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Developing qualified workers to support individuals with intellectual and developmental disabilities in home and community settings: an evaluation study
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Developing qualified workers to support individuals with intellectual and developmental disabilities in home and community settings: an evaluation study
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Content
Running head: DEVELOPING QUALIFIED WORKERS 1
Copyright 2019 Regina M. Morlino
Developing Qualified Workers to Support Individuals with Intellectual and Developmental
Disabilities in Home and Community Settings: An Evaluation Study
by
Regina M. Morlino
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2019
DEVELOPING QUALIFIED WORKERS 2
Abstract
This study incorporated a modified gap analysis to evaluate a health and human service agency
in developing qualified workers. Specifically, the purpose of the study was to evaluate the
degree to which the agency prepared direct care workers to meet state required proficiency on
Virginia’s DSP Competencies Evaluation tool, Section One (person-centered skills, values, and
attitudes). These workers, known as Direct Support Professionals (DSPs), provide home and
community supports to individuals with developmental disabilities (DD). Virginia requires
DSPs to be proficient on the use of person-centered practices to support clients, and this study
evaluated the knowledge and motivation of DSPs to meet this regulation. In addition, the study
looked at organizational influences that impacted performance levels such as agency training and
supervisor feedback. The study used qualitative data collection including interviews,
observations, and document analysis to identify the strengths and needs of workers’ knowledge
and motivation to demonstrate person-centered skills, values, and attitudes and to analyze
organizational influences. Data indicated DSPs were motivated to provide supports and had the
knowledge to demonstrate the skills, but most were not able to name or label their practices as
person-centered. Data also indicated that DSPs were often inundated with too much information
at training sessions. It is therefore recommended that the organization modify their current
training content and format, include job aids to develop conceptual knowledge of the state
requirements, and offer practice opportunities for DSPs to strengthen person-centered practices
to the point that they become automatic.
Keywords: DSPs, competencies, person-centered practices, developmental disabilities
DEVELOPING QUALIFIED WORKERS 3
Dedication
To my nephews, Clayton (1989-2018) and Michael (2001-2012) – you both had a passion
for learning and inspire me every day. You will forever be in our hearts. And to the next
generation – Wyatt, Brayden, and those that follow – be kind to others, find joy in each day,
never stop learning, and remember to always find time to call your Mama.
DEVELOPING QUALIFIED WORKERS 4
Acknowledgements
This has been quite the journey – one I did not take alone. I am grateful for the support
of so many but would like to especially name a few that made this lifelong dream a reality.
The passion for learning came from my parents, Joe and Ellie Marasco. You taught us
we could do anything we put our minds to and committed to with all our hearts. Turns out, once
again, you were right. Thank you for your love, support, and encouragement in so many ways. I
am proud to be your daughter.
My folks also taught us to surround ourselves with good people. Mike Colarusso, my
battle buddy – you have been there for me from the beginning. I will forever be grateful for your
wisdom, your support, your friendship, and sometimes, even the target practice – GO NAVY!
Curt Baker, the godfather – you captured my heart at our first Immersion by taking Lisa, Andrea,
Julie, and me on a tour of some of your favorite spots on campus from your undergraduate days
at USC. Much respect, my friend; thanks for always being there. Bora Kim, my Seoul Sister
and Soul Sister – we shared our first class together and have communicated thanks to FaceTime,
WhatsApp, and Zoom every week of the program since. I will forever treasure our friendship
and “permitted moments.” To the rest of Cohort 7: if seven wasn’t already my favorite number,
it surely is now. From the Madhouse to Super Woman (Candy) to 2.0 (Mike L.) to Top Gun
(Zach) to Yoda (Galvin) to Teta (La Verne) to Lil Sis (Gwen) and all the rest of my incredible
classmates that will forever hold a special place in my heart. Thank you for running this race
with me. I am humbled to be a part of such amazing people, amazing leaders. You give me
hope that we can indeed make this world a better place.
To the faculty and staff at University of Southern California’s Rossier School of
Education – I am proud to be a Trojan and proud to have been first a student and now a
DEVELOPING QUALIFIED WORKERS 5
colleague. Though all my professors know how high maintenance I was as a student, three
professors stood out in taking so much time outside of the classroom to meet with me and
provide me invaluable feedback and encouragement, to challenge me, and to make me and this
project better overall. Thank you Dr. Eric Canny, Dr. Melanie Brady, and Dr. Jennifer Phillips
for your commitment, your time, your knowledge, and your passion for teaching and learning.
No dissertation gets written, reviewed, and approved without a committee. I will forever
be grateful to the professionals on my dissertation committee: Dr. Kimberly Hirabayashi (my
Chair), Dr. Alan Green, and Dr. Susan Sigler. I truly appreciate your support and guidance. Dr.
H., as hard as it was to “Trust the process,” you were right! Thank you for not giving up on me;
you were always so gracious to me with your time and patience. Your insight made me a better
student and a better leader. Dr. Green, thank you for challenging me to make this a better study.
Dr. Sigler, you have always been authentic and a true inspiration. Words are not enough.
Like an awards ceremony, I saved the MVPs for last. Angelo, my husband and my love –
you have been my biggest supporter who has made as many, if not more, sacrifices on this
journey as I have. Thank you for putting up with me, even before this program! You certainly
own a share of this accomplishment. Finally, to my five children, whom I adore, now that you
are grown and out of our house! (OK, that’s only partly true – I adored you when you were at
home, too, as long as you were sleeping!) Rose, you were my first peer reviewer, and you know
we aren’t peers! Thanks for taking the time to read all my drafts and answer all my questions,
even though you had your hands full as you started your PhD the same semester that I finished
my EdD. Go DAWGS! And to my boys – Vito, Vincent, Tony, and Terry – along with your
sister, you inspire and motivate me every day. Very proud of all of you; keep doing what you
can do to make this world a better place. You are the true change agents!
DEVELOPING QUALIFIED WORKERS 6
Table of Contents
Abstract ................................................................................................................................. 2
Dedication ............................................................................................................................. 3
Acknowledgements ............................................................................................................... 4
List of Tables ...................................................................................................................... 10
List of Figures ..................................................................................................................... 11
Introduction to the Problem of Practice .............................................................................. 12
Importance of Addressing the Problem .............................................................................. 13
Organizational Context and Mission .................................................................................. 13
Organization Performance Goal ......................................................................................... 14
Stakeholder Group of Focus and Stakeholder Goal ........................................................... 15
Purpose of the Project and Questions ................................................................................. 16
Review of the Literature ..................................................................................................... 17
Prevalence of Disabilities and History of Service Treatment ....................................... 18
Home and Community Living for Individuals with Disabilities ................................... 19
Funding for supports in home and community settings ........................................... 19
Social inclusion and person-centeredness ................................................................ 19
Direct Care Workers Supporting Individuals with Disabilities ..................................... 20
Workforce overview ................................................................................................. 20
Worker requirements ................................................................................................ 21
Development of Home Care Workers ........................................................................... 22
Training home care workers in specialized fields .................................................... 22
Providing feedback and follow-up training .............................................................. 23
DEVELOPING QUALIFIED WORKERS 7
The Clark and Estes Gap Analytic Conceptual Framework ............................................... 23
Stakeholder Knowledge, Motivation, and Organizational Influences ........................... 25
Knowledge ................................................................................................................ 25
Knowledge of VA’s DSP Competencies ............................................................. 26
Person-centered skills, values, and attitudes ....................................................... 26
Motivation ................................................................................................................ 28
Expectancy-value theory ...................................................................................... 29
Self-efficacy theory .............................................................................................. 29
Organization ............................................................................................................. 30
Organizational culture that values knowledge of person-centered practices ...... 30
Training ............................................................................................................... 31
Conceptual Framework: The Interaction of Direct Support Professionals'
Knowledge and Motivation with New Life Agency’s Organizational Context ................. 31
Qualitative Data Collection ................................................................................................ 32
Interviews ....................................................................................................................... 34
Observations .................................................................................................................. 35
Documents and Artifacts ............................................................................................... 37
Data Analysis ...................................................................................................................... 38
Findings............................................................................................................................... 39
Stakeholder Knowledge, Motivation, and Organizational Influences ........................... 40
Knowledge ................................................................................................................ 40
Knowledge of VA’s DSP Competencies ........................................................... 40
Person-centered skills, values, and attitudes ...................................................... 41
DEVELOPING QUALIFIED WORKERS 8
Motivation ................................................................................................................ 45
