Understanding your HCBS Direct Service Workforce s Strengths and Preparing the Workforce to Serve All Populations with Core Competency Training

Transcription

1 Understanding your HCBS Direct Service Workforce s Strengths and Preparing the Workforce to Serve All Populations with Core Competency Training 2013 National HCBS Conference: September 10, 2013

2 Session Overview Erika Robbins: The Lewin Group, DSW Resource Center Provide Opportunities for Participants to: Hear directly from practitioners in the field about successful workforce development strategies Learn about available resources Share and discuss ideas for adopting and/or adapting successful strategies Desired Outcomes: Participants identify potential partners Participants commit to actions they will take to strengthen the HCBS direct service workforce 1

3 Kate King, Centers for Medicare and Medicaid Services Framing the Issue: What do we know about the Direct Service Workforce? In 2011, conservative estimate of 4 million workers. Over 3.2 million employed largely by agencies in three occupations Nursing Assistants (1,466,700); Home Health Aides (924,650); Personal Care Aides (820,600). An estimated 800,000 independent providers employed across the country in public programs. The federal government requires training only for nursing assistants and home health aides who work in Medicare- and Medicaid-certified nursing homes and home health agencies. States and individual employers may require training and/or certification. Source: 2

4 Kate King, Centers for Medicare and Medicaid Services Framing the Issue: Competencies and Training Growing recognition of the importance of good care coordination Growing trend towards integration of populations in public LTSS programs, particularly Medicaid managed care and programs for Medicare and Medicaid enrollees Growing shortages of direct service workers, and Concerns about service quality. 3

5 Kate King, Centers for Medicare and Medicaid Services Framing the Issue: Competencies and Training Taking a cross-sector, cross-population, competency-based approach to HCBS workforce training that prepares the workforce to serve all populations will: Provide a professional path resulting in worker career growth Leads to improvements in worker wages and benefits, and Thus enhanced worker satisfaction, greater retention, expanded capacity, and improved access for older adults & people with disabilities/chronic conditions Improve the quality of HCBS services Manage LTSS/acute care costs and support better coordination 4

6 Questions to Run On Erika Robbins: The Lewin Group, DSW Resource Center What bold steps can I take to make an impact in promoting workforce competency? How can I engage partners and support competency-based training in development of the direct service workforce? How can I integrate core competencies as the basis for workforce development strategies and practices within my state or organization? What programs, initiatives, or LTSS reform efforts are underway in my state that might lend financial support to HCBS workforce improvement efforts? How can I make the case to funders/partners about increasing investment in the HCBS workforce? 5

7 Erika Robbins: The Lewin Group, DSW Resource Center Who is here today? Why? 6

8 Lori Sedlezky: University of Minnesota, DSW Resource Center CMS Vision & the Road Map Project The Centers for Medicare & Medicaid Services (CMS) aim to achieve a system of Community Based Long-Term Services & Supports: Person-driven Inclusive Effective and Accountable Sustainable and Efficient Coordinated and Transparent Culturally Competent in which people with disabilities and chronic conditions have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health and quality of life. 7

9 Road Map Project Framework Phase I: DSW Competency Inventory 22 sets inventoried; across LTSS sectors: Aging, Behavioral Health, Intellectual and Developmental Disabilities, and Physical Disabilities services Phase II: DSW Competency Analysis Content analysis completed among 7 nationally-recognized competency sets Phase III: DSW Core Competency Validation and Synthesis (See Core Competency Set) Modified Delphi process with leader/expert panel to determine core competencies via online survey methods and in-person Summit conference

10 Purpose & Key Recommendations The DSW Core Competency Set establishes evidence-based practices for training and employment across LTSS sectors to: Frame competency-based training objectives and guide curriculum development. Develop measures of initial worker skills; plan for entrylevel training and resulting competency development. Cultivate skill development by measuring competencies within the current workforce and needs for ongoing training. Serve as the foundation of career ladders and lattices inclusive of a wide variety of DSW roles. 9

11 Summary of DSW Core Competency Set Core Competency Areas (Version 3.0) # of Skill Statements 1. Communication 4 2. Facilitation of Individualized Services 9 3. Evaluation and Observation 4 4. Participant Crisis Prevention and Intervention 6 5. Safety 5 6. Professionalism and Ethics 8 7. Participant Empowerment 4 8. Advocacy 4 9. Supporting Health and Wellness Community Living Skills and Supports Interpersonal and Family Relationships Community and Service Networking Cultural Competency Education, Training and Self-Development 4 TOTAL: 77 10

12 Strategies to Prepare the LTSS Workforce 1. Identify Specific Challenges Experienced DSW skills are lacking in providing community-based settings and across populations. How effective are current training procedures in producing desired results? In what areas do you notice indicators of poor performance? How adequately are new employees prepared for their job roles and functions?

