A synthesis of direct support service workforce demographics …

A synthesis of direct service workforce demographics and challenges across intellectual/ developmental disabilities, aging, physical disabilities, and behavioral health

November, 2008

Prepared by National Direct Service Workforce Resource Center Amy Hewitt, MSW, PhD, senior research associate Sheryl Larson, PhD, FAAIDD senior research associate, Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota Steve Edelstein, JD, national policy director Dorie Seavey, PhD, director of policy research PHI Michael A. Hoge, PhD, senior science and policy advisor, John Morris, MSW, executive director The Annapolis Coalition on the Behavioral Health Workforce

Preparation of this document was funded by the Centers for Medicaid and Medicare Services, Contract #TLG05-034-2967 to The Lewin Group. It was also supported, in part, by Grant #H133B031116 from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education. This document does not necessarily reflect the official positions of any funding agency.

Contents

Introduction and purpose / p.1

The direct service workforce / p. 2 Direct service worker roles and occupational titles / p. 2 Employment locations for DSWs / p. 3 Demographics of DSWs / p. 4

Evolution of support and service models along with guiding principles of direct service work / p. 6

Behavioral health / p. 6 Aging and physical disabilities / p. 6 Intellectual and developmental disabilities / p. 7 Codes of ethical standards / p. 7

Direct service workforce challenges / p. 9 The status and image direct service workers / p. 9 Supply and demand conditions for DSWs / p. 9 Recruitment and vacancies / p. 10 Turnover of DSWs / p. 11 Turnover rates / p. 11 Challenges in measuring turnover / p. 11 Factors associated with DSW turnover / p. 12 Wages and benefits / p. 14 DSW wages / p. 14 Benefits: Access and utilization / p. 14 Public assistance / p. 15 Worker injury and employee assistance / p. 15 Training and education / p. 15 Identified DSW competencies / p. 16 Federal and state training requirements for DSWs / p. 18 Aging and physical disabilities / p. 18 Intellectual and developmental disabilities / p. 19 Behavioral health / p. 20 DSW career paths / p. 20 Behavioral health / p. 21 Aging and physical disabilities / p. 21 Intellectual and developmental disabilities / p. 21 Supervision of DSWs / p. 22 Workplace culture and respect for DSWs / p. 23 Self-direction / p. 24

Promising policies and approaches / p. 25 Improve DSW wages and access to benefits / p. 25 Reform training and credentialing systems / p. 26 Reform long-term care payment and procurement systems / p. 27 Engage the public workforce and education systems to support recruitment and training of DSWs / p. 27 Design worker registries and other supportive resources / p. 27 Develop statewide stakeholder coalitions to develop and implement state level workforce development plans / p. 28

Areas for planning and action / p. 29 Areas of focus / p. 29 Creating new partnerships and strengthening existing partnerships / p. 29 Education and training / p. 30 Recruitment and retention / p. 30 Wages, benefits, and rate structures / p. 31 Status and awareness / p. 32

Conclusion / p. 33

References / p. 34

Appendix A / p. 45 Community Support Skill Standards / p. 45 PHI competencies and skill standards for Direct Care Workers / p. 47 Certified psychiatric rehabilitation practitioner competencies / p. 48 Addiction counseling competencies / p. 48 Foundations / p. 49 Practice dimensions / p. 49

A synthesis of direct service workforce demographics and challenges across intellectual/ 1

developmental disabilities, aging, physical disabilities, and behavioral health

Introduction and purpose

The Direct Service Worker Resource Center brings together a consortium of leading workforce development experts in the areas of aging, physical disability, intellectual and developmental disabilities and behavioral health to provide technical assistance to states, organizations and individuals and to provide support in addressing workforce challenges such as recruitment, retention and training. Funded by the Centers for Medicaid and Medicare (CMS) funded the national Direct Service Workforce Resource Center has worked intensively with 23 states, provided over 1,500 hours of general and approximately 3,700 hours of intensive technical assistance to states and other interested entities. It has logged over 400,000 hits on its web site where users can access thousands of documents regarding the workforce. This paper provides an overview of direct service workforce challenges and practices across four service sectors: intellectual and developmental disabilities, aging, physical disabilities and behavioral health. Another DSW Resource Center national white paper addresses data collection regarding workforce challenges across service sectors.

The direct service workforce is highly fragmented. This fragmentation is deeply rooted and reflects the fact that each sector has its own funding, policy, service and advocacy systems. One of the objectives of the Direct Service Workforce Resource Center is to provide an opportunity for researchers, educators, practitioners, and policymakers to begin dialogue regarding the similarities and differences of the direct service workforce challenges and solutions and their implications for practice and policy across sectors.

The purpose of this paper is to provide an overview of direct service workforce challenges and practices across four sectors: intellectual and developmental disabilities, aging, physical disabilities and behavioral health. While much has been written and studied within sectors about the workforce challenges and solutions, this paper provides a synthesis of the similarities and differences of the workforce challenges and solutions across the sectors. Drawing on the literature, activities and outcomes of the Direct Service Workforce Resource Center since its inception in 2005, the paper identifies the complexities of the service sectors with respect to the workforce that provides hands-on services and supports to people who are aging, have disabilities, or experience substance abuse issues. Another Direct Service Workforce Resource Center white paper addresses data collection regarding workforce challenges across these four service sectors.

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