Expectancy-value theory ..................................................................................... 45
Self-efficacy theory ............................................................................................. 49
Organization ............................................................................................................. 51
Organizational culture that values knowledge of person-centered practices ...... 51
Training . .............................................................................................................. 53
Synthesis of Findings .................................................................................................... 57
Solutions and Recommendations ........................................................................................ 58
Knowledge ..................................................................................................................... 59
Increasing DSPs' conceptual knowledge of VA's DSP Competencies,
Section One ............................................................................................................... 60
Maintaining procedural knowledge to demonstrate person-centered skills ............. 61
Motivation ..................................................................................................................... 61
Organization .................................................................................................................. 61
Developing a culture that values knowledge of person-centered
skills, values, and attitudes ....................................................................................... 62
Establishing a cultural setting where person-centered practices
are the focal point of training, feedback, and reflection ........................................... 63
Limitations and Delimitations ............................................................................................ 66
Conclusion .......................................................................................................................... 67
References .......................................................................................................................... 69
Appendix A: Interview Sampling and Guide ..................................................................... 77
Appendix B: Observation Sampling and Protocol .............................................................. 83
DEVELOPING QUALIFIED WORKERS 9
Appendix C: Document and Artifact Sampling and Protocol ............................................ 87
Appendix D: Credibility and Trustworthiness .................................................................... 89
Appendix E: Ethics ............................................................................................................. 91
Appendix F: Integrated Implementation and Evaluation Plan ........................................... 94
Appendix G: Training Survey Immediately Following Program ..................................... 111
Appendix H: Delayed Training Survey Form .................................................................. 113
DEVELOPING QUALIFIED WORKERS 10
List of Tables
Table 1. Summary of Assumed KMO Influences and Assessments ................................. 24
Table 2. Interview Participants .......................................................................................... 39
Table 3. Participants’ Quotes on Valuing Person-Centeredness ....................................... 47
Table 4. Recommendations for Agency Needs ................................................................. 59
Table F1. Outcomes, Metrics, and Methods for External and Internal Outcomes ............ 96
Table F2. Critical Behaviors, Metrics, Methods, and Timing for Evaluation ................... 97
Table F3. Required Drivers to Support Critical Behaviors ............................................... 99
Table F4. Evaluation of the Components of Learning for the Program .......................... 104
Table F5. Components to Measure Reactions to the Program ........................................ 106
DEVELOPING QUALIFIED WORKERS 11
List of Figures
Figure 1. Interactive conceptual framework .................................................................... 32
Figure F1. Dashboard for survey results ......................................................................... 108
Figure F2. Dashboard of progress on external and internal outcomes ............................ 109
DEVELOPING QUALIFIED WORKERS 12
Developing Qualified Workers to Support Individuals with Intellectual and Developmental
Disabilities in Home and Community Settings: An Evaluation Study
Introduction to the Problem of Practice
Since the 1970s, when individuals with intellectual and developmental disabilities (I/DD)
began resettling from institutions into community residential settings, the demand for quality
Direct Support Professionals (DSPs) increased (ANCOR, 2011). Direct Support Professionals
are workers who provide training and assistance to individuals with I/DD in daily living
activities, health and safety needs, community integration, household tasks, social relationships,
in the workplace, and with other activities needed to live in community settings (Bogenschutz,
Hewitt, Nord, & Hepperlen, 2014). The United States Department of Health and Human
Services – USDHHS (2006) estimated in 2003 that 874,000 DSPs held part-time or full-time
positions working with individuals with I/DD. Between 2003 and 2020, the number of DSPs
needed to provide support will increase by 37%. The challenge will be meeting this growing
need with a qualified workforce.
The resettlement or deinstitutionalization movement increased the demands placed on
home and community service workers, but job requirements were not extensive and remain
minimal (Crites & Howard, 2011; Hewitt & Larson, 2007). A number of providers only require
DSPs to have a high school diploma, a valid driver’s license, and a criminal background
clearance for employment. Without adequately trained DSPs, many individuals with disabilities
will be at risk of being placed back into institutions. If this happens, the United States will have
failed in its promise that these individuals would enjoy the full scope of citizenship and be given
needed assistance to live where they choose (Hewitt & Larson, 2007).
DEVELOPING QUALIFIED WORKERS 13
Importance of Addressing the Problem
Addressing the shortage of qualified DSPs serving adults with I/DD in the community is
important for many reasons: to comply with federal laws, to ensure quality services, and to keep
individuals with I/DD in community settings. The United States has made a commitment to
individuals with disabilities through the Americans with Disabilities Act (ADA) and the
Olmstead Supreme Court decision to serve them in the least restrictive, most integrated setting
possible, and to do this requires a talented and stable workforce (Amado, Stancliffe, McCarron,
& McCallion, 2013). With the deinstitutionalization movement creating more opportunities for
individuals with I/DD to live in the community, DSPs have become a focal point in providing
supports and services (Bogenschutz et al., 2014). If the shortage of qualified DSPs is not
addressed, individuals may go without needed services. In addition, with known high turnover
rates in service organizations, individuals with I/DD may receive low quality services because
new staff are unfamiliar with them and may not understand their unique needs (USDHHS, 2006).
For these reasons, it is important to identify strategies or solutions to hire and adequately train
DSPs and sufficiently address the lack of qualified workers.
Organizational Context and Mission
New Life Agency (a pseudonym) is a private organization licensed by the
Commonwealth of Virginia to provide home and community services to individuals with
developmental disabilities (DD). [Note: Virginia’s classification of developmental disabilities
includes I/DD; therefore, DD will be used for the remainder of this project to include I/DD.] The
agency’s mission is to provide quality supports to individuals with developmental disabilities so
that they may live with dignity as productive citizens in the community. Direct supports and
services focus on daily living skills training, social skills development, adaptive behavior skills
DEVELOPING QUALIFIED WORKERS 14
acquisition, safety awareness, and other skills identified as important to and important for
individuals. The agency currently serves a total of 120 individuals between the ages of 11 and
85 in home and community settings. Individuals can have a diagnosis of developmental
disability or intellectual disability to receive services from New Life.
New Life employs 90 DSPs and 25 supervisory staff. The Administrative Team, made
up of the CEO, COO, and Coordinators, are responsible for ensuring compliance with state
licensing regulations and providing supervision and support to DSPs. Direct Support
Professionals are primarily responsible for providing direct supports to clients. As part of the
agency’s provider licensing criteria, Virginia mandates DSP training and an evaluation protocol.
To maintain its state license to provide services in Virginia, New Life must ensure all DSPs meet
state qualification guidelines.
Organization Performance Goal
New Life’s goal is that Direct Support Professionals will be 100% proficient on VA’s
DSP Competencies Evaluation tool by July 2019. The Department of Medical Assistance
Services (DMAS) is the fiscal manager of Virginia’s Medicaid funding services, and the
Department of Behavioral Health and Developmental Services (DBHDS) is the state’s provider
licensing and regulatory department. In 2016, the Commonwealth of Virginia’s General
Assembly authorized DMAS and DBHDS to establish regulations that improve quality services
for individuals with DD enrolled in Virginia’s Medicaid Waiver programs (Waivered Services
Regulations, 2016). This Emergency Regulation was designed in part to foster a more qualified
workforce by creating a set of competencies by which to evaluate DSPs providing state-licensed
services and to improve providers’ ability to deliver quality supports to individuals with DD
(Waivered Services Regulations, 2016).
DEVELOPING QUALIFIED WORKERS 15
When VA’s DSP Competencies Evaluation tool was published in September 2016, New
Life’s Administrative Team established an organizational goal so that the agency could comply
with state regulations. Without demonstrated proficiency on state competencies, DBHDS will
not permit DSPs to provide home and community services to individuals with DD in Virginia
(Virginia Administrative Code, 2016). New Life’s Administrative Team will monitor each
individual DSP’s success towards reaching proficiency in all competency areas using the state
mandated evaluation tool on an annual basis. If New Life is unable to meet its performance goal,
then the agency will not be able to provide home and community services to individuals with DD
in Virginia. In this situation, the individuals New Life currently serves may go without much
needed services or risk placement in institutions.
Stakeholder Group of Focus and Stakeholder Goal
New Life has a number of stakeholders that contribute to and benefit from the
achievement of the organization’s goal. One stakeholder is the Commonwealth of Virginia,
hereinafter referred to as the “State.” The State is responsible for monitoring all service providers
to ensure compliance with state and federal regulations. Another stakeholder is the
Administrative Team at New Life, responsible for training and supervising DSPs. The
Administrative Team needs to ensure the agency stays in compliance with state regulations and
all DSPs have the proper credentialing to provide quality services to meet State guidelines and
the agency’s mission. A third stakeholder group that contributes to and benefits from achieving
the organization’s goal is the collective group of DSPs. Direct Support Professionals are the
frontline workers expected to demonstrate the skills required by the State to show proficiency
and provide quality services to individuals with DD so New Life stays in compliance with State
regulations and meets its mission. A fourth stakeholder group that will benefit from the
DEVELOPING QUALIFIED WORKERS 16
achievement of the organization goal is the clients served by the agency. Performance levels of
DSPs have a direct impact on New Life’s clients and clients’ hopes of living safely and
independently in the community.
