In 2017, the President’s Committee for People with Intellectual Disabilities provided a report (retrieved from https://www.nadsp.org/wp-content/uploads/2018/02/PCPID-2017_-Americas-Direct-Support-Workforce-Crisis-low-res.pdf) to the President of the United States regarding the workforce crisis for direct support professionals (DSP). Specifically, the number of DSPs needed to support individuals with intellectual disabilities (ID) and autism is not sufficient, causing many individuals to be waitlisted with no supports (see Table 1 of President’s Committee Letter for detailed information). The key variables of the workforce crisis were identified as high staff turnover, growing demand for services due to population growth, increased survival rate for people with ID, fewer people in the workforce, lack of living wage, insufficient fringe benefits, high stress on the job, insufficient training and preparation, and a lack of professional recognition and status for all DSPs. Some recommendations to address these key variables include wage initiatives, use of technology solutions (e.g., remote monitoring, robotics), designation of DSPs as a distinct occupation and career training and credentialing for DSPs. Other entities have also stated concern with the omnipresent workforce crisis and stated similar causal variables and potential remedies (e.g., M. Davis, Pennsylvania Advocacy and Resources for Autism and Intellectual Disability, Letter to Pennsylvania Department of Human Services, 3 April 2018; see also https://www.fixthedspcrisis.com/).
In response to the recommendation of distinct occupation status and training needs for DSPs, some entities have proposed core competencies and credentialing standards for DSPs. The New York State Office for People with Developmental Disabilities, in conjunction with the New York State Talent Development Consortium, has developed some direct support professional core competencies (www.workforcetransformation.org/wp-content/uploads/2017/03/NYS_Core_Competencies_and_NADSP-Code_of_Ethics.pdf). The competencies are presented as seven overarching service goals. The goals are broken into competency areas (e.g., supporting a person’s unique capacities, personality, and potential; demonstrate support for individual choice-making), and competencies are comprised of multiple skills (e.g., communicate directly with individuals; uses person-first language). Although structured in a manner that would lend itself to job training, the competencies are explicitly described as a representation of the “day-to-day work that DSPs perform” and “are not a training program” (see http://www.workforcetransformation.org/nys-dsp-core-competencies-resources/). Adopting the competencies provides a context to define a distinct occupation status and expectations for those employed.
The Behavior Analyst Certification Board (BACB), a nonprofit credentialing corporation, was established to meet the professional credentialing needs of behavior analysts, government and consumers (https://www.bacb.com/about/). The BACB seeks to protect consumers and solve socially significant problems via increased availability of qualified behavior analytic professionals. One credential developed to meet this mission is the Registered Behavior Technician® (RBT®). Registered Behavior Technicians® must meet initial minimum competencies and receive ongoing supervision from professionals with additional training credentials ( https://www.bacb.com/rbt/ ). Requiring DSPs to become an RBT® provides training directly related to the job responsibilities, offers a framework to support DSPs’ professional growth and development, recognizes the DSP role as a distinct occupation within a critical service field, and establishes minimum expectations for acting ethically while supporting individuals.
The New York State competencies and the RBT® credential both have different points to consider. The purpose of this publication is not to debate those options. Rather, the intent is to describe how organizations can be actively engaged in addressing the workforce crisis. Specifically, this publication strives to describe a training and professional development program focused on addressing DSP turnover, emphasizing job specific skill development for DSPs, and providing career paths for DSPs.
Training Program Overview
Melmark is a multi-state human service provider with premier private special education schools, residential living, professional development, training, and research centers. Melmark is committed to enhancing the lives of individuals with autism, intellectual and developmental disabilities, and their families by providing exceptional evidence-based and applied behavior analytic services to every individual, every day. Many of Melmark’s more than 1,100 staff members are DSPs. While the educational requirement for this position is typically a high school diploma, some positions require a bachelor’s degree.
Training at Melmark is designed to increase the professional skills of employees, which in turn increases life outcomes for the individuals we support. Melmark trains based upon the principles of competency-based instruction, performance-based instruction (e.g., Brethower, D. & Smalley, K., 1998. Performance-based instruction: Linking training to business results), and behavioral skills training (e.g., Parsons, M. B., Rollyson, J. H., & Reid, D. H., 2012. Evidence-based staff training: a guide for practitioners. Behavior Analysis in Practice, 5, 2-11.) Competency-based instruction is utilized throughout trainings and is seen in the form of guided notes, fluency timings, and written exams. Performance-based instruction links training to expected job duties; establishes minimum criteria to demonstrate successful performance of job duties; utilizes performance feedback; and trains via observation, guided practice, and demonstration of mastery (sometimes referred to as “I do, we do, you do”).
