Impact Feature Issue on Direct Support Workforce Development
Individual and Family Directed Services: Implications for the DSP Workforce
A quality, sustainable Direct Support workforce is an essential component in the quality of life for individuals with disabilities and their families. In fact, Direct Support Professionals (DSPs) are a key ingredient in an effective support model. The importance of developing a high quality, stable DSP workforce is clear, yet numerous challenges exist in the traditional DSP workforce model.
Current workforce issues have resulted in significant concerns about the quality of care and outcomes for individuals with disabilities. A significant DSP shortage exists (Hewitt, Larson, & Lakin, 2000). Staff quality and inadequate training are persistent concerns. Issues of distrust and maltreatment are often directly related to lack of skills and poor training of support staff. Staff turnover rates have consistently averaged between 45 to 70% (Larson, Hewitt, & Knoblach, 2005). These complex problems require creative solutions that consider alternative ways to find, recruit, and retain quality staff. Program options that allow the flexibility for individuals and families to manage their individual budgets and services, such as consumer-directed supports, are an example of such a solution (Hewitt, 2004).
Benefits of Consumer Direction
Consumer-directed supports is a service option in which individuals with disabilities and their families use individually-set and controlled budgets to select and purchase their own supports. It offers a myriad of positive benefits to individuals, families, Direct Support staff, and funding agencies. Services are provided in a way that minimizes administrative costs and maximizes services and support. Consumer-directed models focus less on organization priorities and more on individual and family needs. They empower individuals and families by providing greater control and choice in relation to their support services. One of the most promising aspects of the consumer-directed supports option is its potential to effectively address many significant DSP workforce challenges.
The active participation of individuals with disabilities and their families in recruitment and hiring helps to address the issue of staff shortages. Individuals and families are often best equipped to understand potential resources in their lives as well as the type of employees that are a good match for their individualized needs. The individual’s and family’s active participation in recruiting and hiring staff provides an opportunity to increase the pool of potential DSPs. Families and individuals often look beyond traditional staffing options to their networks of friends, family, and community members. This flexibility allows for the inclusion of individuals who may not have previously been involved in delivering services to individuals with disabilities (Mellum & Heffernan, 2004).
Under the consumer-directed supports model, staff training is often tailored to the individual’s specific needs. Instead of learning generally about evacuation procedures the staff learns the specific evacuation procedures for the individual they support. Instead of learning from a provider organization about the importance of working with families, the staff learns from the family exactly what their expectations are and how they want the DSP to interact with them. For example, a DSP working with a family with a child with Autism can receive training on the child’s unique Autism-related support needs.
Consumer-directed service options also help to address staff quality. Families have a clear idea of the type of staff who are successful in meeting their individual and family needs, and have the flexibility and opportunity to choose staff and services aligned with those unique needs. This option draws from existing community supports, and builds on the power of relationships and personal connections. This influence flows both ways. The quality of life of individuals receiving supports is enriched, while at the same time the professional experience for the DSP is more meaningful. Individuals and families are able to choose staff that they know and trust, and DSPs experience a greater sense of professionalism, fulfillment, and connection to the needs of the individual and family (Mellum & Heffernan, 2004).
Lastly, wages are consistently associated with higher turnover rates (Hewitt, 2006). Under consumer-directed supports, families are able to compensate staff more flexibly. The skill and diversity that DSPs bring to their work can be directly linked to incentives such as bonuses, increased pay, and raises. The increased compensation as well as professional acknowledgment results in potentially greater job satisfaction and thus greater retention of staff.
Challenges in Consumer Direction
Consumer-directed programs present some new workforce challenges. One challenge is building a sense of community and increasing professionalization for DSPs. The sometimes isolating nature of providing support for a family, without the larger community of professionals, can be a challenge. Although DSPs in consumer-directed services gain closeness to the family and individual, they may lose the network of peers. The informality can lead to a lack of professional identity.
An additional challenge is one of boundaries. With greater individual control comes increased responsibility for individuals and families. Both staff and families report that roles and boundaries may be less clear. Further, some families miss the support system of a larger organization to manage training, administrative tasks, and challenging staff issues.
Overcoming the Challenges
Consumer-directed supports represents an innovative and creative way of looking at services. It also requires new approaches for supporting staff. Although compensation remains an important factor in keeping quality staff, a sense of respect and value remains among the most significant components in the retention equation. Families may need to implement specific supports to facilitate a sense of professionalism and connection for DSPs. Individuals and families can support DSP professionalism by encouraging participation and subsidizing membership in professional organizations such as the National Alliance of Direct Support Professionals and professional conferences.
To build a sense of community it may be helpful to have regular staff meetings and appreciation events. Professional listservs can facilitate communication and a sense of community among DSPs. Families may also find it beneficial to assign another DSP as a mentor. Some families have pooled resources for training and connections across staff. Training such as the online College of Direct Support and Realistic Job Previews are helpful tools for providing effective DSP training in individual and family settings.
While DSPs in the consumer-directed model often make higher wages than when they work in traditional organization-driven services and supports, and individuals and families can access benefits for their employees through fiscal support entities, it remains uncertain how benefit utilization compares to traditional services. The University of Minnesota is currently studying individuals and families who use consumer-directed supports to gain more understanding of wages, benefits, and retention of DSPs who work in individually-directed services and supports.
Consumer-directed supports is an important component of the workforce solution. This model may not solve everything, but it is an important, innovative step toward promoting meaningful, sustainable change in the DSP workforce.
Hewitt, A. (2004). Finding, keeping and training staff when individuals and families control the budget. Impact: Feature Issue on Consumer-Controlled Budgets and Persons with Disabilities, 17(1), 8–9, 28–29.
Hewitt, A. (2006). The direct care support workforce and individually controlled budgets. New Directions, 4(3), 1–4.
Hewitt, A., Larson, S. A., & Lakin, K. C. (n.d.). An independent evaluation of the quality of services and system performance of Minnesota’s Medicaid Home and Community Based Services for persons with mental retardation and related conditions. Minneapolis, MN: University of Minnesota, Research and Training Center on Community Living.
Larson, S. A., Hewitt, A., & Knoblack, B. (2005). Recruitment, retention, and training challenges in community human services: A review of the literature. In S. A. Larson & A. Hewitt (Eds.), Staff recruitment, retention and training for community human service organizations. Baltimore: Brookes Publishing Company.
Mellum, J., & Heffernan, K. (2004). Consumer-directed community supports: A county perspective on a new service option. Impact: Feature Issue on Consumer-Controlled Budgets and Persons with Disabilities, 17(1), 18–19, 31.