A complete analysis would involve all stakeholder groups. For practical purposes, this
study focused on the one stakeholder group with a direct link to the competencies training and
whom the competencies impact the greatest. Therefore, the stakeholders of focus for this study
are New Life’s DSPs. Direct Support Professionals’ ability to learn and deliver quality supports
are critical to New Life meeting its organizational goal. New Life’s Administrative Team
determined the stakeholder’s goal of being 100% proficient on VA’s DSP Competencies
Evaluation tool, Section One (person-centered skills, values, and attitudes) by April 2019 as a
progression towards becoming proficient on the entire evaluation tool. If the stakeholder’s goal
is not met, the organization will fail in meeting its organization goal, and New Life risks losing
its license, employees risk losing their jobs, and clients risk going without services.
Clients were considered as the stakeholder group of focus for this study, but with the
majority of New Life’s clients having a moderate to severe disability, it was determined that
clients most likely would not have the insight needed to accurately assess performance gaps. In
addition, it is unlikely that the Virginia’s Institutional Review Board (IRB), University of
Southern California’s IRB, or New Life agency itself would have granted approval to interview
this protected population.
Purpose of the Project and Questions
The purpose of this project was to evaluate the degree to which New Life is meeting the
organization goal that Direct Support Professionals will demonstrate 100% proficiency on VA’s
DSP Competencies Evaluation tool by July 2019. The project incorporated a modified gap
DEVELOPING QUALIFIED WORKERS 17
analysis as prescribed by Clark and Estes (2008) and focused on knowledge, motivation, and
organizational influences related to achieving the organization goal. While a complete
evaluation project would focus on all stakeholders, for practical purposes, New Life’s DSPs were
the stakeholders of focus in this analysis.
As such, the questions that guided this study were the following:
1. What are the Direct Support Professionals’ knowledge and motivation related to
achieving New Life’s goal of DSPs demonstrating 100% proficiency on Section One
(person-centered skills, values, and attitudes) of VA’s DSP Competencies Evaluation
tool by April 2019?
2. What is the interaction between New Life’s organizational culture and context and
Direct Support Professionals’ knowledge and motivation as it relates to achieving
New Life’s goal of DSPs demonstrating 100% proficiency on Section One (person-
centered skills, values, and attitudes) of VA’s DSP Competencies Evaluation tool by
April 2019?
3. What are the recommendations for New Life’s organizational practices in the areas of
knowledge, motivation, and organizational resources as they relate to achieving New
Life’s goal of Direct Support Professionals demonstrating 100% proficiency on
Section One (person-centered skills, values, and attitudes) of VA’s DSP
Competencies Evaluation tool by April 2019?
Review of the Literature
Examined in this literature review are variables that influence training for Direct Support
Professionals. The review begins with general research on the prevalence and history of
treatment for disabilities, followed by an overview of the literature on home and community
DEVELOPING QUALIFIED WORKERS 18
supports for individuals with disabilities. Next, the review includes research on the workforce
providing home and community supports. Following this is research on effective workforce
training and development practices. After the general research literature, a modified gap analysis
framework per Clark and Estes (2008) is presented. This framework identifies possible
knowledge, motivation, and organizational influences on DSPs and their success on meeting the
stakeholder performance goal.
Prevalence of Disabilities and History of Service Treatment
It is estimated that more than 40 million people in the United States, or more than 1 in 10
Americans, have a disability (U.S. Census Bureau, 2016). This one-year estimate from the
American Community Survey, indicating that more than 12% of the U.S. population has a
disability, included categories of disabilities such as difficulty with hearing, vision, cognition,
ambulatory, self-care, and independent living.
Over the last 50 years, largely due to public policy and a Supreme Court ruling, there has
been a shift from serving individuals with disabilities in institutions to allowing them to live in
the home settings of their choice. Wolfensberger (1972) identified the philosophy for
intellectually disabled individuals leaving institutions for community settings as normalization.
There was a shift known as deinstitutionalization where individuals with disabilities were no
longer placed in institutions but allowed to live in home and community settings of their choice
(Agranoff, 2013; Lakin, Prouty, Polister, & Coucouvanis, 2003). The United States Supreme
Court ruled in Olmstead v. L.C. and E.W. (1999) that states could not place individuals with
disabilities in institutions if their condition allowed for less restrictive community placements,
and they chose that option (Agranoff, 2013).
DEVELOPING QUALIFIED WORKERS 19
Home and Community Living for Individuals with Disabilities
The deinstitutionalization movement saw individuals with DD leaving institutional
settings to live in less restrictive community and residential homes. This resettlement
necessitated different support needs including funding and inclusion efforts.
Funding for supports in home and community settings. With the majority of
individuals with DD in the U.S. choosing to live in their own homes or other community
settings, funding these living arrangements became a primary emphasis. The passage of the
1981 Omnibus Budget Reconciliation Act helped facilitate the deinstitutionalization movement
for people with long-term healthcare needs by authorizing state administrators through Section
1915 of the Social Security Act to operate Home and Community Based Services (HCBS)
waivers (Friedman, 2017; Rizzolo, Friedman, Lulinski-Norris, & Braddock, 2013; Velott et al.,
2016). By waiving a number of Medicaid requirements, the 1915 (c) waivers facilitate the
opportunity for individuals at-risk of institutional placement to be supported in the general
community or their own homes (Velott et al., 2016). With more than 75% of long-term services
and supports (LTSS) funded by Medicaid’s Home and Community Based Services waivers,
HCBS waivers are the primary source of LTSS for individuals with DD (Braddock, Hemp,
Tanis, Wu, & Haffer, 2017; Rizzolo et al., 2013).
Social inclusion and person-centeredness. Once individuals with DD are physically
located in the community, social inclusion with a person-centered focus should be a primary
emphasis on supports. Amado et al. (2013) emphasize the importance of individuals with DD
being members of the community or having a sense of belonging to the greater community
which should involve having significant relationships with non-disabled peers. It is not enough
for individuals with DD to simply be in the community because of deinstitutionalization; social
DEVELOPING QUALIFIED WORKERS 20
inclusion is important to feel part of the community with meaningful social relationships (Amado
et al., 2013; Callicott, 2003).
Person-centered planning focuses on social inclusion, along with empowerment and
normalization for individuals with disabilities, and is a valuable tool that keeps the individual
with disabilities the central focus of any planning process (Griffiths, Summers, & Stavrakaki,
2002). Involving family, friends, service providers, and other advocates in the ongoing process
of planning home and community supports, person-centeredness ensures the person with a
disability is not only the primary focus but maintains ownership in planning for a healthy life,
inclusive of dreams and desires (Griffiths et al., 2002; Westgate & Blessing, 2005). This
planning process is a meaningful one, inclusive of the individual’s plans for work, living, leisure
choices, and full participation in the greater community (Callicott, 2003). In order to facilitate
these inclusion efforts, trained direct care workers will be needed.
Direct Care Workers Supporting Individuals with Disabilities
Direct care workers provide supports and assistance that allow individuals with DD to
live safely and as independently as possible in the greater community. Quality supports are
dependent on the DSP workforce and worker skills.
Workforce overview. In addition to the need for qualified workers, there is a growing
concern of the retention of qualified workers with the expected growth in the number of
individuals with disabilities in the U.S. The United States Department of Health and Human
Services (2006) estimates that by 2020, nearly 1.4 million individuals with DD will need
supports to live safely in the community. However, the traditional workforce that fills DSP
positions, namely workers 20-39 years old, is expected to only increase by 7.2% by 2020, which
would fall short of the need for the DSP workforce.
DEVELOPING QUALIFIED WORKERS 21
Compounding this gap is a concern regarding DSP turnover. Turnover for this position is
due to low wages and impacts not only workers but also clients and service organizations
(Powers & Powers, 2011). With the current average pay rate of this position, DSPs with a family
of four would likely need to rely on a second source of income as their annual wages would be
below the federal poverty line (Bogenschutz et al., 2014). Firmin, Orient, Steiner, and Firmin
(2013) recognize the challenge of turnover for any organization; however, given the special
needs and limited development of the clients involved in this domain, turnover seems more
critical when working with individuals that have DD.
Seavey (2011) recommends that to meet the growing demands for home and community-
based services, organizations need to develop a more competent and stable workforce. Workers
that are tired or overworked and do not receive adequate training deliver sub-par quality care,
which results in underserved and dissatisfied clients (Seavey, 2004). Direct Support
Professionals are a critical link to the integration of individuals with DD into the general
community, and organizations must find ways to retain and support DSPs.
Worker requirements. While there is no widely recognized set of competencies, the
direct support profession requires a special skill set. Training for direct care workers is often
limited to one or two days when employees are first hired with minimal follow-up training on
service delivery, even though this workforce focuses on valuable human needs such as the safety
of individuals, daily living tasks, and emotional support (Hoge et al., 2016). While core
competencies for this workforce has gained national attention, Alaska is one of a few states to
introduce a cross-sector set of competencies for direct care workers that identified necessary
skills for health and human service workers (Hoge et al., 2016).
