As the need for direct service workers (DSW) increases nationwide, ensuring that they provide quality support is of paramount importance. However, for DSWs, pay has stagnated and turnover is high, often resulting in a lack of quality care.

Because of this and other issues, the Centers for Medicare and Medicaid Studies (CMS) sponsored the creation of the Road Map for Core Competencies for the Direct Service Workforce (DSW), in order to establish evidence-based practices for training this critical workforce. The Core Competencies are to be implemented through the National Direct Service Workforce Resource Center.

To help agencies better understand the Core Competencies and their effect on the direct support workforce, as well as how the Competencies were developed, this past January DirectCourse sponsored a webinar, entitled CMS Direct Service Workforce Core Competencies: Implications for Training.

The one-hour webinar was led by Lori Sedlezky, who is the Director of Knowledge Translation at the Research and Training Center on Community Living at the University of Minnesota. Ms. Sedlezky focuses on workforce development strategies of recruitment, selection, training, and retention of the direct support workforce, and has assisted many states on training development and promotion of DSWs. She has also developed numerous training and curricula, and is part of the online curriculum development leadership team of the College of Direct Support.

“The purpose of Core Competencies is to establish evidence-based practices for training and employment across sectors,” Sedlezky states in the webinar. “Core Competencies can help us to frame training objectives and guide the evaluation of existing curriculum or identify the need for new curriculum development. It can develop measures of initial worker skills, it can help with performance evaluation, it can cultivate skill development by measuring competencies.” She notes that Core Competencies can also help to build the foundation of a great career… and not just one with upward movement. Sedlezky describes the ideal career is one that involves a “career ladder” or a “career lattice.” In this way, “[P]eople who are excellent at their work—a very good DSW—don’t have to think about only moving up into a front line supervisor position, but can also move into a more specialized position and receive increased pay without movement because they are showing increased skill.”

In the webinar, Sedlezky explains that the workforce includes direct service providers across the four main sectors: behavioral health, aging, physical disabilities, and intellectual and developmental disabilities (IDD). There are over four million workers, of which over 3.4 million are employed as nursing assistants, home health aides, and personal care aides. The remaining 800,000 are mostly independent providers.

“Although this is one of the largest, and fastest-growing, occupations, direct care workers are often underpaid,” Sedlezky notes. She points out that 46% of direct care workers use some form of public assistance (such as food assistance or public housing subsidies). “Unless they have a second job, they are not living above the poverty line. To make matters even more acute, wages have actually declined since 2003.”

Situations like these are responsible for the 40-75% turnover rate. “This is the result of low pay, training, feeling of confidence and competence in the job, relationship with the supervisor.” She also observes that the turnover rate adversely affects organizations as well, as the cost of recruiting and training new staff is often excessive. “Naturally,” she observes, “the person receiving service has less quality care.” With people coming in and out of an individual’s lives, care cannot be as good.

Sedlezky notes that there are few and varied training requirements. “If you look across the nation, states vary greatly in terms of their requirements for training.” Additionally, DSWs are typically not rewarded for being trained. “We need to understand and have more consistency about training, and ensure that we are rewarding staff.”

However, work is being done to address these issues, most notably the Core Competencies. Created in partnership with dozens of stakeholder organizations, the Core Competencies can help foster meaningful community living for Americans with disabilities and older adults, by helping create a standardized direct service workforce.

In addition, Sedlezky discussed how DirectCourse curricula, specifically the College of Direct Support (CDS), the College of Personal Assistance and Caregiving (CPAC), and the College of Recovery and Community Inclusion (CRCI), provides the training tools needed to lead DSWs to become proficient in the new competencies. Sedlezky presented a crosswalk to identify how each curriculum addressed the Core Competency areas completely. “You could create a very specific module that contained all the training necessary to train people on these twelve Core Competencies,” she observes. However, all of the DirectCourse curricula is flexible, and can be altered to suit the needs of an individual, or an organization. She notes that, for instance, if a person is already well trained in the area of safety, you can use DirectCourse to augment the existing training of the Core Competencies.

Finally, Sedlezky offers valuable tips and suggestions on how to building Core Competencies into your training.

To listen to the DirectCourse webinar, click here!

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