13 Strategies to Prepare the LTSS Workforce 2. Use the DSW Core Competency Set to; Compare Assess Review DSW job descriptions Current employee skills (e.g. competency assessments) Current training methods (incl. training needs & outcomes that service participants desire) Mandatory training requirements State and organizational policies related to training Performance review systems

14 Strategies to Prepare the LTSS Workforce 3. Establish a Workforce Development Plan Design & implement a training program based upon DSW Core Competency set Develop & emphasize policies that affirm competent, well-trained DSWs (CMS & ACL vision) Identify & engage stakeholders needed to support and carry out the plan Decide how the plan will be drafted, revised, and implemented to meet needs of all served Utilize the DSW Resource Center to assist in carrying out your mission

15 Key Recommendations: How to Utilize the DSW Core Competency Set State Agencies Start a conversation with other agencies in the state about establishing common policies around training, and sharing training resources Guide the development of cross-sector statewide training requirements Develop a realistic job preview Managed Care Organizations Use the set as a checklist to assess capacity of providers in the network Require providers to show evidence of training in all the competency areas Provider Agencies Consult the set to make revisions and updates to orientation training Use the set to develop hiring and selection criteria Inform employee performance review criteria

16 Key Recommendations: How to Utilize the DSW Core Competency Set Worker Associations Plan content for professional development events Organize content of new resources and publications Participant-Directed Services Consumers can use to identify what skills their DSWs need Create job descriptions Identify and select training approaches Universities & Educators Guide development of curricula and workforce development activities Update existing training programs and curricula Serve as a foundation of career pathway programs

17 Proposed Next Steps Road Map Implementation Continuation of Phase III: Field Testing and Validation of Core Competencies Stage 1. National Validation Workshops DSWs, Supervisors, and Participants Across Sectors Stage 2. National Validation Survey Large Representative Sample Stage 3. Dissemination and Technical Assistance Potential development of common training programs across sectors, basic curricula for all entry level HCBS workers, and specializations within each sector 16

18 Lori Sedlezky: University of Minnesota, DSW Resource Center Questions to Run On What bold steps can I take to make an impact in promoting workforce competency? How can I engage partners and support competency-based training in development of the direct service workforce? How can I integrate core competencies as the basis for workforce development strategies and practices within my state or organization? 17

19 Lori Sedlezky: University of Minnesota, DSW Resource Center Commitments to Action What commitment to action can you make? What will you do in the next 2 weeks as a result of something you heard today? 18

20 Erika Robbins: The Lewin Group, DSW Resource Center What does CMS think about the Coverage of Training within Medicaid Rate-Setting? July 13, 2011 CMCS Informational Bulletin Medicaid reimbursement for covered services delivered by a qualified provider to an eligible beneficiary. requirements that are prerequisite to being a qualified Medicaid provider are not reimbursable by Medicaid. maintaining status as a qualified provider may be included in determining the rate for services. A State may recognize such continuing education expenses as a cost to the provider of doing business. 19

21 Erika Robbins: The Lewin Group, DSW Resource Center What does CMS think about the Coverage of Training within Medicaid Rate-Setting? July 13, 2011 CMCS Informational Bulletin - Continued A State may wish to promote advanced provider skills training to increase the availability of providers qualified to serve beneficiaries with more complicated or difficult medical needs. Can be included in the development of rates paid for services requiring more complex levels of care. Can set provider qualification requirements at a separate and distinct level for those advanced level providers, and pay rates commensurate with their higher skill levels. 20

22 Erika Robbins: The Lewin Group, DSW Resource Center How can States integrate the coverage of continuing education and training within Medicaid rate-setting? 1. Review and Use the DSW RC Resource: Coverage of Direct Service Workforce Continuing Education and Training within Medicaid Policy and Rate Setting: A Toolkit for State Medicaid Agencies. Includes background information on the workforce and relevant strategies to address challenges and improve service outcomes Contains illustrations of the inclusion of continuing education and training within rate-setting Provides tools and resources to develop a health and human service workforce strategy 2. Conduct an Environmental Scan of your State s Training Requirements and Rate Structure and Perform a Workforce Gap Analysis. 3. Identify Workforce Partners and Establish an Integrated Workforce Vision and Action Plan. 21

23 Erika Robbins: The Lewin Group, DSW Resource Center How can we access the Training in Rates Toolkit? Seek Technical Assistance from the DSW Resource Center! Coverage of Direct Service Workforce Continuing Education and Training within Medicaid Policy and Rate Setting: A Toolkit for State Medicaid Agencies Submitted by: National Direct Service Workforce Resource Center Toolkit is located at: 22

24 Erika Robbins: The Lewin Group, DSW Resource Center Remember the Questions to Run On What programs, initiatives, or LTSS reform efforts are underway in my state that might lend financial support to HCBS workforce improvement efforts? How can I make the case to funders/partners about increasing investment in the HCBS workforce? 23

25 Commitments to Action Erika Robbins: The Lewin Group, DSW Resource Center What commitment to action can you make? Is there something you can do right now as a result of something you heard today? 24

26 Contact Us National DSW Resource Center Kate King, Project Officer CMS, CMSO, DEHPG, DCST Erika Robbins, Senior Consultant The Lewin Group Lori Sedlezky, MSW, Director of Knowledge Translation University of MN Research and Training Center 25