DEVELOPING QUALIFIED WORKERS 22
Hewitt and Larson (2007) emphasize that a qualified direct care workforce is vital to
support individuals with DD, so individuals can live where they choose and be full participants
in family and community activities. With the commitment that the United States has made to
individuals with disabilities, it is critical to have a qualified, stable workforce (Amado et al.,
2013). A qualified workforce will facilitate increased integration of individuals with DD into the
general community.
Development of Home Care Workers
The development of home care workers in several health and human service fields has
been successful due to training in specific industry standard practices as well as efforts that
involve direct feedback and ongoing training for workers. These practices would benefit all
home care workers, including DSPs.
Training home care workers in specialized fields. There is limited research on the
creation of industry-standard practices or competencies for workers serving individuals with DD
in home and community settings. There are, however, other fields such as gerontology, applied
behavior analysis (ABA), and mental health care which have had success implementing training
programs that may be useful for DSPs working with individuals with DD. Paraprofessionals are
direct care workers that work in the field of geriatrics aiding in the areas of feeding, dressing,
and bathing when individuals cannot care for themselves (Stevens-Roseman & Leung, 2004).
Though these workers are often not prepared entirely for their roles, when agencies put efforts
into applied training programs with systematic evaluations, paraprofessionals’ morale,
knowledge, and skills have all been positively impacted (Stevens-Roseman & Leung, 2004).
Luiselli, Bass, and Whitcomb (2010) emphasize the critical nature of staff training in behavioral
health care organizations. One agency conducted a study focusing on ABA orientation for new
DEVELOPING QUALIFIED WORKERS 23
hires working with adults with DD and effectively administered an on-the-job training protocol
that was both practical and efficient. Pre and post tests were administered along with a social
validity questionnaire. It was concluded that the training program was effective, and targeted
knowledge competencies increased in new hires (Luiselli et al., 2010). In the area of mental
health services, Styron, Shaw, McDuffie, and Hoge (2005) acknowledge the quality of service
and safety of the clients are negatively impacted by poor training of direct care workers. Good
training has increased workers’ self-efficacy in fulfilling duties and improved the quality of
services in the mental health sector (Styron et al., 2005).
Providing feedback and follow-up training. In addition to on-going training, specific
and direct feedback will enhance the development of direct care workers in health and human
service fields. Schute (2008) explains in the learning process, feedback is often more helpful
when it describes the what, how, and why of a given circumstance, situation, or expected
outcome. In addition, Kluger and DeNisi (1996) emphasize feedback is important for learning
and should be specific to a given task, not the worker. When feedback is communicated to
workers in a direct and clear fashion, learning is enhanced (Schute, 2008).
Direct feedback and ongoing training positively impact workers and the quality of work
performed. A conceptual framework would be useful in identifying influences on workers’
performance towards achieving a goal, specifically influences in the areas of knowledge,
motivation, and organizational processes.
The Clark and Estes Gap Analytic Conceptual Framework
Clark and Estes (2008) provide a conceptual framework for reviewing an organization’s
performance whereby an organization measures any gap between its current performance and
where it needs to perform to achieve a goal. This technique is known as gap analysis, and
DEVELOPING QUALIFIED WORKERS 24
concepts of knowledge, motivation, and organizational influences (KMO) are examined in
relation to the stakeholder and the achievement of the performance goal (Clark & Estes, 2008).
Each component of Clark and Estes’ (2008) KMO gap analysis was studied to see how
knowledge, motivation, and organizational processes impacted DSPs’ ability to achieve their
goal of 100% proficiency on VA’s DSP Competencies, Section One (person-centered skills,
values, and attitudes) by April 2019. Table 1 highlights the assumed KMO influences and
assessments of this study.
Table 1
Summary of Assumed KMO Influences and Assessments
Stakeholder Goal
By April 2019, DSPs will demonstrate 100% proficiency on Virginia’s DSP Competencies
Evaluation tool, Section One (person-centered skills, values, and attitudes).
Assumed Knowledge Influences
Knowledge Influence Assessments
Knowledge (Conceptual): Direct Support
Professionals need conceptual knowledge to
articulate VA’s DSP Competencies.
Interviews and Observations.
Knowledge (Procedural): Direct Support
Professionals need to know how to
demonstrate person-centered skills, values,
and attitudes.
Interviews, Observations, and Document
Analysis.
Assumed Motivation Influences
Motivation Influence Assessment
Motivation (Value):
Direct Support Professionals need to see the
value in person-centered practices.
Interviews and Observations.
Motivation (Self-efficacy): Direct Support
Professionals need to believe they can provide
person-centered supports.
Interviews.
Assumed Organizational Influences
Organizational Influence Assessments
Organization (Cultural model): New Life
needs to have a culture that values knowledge
of person-centered practices.
Interviews and Observations.
DEVELOPING QUALIFIED WORKERS 25
Organization (Cultural setting): New Life
needs to establish robust training that
provides DSPs with resources and direct
feedback to ensure proficiency on VA’s DSP
Competencies, Section One (person-centered
skills, values, and attitudes).
Interviews, Observations, and Document
Analysis.
Stakeholder Knowledge, Motivation, and Organizational Influences
Knowledge. The examination of knowledge draws from the Educational Taxonomy,
originally published in 1956 and revised in 2002 by David Krathwohl. In this taxonomy, there
are four types of knowledge: factual, conceptual, procedural, and metacognitive (Krathwohl,
2002; Rueda, 2011). Factual knowledge is made up of basic elements such as common facts like
terminology or details of a specific domain needed to understand or solve a problem in a
discipline (Krathwohl, 2002; Mayer, 2011; Rueda, 2011). Conceptual knowledge is the
interrelationships of basic elements that make up a larger structure of a domain area such as
categories, classifications, models, and principles (Krathwohl, 2002; Mayer, 2011; Rueda, 2011).
Procedural knowledge is the “how to” part of knowledge such as a step-by-step process to do
something, or knowing specific skills, algorithms and techniques, or methods of inquiry that lead
to accomplishing specific activities (Krathwohl, 2002; Mayer, 2011; Rueda, 2011).
Metacognitive knowledge refers both to the awareness of and control of one’s own cognition,
also known as self-knowledge, which aids a learner in knowing when and why to perform certain
actions (Krathwohl, 2002; Mayer, 2011; Rueda, 2011). Since instructional strategies and
assessment methods vary depending on the knowledge influence identified in each situation, it is
important to differentiate between knowledge types. An evaluation of New Life’s stakeholder
performance goal reveals two knowledge influences that are likely to impact achievement of this
goal.
DEVELOPING QUALIFIED WORKERS 26
Knowledge of V A ’s DSP Competencies. New Life’s Direct Support Professionals need
knowledge of VA’s DSP Competencies’ expectations, including the specific contents of the DSP
Competencies Evaluation tool, to achieve the stakeholder goal. Rueda (2011) contends that if
learners do not know what they are expected to know, they will have a hard time achieving
goals. Virginia’s Emergency Regulations of the Administrative Code (Virginia Register of
Regulations, 2016) requires all DSPs to receive training on core competencies related to
characteristics of individuals with developmental disabilities. Recommended training will
include knowledge of Virginia’s DD waivers, person-centered practices, specific health risks,
and best practices to support individuals with DD. Direct Support Professionals must then pass a
State-approved test of skills and knowledge prior to providing services reimbursed by State
waivers, and knowledge will be confirmed during State compliance audits (Virginia Register of
Regulations, 2016). Therefore, New Life’s DSPs need knowledge of the various principles and
theories of the competencies tool. Based on Krathwohl’s (2002) classification, this would be
considered conceptual knowledge. With a growing number of individuals with DD living and
working where they choose, service organizations face an increasing challenge to provide
qualified and competent DSPs to meet their needs (Hewitt et al., 2004). In recent years,
organizations are employing competency-based training efforts to strengthen the knowledge and
skills of DSPs, particularly in areas of community integration, health, safety, and rights and
choices of individuals with DD (Bogenschutz, Nord, & Hewitt, 2015). Virginia includes
components of these areas of focus in its DSP Competencies curriculum (Waivered Services
Regulations, 2016).
Person-centered skills, values, and attitudes. The first competency in VA’s DSP
Competencies Evaluation tool focuses on person-centered skills, values, and attitudes.
DEVELOPING QUALIFIED WORKERS 27
According to Bogenschutz et al. (2015), competency-based training methods have been
successful in assisting DSPs in strengthening skill sets which should lead to improved quality
services for individuals with DD. A person-centered approach provides the foundation for all
subsequent supports and offers a collaborative perspective of what a good life looks like to and
for the individual with a disability (Westgate & Blessing, 2005). New Life’s DSPs need to know
how to demonstrate person-centered skills, values, and attitudes to achieve the stakeholder goal,
a procedural knowledge type.
There are 11 specific competencies in Section One of VA’s DSP Competencies
Evaluation tool that DSPs are required to demonstrate (Virginia Department of Behavioral
Health and Developmental Services, 2016). Competencies related to person-centered skills,
values, and attitudes include:
1. Articulate the value of choices in one’s life, and offer individuals real choices in a
variety of ways.
