Frontline Initiative Direct Support Professionals

Consumer Choice:
Training DSPs and Self Advocates


Lewis Kraus is a Vice President at InfoUse in Berkeley, California, and helped develop the Consumer Direction in Personal Assistance Services training program.

Marie E. Marra of Program Development Associates, distributors of this and other multimedia disability training resources, also contributed to this article.

For people with disabilities, the trend is out of institutions and into life at home or in the community. Laws reinforcing this independent living trend include the 1999 Olmstead Supreme Court decision which ruled that and the New Freedom Initiative (requesting implementation of Olmstead and more community living options). One result of this independent living trend is an increasing demand for trained direct service providers.

Here at InfoUse in Berkeley, CA, we research demand for and providers of these personal assistant services. We have identified a large and growing need for direct service providers who understand consumer-directed care, in order to meet another emerging demand: for more self-determination by people who receive these personal services. This showed a need for updated training resources, particularly for agencies who train and place direct service providers.

What is Consumer-Directed Care?

People with different physical and mental abilities, people receiving elder care services, and people in rehabilitation require customized personal care services to support their daily life and work activities. Through focus group research, analysis of existing personal assistant training programs, and a review of service delivery demonstration programs, InfoUse found preferences among those Personal Assistance Services (PAS) consumer groups for —

  • Participating in the hiring, training, and supervision of their service providers;
  • Actively directing customized and individualized services they need; and
  • Developing more of an employer-employee working relationship, even when administrative functions — such as payroll, recruitment, taxes, and insurance — are managed by a home care or public agency.

These preferences for more self-determining, consumer-directed support services points to updated training that focuses on disability awareness, improved communication/confl ict resolution skills, and a service attitude that supports modifying routines, procedures, and services to meet individual needs … by collaborating with the consumer-as-boss. Such updated training, focused on a consumer-directed service model, would build upon basic, required personal assistant services, such as training on body systems, equipment, assistive technology, home management, and emergency response.

“Musts” for the New DSP Training Package

InfoUse’s focus group research points to must-have training topics that support consumer direction, or self-determination, including —

  • Consumer self-assessment of needs and preferences
  • Clear rights and responsibilities of the DSP and the consumer
  • Disability awareness
  • The hiring process (for independents and home care agency providers)
  • Job hunting for DSPs
  • Communication skills
  • Management responsibilities (payroll, money, taxes, insurance) • Individualizing standard care tasks
  • Safety (lifting, universal precautions, preventing injuries)
  • Backup and emergency systems

InfoUse also determined a clear need for cooperation across institutional players, since some currently train consumers, while others train direct service providers. New PAS training should meet the needs of younger as well as older PAS consumers, as research concluded that younger consumers of PAS preferred more involvement and management of their service relationship. Last on the “must have” list, updated training must support consumers who receive services through home health care or intermediary service agencies, as well as those who hire independent providers (Kraus et al. 1999).

Developing New Consumer-Directed Training Resources

The InfoUse team has created a CD-ROM for DSPs and a Web site for PAS consumers. We applied mixed learning techniques, including —

  • Text goals and factual information
  • Behavioral modeling through depicted scenarios and interviews
  • Paced practice sets, self-tests, and review
  • Diverse ethnic, racial and cultural inclusion
  • Easy comprehension by the use of sixth grade-level language and abundant visual reinforcements

InfoUse’s development team emphasized consumer choice and increasing DSP awareness of their role in supporting it. A key objective in developing the CD-ROM was to provide DSPs with practical tools to solve on-the-job needs, such as how to communicate with consumers or family members, how to rectify miscommunication, how to make choices, how to deal with personal stress, and how to increase their effectiveness on the job. 

The Training Package

“Consumer Direction in Personal Assistance: How to Work Together” is available in interactive CD-ROM format or in four self-paced videos with Learning Guides. Here are the main topics covered in the package —

  1. Consumer Direction: Defining consumer-directed personal services; identifying tasks.
  2. Health & Safety: Emergency response; protecting the consumer and the service provider from disease, infection, and injury; techniques to relieve stress.
  3. Communication: Problem prevention tips; clarifying what the consumer prefers; problem solving and resolution; increasing disability awareness and using person-fi rst language; meeting expectations and communicating with people who have different management styles and abilities.
  4. Rights & Responsibilities: How to write up work agreements; reliability and schedules; respecting personal boundaries; recognizing and reporting abuse to proper authorities.

Professionals who tested, implemented, or reviewed this training said —

  • “Excellent job conveying an Independent Living perspective. You folks produce a professional tutorial.” — Alfred H. DeGraff, author, Caregivers and Personal Assistants.
  • “Integral part of training on issues involving personal assistant care.” —Joseph Havranek, Journal of Applied Rehabilitation Counseling

  • Flanagan, S. (1997). Consumer-directed personal assistance services: Key operational issues for state CD-PAS programs using intermediary services. Washington, DC: Medistat/SysteMetrics.
  • Health Affairs. (2003). Cash & counseling study. Mathematica Policy Research. Retrieved from
  • Kraus, L. E., Nelson, J., Ripple, J., & Temkin, T. (1999). Training needs in personal assistance services of consumers, providers and family members. Journal of Rehabilitation Administration, 22(4), 217–231.