up a stressful stew. Change is difficult because it usually involves loss and disruption. We are creatures of habit and even if the change is a positive one and will eventually prove worthwhile, the transition is stressful. Change can involve a loss such as being displaced from our social support system when moving from one group home to another, or new expectations such as being required to input data on a computer when you’re used to writing reports or filling out forms by hand. 

Take Carla, for example. She is a DSP who worked for over 15 years in a group home where eight people lived. She transferred to a supported living environment where two of the eight men she previously worked with had moved to share an apartment. While she knew the improved living conditions and opportunities for those two men were important, she started to dread coming to work each day. She missed the interplay of the diverse personalities of the eight guys with whom she had become so familiar. In the past, if she had difficulty relating to one of the house members, she had seven others to relate to. In the new setting, she felt these opportunities were limited. She realized she was more comfortable in a larger setting. After struggling for 6 months, she left the agency and the field.

 Then there was Bryson, an area supervisor in a sheltered workshop where 75 people with developmental disabilities assembled food trays for an airline caterer. Bryson was with one agency for six years and enjoyed the challenge of weaving together social, vocational, and education experiences for the people who worked there. When the workshop model was changed to a community integration model, the 75 workers were dispersed to over 20 different work settings, providing them with new opportunities. Bryson found that he needed a new set of skills to work effectively in this new setting. He became coordinator of the program and embraced the added challenge of preparing and supporting not only the people he already knew, but also the workers at new sites. It was an opportunity he would not have had if nothing had changed.

Both examples illustrate typical changes now being felt throughout the field of support services for people with disabilities. They demonstrate how two people respond to a complete upheaval of their roles, needs, and skills. Most scenarios of change don’t result in such cut-and-dried responses of either thriving or leaving, but rather represent peaks and valleys of reception and rejection attitudes. All changes reflect a loss and win situation.

Because it is likely that change will always be part of this field, a DSP who can be flexible and open to new opportunities will do the best. The following are suggestions for coping with changes experienced by DSPs.

  • Keep abreast of the thought shifts in the profession. Prepare for the inevitable changes in the scope and focus on providing supportive care. Try and keep from being blind-sided by changes you never saw coming.
  • Learn new skills. Familiarize yourself with new technologies, philosophies, people skills, collaboration efforts and research techniques. Learn to use the tools of change.
  • Equate change with opportunity. Look to see how you could contribute to the successful transformation that change inspires. A positive attitude usually prefaces a positive performance.
  • Initiate change. Instead of being an innocent bystander of change, be an agent of change. Take a critical look at how things are done at your agency or throughout the profession and make suggestions to improve outcomes. Eric Hoffer observed in his book The Ordeal of Change, “In human affairs, the best stimulus for running ahead is to have something we must run from.”

And Remember–“Nothing is permanent but change.” –Heraclitus, 500 B.C.