2. Describe the value of natural supports, and facilitate interactions with others in
natural settings with persons without disabilities (other than those paid to support
the individual).
3. Describe the value of community integration, and support individuals to locate
and participate in community activities that reflect the individual’s personal
preferences and assures they are safe and accessible for them.
4. Articulate that people with disabilities have unique needs and preferences and
need supports tailored in different ways.
5. Convey an understanding of behavior as a means of communication.
DEVELOPING QUALIFIED WORKERS 28
6. Demonstrate understanding of what is important TO and important FOR the
individuals they support.
7. Describe and record new learning about the individuals they support.
8. Listen to individuals and share ideas for planning, such as suggesting other
services or supports available (including natural supports) that might be helpful in
achieving desired outcomes for the individuals supported.
9. Communicate respectfully, as demonstrated by age appropriate and person-first
language, typical tone of voice; refrain from being condescending or parent-like.
10. Pay close attention to both words and actions in understanding communication.
11. Communicate effectively with individuals about support being provided (e.g.,
asking permission before touching, stating steps about to occur regarding
transfers, etc.).
For the purposes of this study, only the first seven competencies were evaluated to help
answer the research questions since they focus specifically on DSPs. The remaining four
competencies in Section One involve communication with clients, and since no data was
authorized to be collected on clients, these competencies were not evaluated in this study.
Motivation. Motivation consists of three critical indicators that affect outcomes of goal
achievement: active choice, persistence, and mental effort (Clark & Estes, 2008; Rueda, 2011).
Active choice involves people choosing activities that lead to goal achievement; persistence
refers to actions people take to pursue their goal when faced with other goals and distractions;
and mental effort is an investment to persist and work “smarter” to develop novel solutions
(Clark & Estes, 2008; Rueda, 2011). These three common indicators will have a significant
impact on whether New Life’s DSPs achieve their performance goal. An evaluation of New
DEVELOPING QUALIFIED WORKERS 29
Life’s stakeholder performance goal reveals two motivational influences that impact
achievement of the goal; expectancy-value theory and self-efficacy theory influence DSPs
reaching their performance goal.
Expectancy-value theory. Direct Support Professionals need to see value in person-
centered practices. As Eccles (2006) noted in her approach on expectancy-value, it is relevant
for DSPs to ask themselves if they can even complete the task and possibly more importantly, is
it something they even want to complete. Even if DSPs feel they can do person-centered
practices, if they do not see the value in the practices or want to do the task, it is unlikely they
will carry out the practices. Four constructs are delineated within the expectancy-value theory:
intrinsic value, attainment value, utility value, and cost value. Eccles (2006) and Rueda (2011)
explain that intrinsic value identifies the interest or enjoyment a person feels in an activity;
attainment value is achieved when one does well or identifies with a task; utility value refers to
the usefulness of a given activity to achieve a long-range goal; and cost value is how much time
and effort is needed to engage in the activity. Expectancy-value theory and the value DSPs place
on person-centered practices influence whether they are successful in achieving the stakeholder
goal.
Self-efficacy theory. Direct Support Professionals need to believe they can provide
supports with person-centered skills. Self-efficacy, the belief people can achieve intended
results, impacts peoples’ goals and efforts (Bandura, 1982, 2000). Self-efficacy theory, like
expectancy-value theory, is linked to active choice, persistence, and mental effort, and is
important when learners are engaged in difficult tasks (Rueda, 2011). People with high self-
efficacy believe in their own competence and expect great outcomes, which will lead them to
make an active choice to engage in, persist in, and put forth the mental effort to achieve the goal
DEVELOPING QUALIFIED WORKERS 30
(Rueda, 2011). Evidence shows people are more likely to pursue activities and tasks that they
feel competent in their ability to complete and will avoid those when they do not feel confident
or competent (Pajares, 2006). Self-efficacy theory is a contributing factor to the motivation of
DSPs in achievement of the stakeholder goal.
Organization. When examining the organization’s impact on stakeholders achieving
their goals, it is important to examine work processes including organizational culture and
material resources (Clark & Estes, 2008). Culture can be described as all that a particular group
or entity learns as it evolves (Schein, 2017). Gallimore and Goldenberg (2001) explain that there
are cultural models which are generally invisible, shared bits of understanding of how things
work or should work, and cultural settings, which are concrete displays of what happens when
two or more people work together within activity settings. Cultural models and cultural settings
can influence an organization’s success or failure when working towards performance goals. An
evaluation of New Life’s stakeholder performance goal reveals two organizational influences
that likely impact stakeholders’ achievement of this goal.
Organizational culture that values knowledge of person-centered practices. As
Gallimore and Goldenberg (2001) point out, cultural models in organizations are what is ideal
and valued. New Life Agency needs to value knowledge in person-centered practices, since
Virginia mandates that DSPs rate a level of proficiency in this area on the State’s competencies
evaluation tool and will confirm DSP knowledge during State compliance audits (Virginia
Register of Regulations, 2016). Organizational culture of knowledge begins with the leaders of
New Life in establishing a conducive climate to organizational change needed to meet the State’s
new regulations. As Schneider, Brief, and Guzzo (1996) establish, the values that are important
to employees will impact their reaction to organizational practices. New Life leaders need to
DEVELOPING QUALIFIED WORKERS 31
make clear the expectations of the State and the agency and establish practices that reinforce a
culture of knowledge until the culture becomes, as Gallimore and Goldenberg (2001) reference,
something taken for granted.
Training. New Life needs a robust culture of training to provide DSPs with needed
resources and direct feedback to ensure quality work and proficiency on person-centered
competencies. As Luiselli et al. (2010) point out, training for staff is critical in health care
organizations and must be practical and often integrated while workers are on the job. To
improve the quality of care, it is vital to have vigorous training programs that develop the
workforce (Styron et al., 2005). Feedback needs to be communicated clearly to improve learning
outcomes (Schute, 2008). This is valuable when DSPs are working towards the stakeholder goal
and should describe the what, how, and why of the situation or expected outcome (Schute, 2008).
Conceptual Framework: The Interaction of Direct Support Professionals’ Knowledge and
Motivation with New Life Agency’s Organizational Context
According to Maxwell (2013), a conceptual framework gives the researcher a model that
helps frame a research study and provides a written and sometimes visual representation of the
tentative theory being constructed to explain what phenomena exists and why. The conceptual
framework for this study is depicted in Figure 1. The blue rectangle displays the organization
being evaluated and its cultural influences that will interact with stakeholders’ knowledge and
motivation influences, which are inside the red circle. These influences, based on general
literature review and experiential knowledge, interact and lead to achievement of the stakeholder
goal, represented by the green rectangle. The conceptual framework figure shows that when
New Life values knowledge of person-centered practices and provides robust training and direct
feedback to DSPs, then DSPs gain the conceptual knowledge of competencies and the procedural
DEVELOPING QUALIFIED WORKERS 32
knowledge of person-centered skills, values, and attitudes they need to be qualified workers.
The qualified DSPs value person-centered practices and have the self-efficacy needed to provide
quality supports to individuals with DD in home and community settings. These influences all
interact, and DSPs will demonstrate 100% proficiency on Section One of VA’s DSP
Competencies Evaluation tool by April 2019.
Figure 1. Interactive conceptual framework.
Qualitative Data Collection
Data collection methods included interviews, observations, and document analysis. This
multi-method approach was well suited for the conceptual framework of this study and provided
DEVELOPING QUALIFIED WORKERS 33
the opportunity for rich data collection to answer the research questions. Interviews, which
began in mid-October 2018 and took approximately two weeks to complete, provided the
opportunity to gather data on all assumed KMO influences. Observations, which included a
combination of worker field observations and staff training observations, lent themselves to
evaluating conceptual and procedural knowledge of stakeholders. Worker observations,
conducted over the course of one week in November 2018, were used to assess stakeholders’
value and motivation in choosing to engage in person-centered practices. Training observations,
which began in late September 2018 and continued into mid-October 2018, were valuable in
assessing the organization’s cultural setting. Data obtained from observations were compared
with data garnered from interviews. Document analysis, which was conducted over the course of
three weeks on-site beginning in late September 2018, was specifically used to analyze
stakeholders’ procedural knowledge and the organization’s cultural setting. The review included
de-identified client case notes, agency policies and procedures, training calendar, training
agendas, and training curriculum.
To introduce myself and the study to DSPs, I attended a staff payday session at the
agency on September 28, 2018. No members of the New Life Administrative Team were present
when I explained the study and asked for volunteers to participate, offering DSPs an opportunity
to share their insights while lending to the field of study and industry practices. I distributed
contact cards with my name and contact information asking DSPs to contact me if they were
interested in participating in the study. I followed this introduction up by asking for volunteers
at two DSP training sessions in early October, again ensuring that no members of New Life’s
Administrative Team were present. Between these three invitations, I received phone calls,
DEVELOPING QUALIFIED WORKERS 34
texts, or emails from 14 volunteers. When I followed up with each volunteer, only 11 agreed to
participate in the study. Appendix A identifies the criteria for participating stakeholders.