The professional development department is responsible for implementing the training model and ensuring all trainings align with the mission and vision of the organization. All members of this department have at least a bachelor’s degree, previous experience supporting individuals with disabilities, and demonstrated competence on all training procedures prior to training. On average, the department conducts 5-15 trainings per week across various programmatic settings, and all training needs are derived from federal, state, and local regulatory requirements; policies and procedures; clinical practice guidelines; and evaluations of the organization and employee performance. The descriptions of Melmark’s training processes can be found below and are fully developed and are being increasingly implemented across all service divisions. These training processes are targeted for full implementation in 2019.
All new employees are required to complete a three to four-week orientation. The first week of training provides new employees with foundational knowledge of Melmark and the individuals served. The second week provides employees with a comprehensive overview of applied behavior analysis and how it is implemented. The training topics align with the BACB RBT® Task List (see https://www.bacb.com/rbt/). Employees are provided with an orientation binder containing organizational information, materials to aide in the acquisition of knowledge, and all competency assessments. This aspect of training has been implemented in all state divisions.
At the beginning of the third week of orientation, new employees observe colleagues performing job duties and receive department-specific training. Training is competency based and focused on teaching employees the specific skills needed to perform their job. Similar to orientation, each new employee receives an on-site training binder that contains department-specific material and competency assessments. The on-site training supports the first 90 days of employment. This aspect of training has been implemented in at least one state division with plans to implement across all locations.
To guide new employees’ professional growth during their first year, all staff are provided with a one-year training plan specific to their job. The first 90-180 days of each plan is dedicated to orientation and on-the-job training. The third and fourth quarters emphasize career path development by providing opportunities for professional growth (e.g., cross training for positions that would be a promotion). This aspect of training is currently being rolled out in one state division with plans to implement across all locations.
Professional Development Plans
Professional development plans serve as a planning tool for employee growth and development. This tool prompts supervisors to define professional goals, align goals with internal training and professional development activities, and coordinate goals with external training and professional development activities. Internal activities might involve completing various organizational trainings (e.g., expert speaker presentations), observing and learning job requirements of closely related positions, and receiving mentorship. External activities might include professional conferences, training workshops, and university courses. Melmark offers a tuition reimbursement benefit to create an avenue for employees to further their professional development.
Outcome of Training Program
Previous research has indicated (e.g., Kazemi, E., Shapiro, M., & Kavner, A., 2015. Predictors of intention to turnover in behavior technicians working with individuals with autism spectrum disorder, Research in Autism Spectrum Disorder, 17, 106-115; Novack, M. N., & Dixon, D. R., 2019. Predictors of burnout, job satisfaction, and turnover in behavior technicians working with individuals with autism spectrum disorder, Review Journal of Autism and Developmental Disorders, DOI 10.1007/S40489-019-00171-0) that the enhanced training model described above would increase retention of DSPs. Since the implementation of the program, Melmark has seen an 36% decrease in staff turnover (i.e., 47% to 29%). Compared to the national average of 45%, Melmark currently is 16% below the average. This increased retention directly impacts the individuals served because it is 91 positions that did not need to be hired and trained during the year. Melmark is committed to achieving a manageable rate of staff turnover and to creating a highly skilled workforce to better support our employees and the individuals we serve.
The DSP workforce crisis is a current issue with projections indicating it will continue to worsen. As shown by various entities, there are several variables to act upon that will lessen the crisis. In relation to occupational identity and job training, there are big picture opportunities such as state credentials (e.g., State of New York Competencies) and accredited organization credentials (e.g., RBT®). Additionally, organizations can move to adopt training and professional development practices that encourage these same outcomes.
Shawn P. Quigley PhD, BCBA-D, is Senior Director of Clinical Services and Professional Development; Jennifer Ruane MS, BCBA, is Director of Clinical Training; and Lindsey Dunn MA, SPHR, CPHRM, is Senior Director of Human Resources at the PA Division of Melmark.