Interviews
Using open-ended questions, I interviewed 11 DSPs via telephone, which was requested
by participants. Patton (2002) explains that interviews are used to find out things that
researchers cannot directly observe and give researchers an opportunity to learn others’
perspectives or to find out their stories in their own language. A semi-structured interview
approach to data collection was utilized with the 11 volunteers. Merriam and Tisdell (2016)
reinforce that most of a semi-structured interview is framed by a series of questions or topics that
give the researcher flexibility in modifying the wording or order as appropriate for each
interview. Probes, which Merriam and Tisdell (2016) define as follow-up questions or
comments on content previously asked or answered, were used for clarification or elaboration.
An interview guide (see Appendix A) was used to provide a framework for the interviews.
Patton (2002) notes that an interview guide, which is a list of questions to be used, helps keep the
interviewing process systematic and comprehensive. Interview guides are valuable when a
number of different people are being interviewed.
Merriam and Tisdell (2016) note the importance of a beginning interviewer to remain
neutral, respectful, and non-judgmental. The open-ended questions used in the semi-structured
interviews addressed each assumed KMO influence in the study. Data collected in this phase
gave me a strong understanding of the stakeholders’ knowledge and their perspective on
motivation and cultural influences that impacted their performance. This data was useful in
determining what specifically should be reviewed in document analysis, specifically client case
notes, and also what to look for in observations. Each interview lasted approximately one hour
DEVELOPING QUALIFIED WORKERS 35
or less in length. With permission from each participant, I recorded the interviews with an audio
device that was password protected. I took notes throughout the interviews to document
observer’s comments, hoping they would lend insight to the interviews and complement the
audio recordings.
Observations
Observations allow us to see overt behavior (Merriam & Tisdell, 2016). After the
interview phase of this study, I asked DSPs for their permission to observe them in a public
setting. I observed three DSPs on community outings. Data was only collected on DSPs, as they
were the stakeholder of focus for this study; no data was collected on clients or any individual
not giving informed consent and not approved by the University’s Institutional Review Board for
the purposes of this study. Specifically, I observed and documented the presence or absence of
the KMO influences identified in this study’s conceptual framework using the protocol in
Appendix B. New Life’s CEO granted permission for observations with the guarantee that
HIPAA regulations would be followed, and programming would not be disrupted. Each
observation lasted approximately one hour, and I wrote field notes using paper and pen to
capture as much detail as possible. Per recommended guidelines on recording observations from
Merriam and Tisdell (2016), I typed my notes on a computer as soon as was feasible following
the observations to record rich detail, summarizing the setting, recording reflective notes, and
adding diagrams, when applicable. Merriam and Tisdell (2016) note that observations should
include direct quotations when possible, observer comments should be recorded using initials
“OC,” and enough detail should be provided for readers to picture the setting. I believe
observations offered me the best possibility to determine the procedural knowledge of DSPs in
regard to person-centered skills and practices.
DEVELOPING QUALIFIED WORKERS 36
I also observed one New Hire/Orientation training and one annual staff training, both
included VA’s DSP Competencies curriculum. The New Hire/Orientation training had 13 newly
hired staff in attendance. The COO began the training by covering agency background,
organization chart, and benefits, as well as general agency policies and procedures. Following
these agenda items, the lead trainer took over, reviewing content such as risk management,
human rights, and the State’s curriculum for DSP competencies. During this portion of the
training, the new hires had to complete several forms and even took assessments for nearly every
agenda item. Some material was viewed on PowerPoints and some were in packets given to
each new hire. Forms and assessments were collected after each agenda item to be placed in
personnel files. As training was going on, I observed Human Resources staff pull some new
hires aside to review additional paperwork needed for their personnel file such as background
checks and tax forms.
The annual staff training was one of three training sessions scheduled; staff only had to
attend one session. The training I observed had 14 staff members, all but three were DSPs, and
the training was facilitated by the lead trainer. Content covered in the annual training session
included a review of human rights along with a knowledge assessment, review of agency
emergency preparedness procedures, and a review of risk management including an exercise in
properly using protective gloves for blood borne pathogens. After these activities, anyone who
was not a DSP was allowed to leave. Then a documentation specialist led the DSPs in a
discussion on proper documentation techniques and conducted an exercise where DSPs were
able to complete and review a mock client case note. The training concluded with the lead
trainer reviewing positive behavioral supports using a PowerPoint presentation followed by a
review of VA’s DSP Competencies curriculum, also using a PowerPoint presentation.
DEVELOPING QUALIFIED WORKERS 37
Documents and Artifacts
Document analysis was conducted concurrently with other data collection phases and
consisted of reviewing the agency’s policies and procedures, client case notes, training calendar,
training agendas, and VA’s DSP Competencies training curriculum. To comply with HIPAA
regulations, client case notes were de-identified before the review phase using federal Safe
Harbor guidelines (USDHHS, 2015). No identifying information such as client name, date of
birth, social security number, medical identification number, or address were available to the
researcher. Names of the DSPs were also de-identified, and there was no way of identifying if
the case notes reviewed were written by any of the DSPs that volunteered for this study. New
Life’s CEO granted permission for document analysis and ensured that all documents were de-
identified per federal regulations prior to the review phase. The agency selected the case notes
that were included in document analysis. Notes were recorded using the protocol in Appendix C.
Document analysis helped gain a better understanding of the agency’s organizational culture as
well as DSPs’ knowledge, both key components in the study’s conceptual framework. Merriam
and Tisdell (2016) acknowledge that reviewing documents can be the most natural part of any
investigation because it is not as intrusive as other data collection methods. I found value in
reviewing client notes and what DSPs documented throughout the course of service delivery.
Merriam and Tisdell (2016) refer to an investigator reviewing documents as a personal snapshot
of what a participant thinks is important. This practice gave me insight into what person-
centered practices the DSPs deemed valuable enough to engage in and record on the client case
notes. The client case notes were also helpful in gaining insight into procedural knowledge of
DSPs, as they documented activities performed during supports, which often included person-
centered practices.
DEVELOPING QUALIFIED WORKERS 38
Data Analysis
Like many scholars of qualitative research, Merriam and Tisdell (2016) suggest that data
analysis be done simultaneously with data collection. Therefore, I began data analysis
immediately after my first observation and first interview. Memos have aided in the data
analysis process. Harding (2013) suggests that data memos give researchers an opportunity to
document information to be considered further in analysis. Miles, Huberman, and Saldana
(2014) recommend that the practice of writing memos begin from the start of field data and
continue until the final report as memos are valuable sense-making tools that complement any
study. Included in my memos were initial thoughts and concerns regarding the data or the
process and even included some initial assertions in relation to my conceptual framework and
research questions. As more data was collected, I began looking for patterns and themes across
data sets. To do this, I employed a process of coding. Merriam and Tisdell (2016) describe
coding as an activity in which the researcher pulls data such as a word or a phrase from the
study’s collection and gives it a designation for organization and retrieval purposes. Corbin and
Strauss (2008) explain that coding is a method of analysis where raw data is translated into a
conceptual realm. The concepts that come from the act of coding are then referred to as codes.
When I completed each interview, I outsourced transcribing to a third-party service, Rev.com.
Combing through each transcript in Microsoft Word, I initially highlighted words and phrases
that stood out as possible codes and transferred them to a codebook that I recorded in a Microsoft
Excel spreadsheet.
Coding and the entire data analysis process is an iterative one, and I continually read over
the transcripts, highlighting key words and phrases using different colors and text features, all the
while updating my codebook as appropriate. I highlighted phrases in the interviews of the
DEVELOPING QUALIFIED WORKERS 39
participants’ own words, a coding method that Miles et al. (2014) refer to as in vivo coding. In
another read of the transcripts, I marked a priori codes, which Harding (2013) describes as codes
derived from a researcher’s conceptual framework or prior readings. During another read of the
transcripts I began to employ axial coding strategies, which Harding (2013) refers to as a search
for commonality. The axial codes, or themes, where then transferred to my codebook.
All data collected was analyzed in relation to the conceptual framework and guided by
the research questions of this study. Data included interview transcripts along with observer
comments, observation field notes, and document analysis notations. Validity strategies for this
research project are identified in Appendix D: Credibility and Trustworthiness. All data was
collected and analyzed using ethical practices (see Appendix E).
Findings
The interviews, observations, and document analysis led to the findings for this study
reported below. Pseudonyms are used for the 11 DSP interview participants (see Table 2).
Findings are organized by the knowledge, motivation, and organization (KMO) conceptual
framework.
Table 2
Interview Participants
Participant (Pseudonym) Gender Years in the field as a DSP
Kenya Female Less than 1 year
Erenda Female 6 or more years
Antonio Male 6 or more years
Quincy Male 1-3 years
Glenda Female 6 or more years
Keisha Female 4-5 years
Michele Female 1-3 years
Lynette Female 1-3 years
Brenda Female Less than 1 year
Sabrina Female 6 or more years
Crystal Female 6 or more years
DEVELOPING QUALIFIED WORKERS 40
Stakeholder Knowledge, Motivation, and Organizational Influences
Knowledge. Given the stakeholder performance goal of 100% proficiency on VA’s DSP
Competencies Evaluation tool, Section One (person-centered skills, values, and attitudes), DSPs
need an understanding of what Krathwohl (2002) and Rueda (2011) refer to as conceptual
knowledge. DSPs need to articulate the theories and principles of person-centered thinking. In
addition to this conceptual knowledge, DSPs need to demonstrate person-centered skills and
practices in order for supervisors to confirm proficiency on VA’s DSP Competencies, Section
One. The “how-to” or knowing how to perform a skill is referred to as procedural knowledge
(Krathwohl, 2002; Rueda, 2011). Both conceptual knowledge and procedural knowledge impact
achievement of the stakeholder goal.
Knowledge of V A ’s DSP Competencies. Eight of 11 DSPs were not familiar with VA’s
DSP Competencies. Some were unable to recall specifics of the competencies while others had
no memory of the assessment at all. Michele expressed, “This is something I’m supposed to
know but my mind has gone blank; I truly can’t think right now.” When probed further, Michele
stated that she did not know about the VA DSP Competencies. She said, “I really don’t want to
admit that I don’t know them because I don’t want to look stupid.” Antonio acknowledged that
he could not recall off the top of his head, saying, “I’d be lying to you if I said I did.” He
continued, “I’ve had a lot of trainings, so I’ve probably taken it. I just can’t remember it.”
Antonio seemed familiar with the terminology but simply could not recall any specifics.
Two additional participants seemed to have never heard of VA’s DSP Competencies
before. When asked about the competencies, Lynette responded, “I don’t have any
understanding of them.” Similarly, Brenda responded with her own question, “What did you say
DEVELOPING QUALIFIED WORKERS 41
again?” When probed further, neither Lynette nor Brenda had any knowledge of the assessment
tool.
In other interviews, three DSPs were able to describe the specific training where VA’s
DSP Competencies were addressed and recalled there was a test but did not have knowledge of
specific skills covered or evaluated. In general, these DSPs summed up the competencies as
helping the individuals they support be more independent and meeting their wants and needs.
Specifically, Keisha noted that the competencies were designed, “to allow the client to have an
independent life to be able to do the things that make them happy.” She continued, “So, we
support them, their needs, and their wants.” Sabrina described the training as follows:
That’s a training to see how much you understand with this particular special needs
population…the purpose is to let you know how to handle a special needs individual in a
particular situation. Make them feel independent as possible.
This evidence indicates that a few DSPs remembered the training and at least the central
theme or purpose of the training. The lack of specific knowledge or recall reveals that most
DSPs do not have the conceptual knowledge to meet the stakeholder goal. Without the
conceptual knowledge of the competencies, DSPs will not score a proficient rating on the
assessment tool, as the State assessment requires DSPs to articulate specific principles within the
competencies. Without DSPs being 100% proficient on VA’s DSP Competencies, the agency
will not be in compliance with State regulations and risks losing its license. Observations and
document analysis were not used to determine DSPs’ conceptual knowledge.
Person-centered skills, values, and attitudes. Though participants were unable to name
or label the conceptual knowledge of VA’s DSP Competencies, data indicated that participants
demonstrated procedural knowledge of the State’s expectations on person-centered skills, values,
DEVELOPING QUALIFIED WORKERS 42
and attitudes. This procedural knowledge was evident throughout all 11 interviews, all three
observations, and in reviewing all five sets of weekly case notes during document analysis. As a
relative strength, knowing the skills required to provide person-centered practices will be an
asset that should be capitalized on to close the conceptual knowledge gap of articulating the
principles and concepts of VA’s DSP Competencies.
When asked during interviews to walk me through a day or an activity with a client
where person-centered skills were used, no participant hesitated to recall a scenario. Every
participant quickly went into describing a day or series of activities that indicated they
understood and carried out the procedural knowledge of person-centered practices. Kenya
explained that she and her client discuss his likes and interests to determine daily community
outings:
The first day I was with my client, I talked to him to see what he actually liked…I went
over his ISP with him…asked him where he liked to go. When he said he wanted to go
someplace different, we went on a hunt on the computer for volunteer work. That’s how
we came across our activities.
Erenda highlighted the importance of rights and choices when she replied:
Most people when they see a person with a disability, they see the disability first. My
client is an adult, and he has the right that every adult has. He can drink, he can go out;
he’s an adult. My job as his staff is to find the balance between letting him have a beer if
that’s what he wants to do but watching to make sure he doesn’t have 20 beers, because
he won’t stop. The clients have choices. That’s what person-centered care is all about.
When asked to share an account of a person-centered activity, Quincy responded:
DEVELOPING QUALIFIED WORKERS 43
When my client cooks, I have to make sure he eats a vegetable with his meal. He eats a
complete meal. With that, I have to explain sometimes why it’s important for him to eat
a vegetable instead of just letting him eat what he wants to eat. I have to explain it’s
important for you to eat the vegetable because it’s healthy and good for your body.
Likes, choices, and what’s important for a client are all elements of person-centered skills,
values, and attitudes (Virginia Department of Behavioral Health and Developmental Services,
2016). Each DSP demonstrated the procedural knowledge, the “how-to” in providing person-
centered care, by identifying the client’s likes, by giving the client choices, and by incorporating
“what’s good for” the client into the daily routine. These are the skills that DSPs need to
demonstrate in order to score a rating of proficient on Section One of VA’s DSP Competencies
(Virginia Department of Behavioral Health and Developmental Services, 2016). This knowledge
was evident when interviewing participants.
Similar to the interviews, data from observations indicated all three DSPs have
procedural knowledge of person-centered practices. The DSPs transported their clients into
community settings where non-disabled peers were present, which is a valued component of
person-centered care. On each respective outing, each DSP demonstrated procedural knowledge
while supporting their client. Erenda allowed her client to make a beverage choice after
explaining the consequences of choosing a caffeine drink after 6:00 p.m.; Kenya verbally
identified the menu items at the restaurant and gave her client the opportunity to order the lunch
of his choice; and Crystal had a discussion with her client when grocery shopping, explaining
why certain foods were good for his health and growth. All three participants demonstrated they
had the procedural knowledge that will lead to stakeholder goal attainment.
DEVELOPING QUALIFIED WORKERS 44
The case notes reviewed during the document analysis phase provided further evidence
that DSPs have the procedural knowledge needed to meet the stakeholder goal. Although I am
not certain who the DSPs were that completed the daily client case notes because the names were
redacted by New Life personnel, all five sets of client case notes I reviewed included
documentation that the DSPs were offering their clients choices, integrating them into the
community, communicating with them on their level, and nurturing natural supports. These are
all principles expected of DSPs in VA’s DSP Competencies. Client case notes are documents
that are required by the State to prove services were provided. They must include a narrative of
activities and clients’ progress on outcomes outlined in their Individual Person-Centered Plan. In
reviewing the client case notes, the DSPs seemed to have a strong understanding of the clients’
plan and outcomes and were thorough in their documentation of supports. All five sets of client
case notes reflected procedural knowledge that would meet state guidelines, including
identifying and engaging in activities that were “good to” the client as well as activities that were
“good for” the client.
Section One of VA’s DSP Competencies focuses on person-centered skills, values, and
attitudes which includes understanding the value of community integration, articulating the value
of choices, and demonstrating an understanding of what is “important to” and “important for” an
individual (Virginia Department of Behavioral Health and Developmental Services, 2016).
Interviews, observations, and a review of client case notes showed that participants have the
procedural knowledge of person-centered practices needed to reach the stakeholder goal. It is
the conceptual knowledge that needs to be strengthened or developed, because many participants
were unable to name what they were doing.
DEVELOPING QUALIFIED WORKERS 45
Overall, in terms of knowledge, it appeared participants simply were unable to name the
practices (conceptual knowledge) as required by Virginia regulations. Having the procedural
knowledge should help bridge this gap.
Motivation. Another influence on stakeholders reaching their performance goal is
motivation. To achieve the stakeholder goal, DSPs likely need to value what they are expected
to accomplish. In addition, DSPs need to believe in their abilities to perform the expectations, or
have self-efficacy, in order to meet the stakeholder goal. Self-efficacy impacts people’s active
choice in pursuing a goal, their persistence, and their mental effort (Clark & Estes, 2008; Rueda,
2011).
Expectancy-value theory. New Life DSPs who participated in this study value person-
centered practices. Evidence from all 11 interviews reveals that New Life’s DSPs value person-
centered practices in some way, which will be an asset for the agency in its efforts to achieve the
organizational goal. DSPs indicated that providing supports to meet the needs of the clients was
a priority and a driving force behind their everyday interactions with them. Other data collection
methods were explored to confirm this finding. The DSPs that were observed for this study
exhibited active choice by choosing to use person-centered skills and persisted in the observed
activities. Document analysis was not used to confirm this finding, as it is not an appropriate
method to identify motivational influences.
Participants were asked how important it was to provide supports using person-centered
skills, values, and attitudes. Crystal did not hesitate to respond:
It’s very important because basically our job is to meet the needs of the individual. So, for
it to be more geared towards them and following the plan is definitely important … what’s
important about it is, for me, I believe the meeting had to take place, so they feel like it is
DEVELOPING QUALIFIED WORKERS 46
important to the individuals. So, anything important to them, I feel like this is what I need
to be doing. So, it’s important for me to do my job.
Here Crystal references the Person-Centered Plan (PCP) that is created by the Team. The PCP
identifies outcomes “good to” and “good for” the individual, painting a picture of a good life for
the individual. Crystal is saying if the Team, led by the individual and includes family members,
service providers, and a support coordinator, identified the outcomes as “important to” or
“important for” the individual to be included in the PCP, then as a Direct Support Professional,
she is obligated to help the individual meet these outcomes. Crystal’s beliefs are an example of
the utility value construct, which Eccles and Wigfield (2002) and Rueda (2011) identify as useful
in facilitating achievement of future goals. Crystal’s statements indicate that she sees the value
in person-centeredness to meet the needs of her client.
Answering the same interview question, other participants also reflected utility value in
their responses. Glenda said, “Person-centeredness is of the utmost importance. It’s absolutely
imperative that we focus on the client, and that he is the center of all activity.” Sabrina
expressed a similar view:
It is very important because you want to make sure that the needs of the client are being
met. You can’t just go in there and work with the client and not know what their needs
are or what they’re working on, unless you look at the person-centered plan.
Likewise, Antonio stated:
Person-Centered supports are very important because if you look at it, we are guests in
their home. This is their home. I can’t come in here and just tell my client, ‘Hey, it’s
four o’clock, you better go and do this. You better go fix your lunch and dinner.’ This is
his house. If he doesn’t want to fix his dinner until nine o’clock at night, that’s his
DEVELOPING QUALIFIED WORKERS 47
choice. Our number one goal is to keep them safe and to meet their needs, but we should
always be giving them choices and respect that they are adults and in their own homes.
Antonio emphasizes that the client deserves the opportunity to make choices, provided his
client’s safety is not compromised. Like Crystal, Glenda, and Sabrina, Antonio expressed utility
value in person-centered practices.
Table 3 identifies the remaining seven participants’ responses to the question, “How
important is it to provide supports using person-centered skills, values, and attitudes?” Though
the majority of participants expressed utility value as the construct for the use of person-centered
practices, one DSP’s response indicated attainment value while another revealed intrinsic value.
Attainment value refers to a task reflecting one’s self-image (Eccles, 2006) or the importance
one feels in doing something well (Rueda, 2011). Intrinsic value is when one finds enjoyment
completing a task (Eccles, 2006; Rueda, 2011). No DSP revealed cost utility as their value
construct. Eccles (2006) describes cost utility as the cost someone perceives, or what they give
up, to engage in a task.
Table 3
Participants’ Quotes on Valuing Person-Centeredness
Value-related
constructs
Participant Responses
Utility Kenya
“Very important...Because, I mean, they're humans
too, they have rights, they have a say so in what they
want to do, and what they like to do and they, all of
'em, have a way of communicating to you about what
they want or what they need.”
Quincy
“It is very important because the client is the most
important thing; like that's your job. That's what you're
there for, so you want to be making sure you are
carrying out your job in a way that is centered around
them, in a way that is impactful to them.”
DEVELOPING QUALIFIED WORKERS 48
Keisha
“It’s important to me that I make sure I meet the needs
of that client. Whatever that is – improvements in
skills, less behaviors, whatever. I want what they want.
I want the client to be happy. I want the client to be
independent.”
Michele
“It's very important. They can't be active out in the
community...if they’ve never been taught and shown
how to be out in the community. It's the top of the list
that you got to make sure your client is pleased and
satisfied. Give them the care like you want somebody
to do you like that.”
Brenda
“The most important thing working with this agency is
keeping my patient happy, clean, and make sure I look
out for them. Make sure I can give them the best care I
can…It’s important that during your shift, the client is
the center of your attention the whole time you’re there
with that client; making sure that client gets what they
need.”
Attainment Lynette
“I want to be there for my client. I need to keep her
safe and healthy and clean…I kind of know what she
likes. That’s important to me.”
Intrinsic Erenda
“I think it's very important because like I said I'm
trying to help my client do the things that he would do
if he didn't need my help. And that's the main thing
about the job; that's why I like the job.”
Value was also evident when I observed a DSP providing community supports to a client.
I observed Erenda on a community outing to a pool hall with her adult client. When they walked
in, I overheard the client express that this was one of his favorite places. Erenda said, “Well,
that’s why we’re here.” The client wanted to buy a soda, and Erenda explained that it was after
6:00 pm and that he should consider a caffeine-free drink. The client chose a Yahoo milk drink
instead and paid with minimal verbal prompts. When at the register, Erenda encouraged the
client to communicate directly with the cashier. Erenda praised the client for his communication
efforts and his drink choice. She then asked the client if he wanted to play a game, and the client
quickly responded, “Yes.” The pair conversed throughout the game, talking about their day and
DEVELOPING QUALIFIED WORKERS 49
making plans for the next day. Erenda asked the client where he wanted to go and offered to
take the client to see his girlfriend. The client seemed very excited about this and expressed his
desire to see his girlfriend and possibly go to a movie. They planned to pick the girlfriend up the
next day and go see a movie. Throughout the observation, it was clear that Erenda had
procedural knowledge and also valued person-centered practices by providing the client choices,
supporting the client in community integration, and facilitating interactions with others.
When individuals value an activity, they are likely more motivated to engage in behaviors
that lead to goal achievement. Rueda (2011) emphasizes that the value a person places on an
activity directly impacts the individual’s choice to engage and persist in the activity. If DSPs
value person-centered practices, they are more likely to choose, persist, and engage in person-
centered practices. Interviews and observations indicate that New Life DSPs value person-
centered skills, values, and attitudes, which will help lead to the achievement of the stakeholder
goal. Document analysis was not used as evidence to determine stakeholder need in this area.
Self-efficacy theory. DSPs have strong self-efficacy in their abilities to support their
clients. All 11 participants interviewed expressed confidence in their work and the quality of
care they provide their clients. Most attributed their confidence to their experience in the field;
some believe it is just who they are as people and workers. When asked how she felt about her
ability to provide person-centered supports, Crystal responded, “I think I’m great. I stick to what
needs to be done, and I actually just do it. Not that I’m trying to toot my own horn.” When
asked what influenced her confidence in providing person-centered care, Crystal continued:
I would say just the amount of years that I’ve been in the field, and you know, I’ve grown
so passionate about it, and I understand how important it is to have your needs met. I just
know what the job entails, and even though its different for each individual, throughout
DEVELOPING QUALIFIED WORKERS 50
the years having to deal with so many different individuals, I feel like I pretty much dealt
with it all…I am a person that loves challenges, so I’ll take on any and everything. So
far, I’ve just been successful with it all.
Sabrina, likewise, is confident but believes additional training could be helpful. She said, “I feel
like I’m comfortable with person-centered planning, but having additional training on person-
centered planning would also be helpful because things are changing all the time, especially with
State regulations.”
In response to what influences her confidence, Sabrina stated:
I’m confident because I like helping people. I like helping people and I’m comfortable
with this population. I’m like this, treat somebody the way you would want to be treated.
If you want somebody to treat you with respect, then you should also treat that client with
respect.
Another DSP, Antonio, attributed his self-efficacy to training and experience. He stated, “I think
the education as well as the experience that I have in this field plays a big part. I believe in
myself and know this is what I was put here to do.”
All 11 participants seemed to have strong self-efficacy in their skills. They were
confident in their abilities to support their clients, which will be beneficial in achieving the
stakeholder goal. Rueda (2011) contends that prior knowledge, along with other factors
including past successes and failures, impacts an individual’s self-efficacy. With all 11
participants revealing some degree of self-efficacy in their ability to provide person-centered
supports, it is likely prior knowledge of the skills contributed to this motivational influence.
Observations and document analysis were not used to determine strengths or needs for this
influence. Interviews provided the most insight to determine participants’ self-efficacy.
DEVELOPING QUALIFIED WORKERS 51
Organization. In addition to knowledge and motivation influences, achievement of the
stakeholder goal is influenced by cultural models, which Gallimore and Goldenberg (2001)
describe as invisible understandings of how things ought to be, and cultural settings, which are
the concrete manifestations of the cultural models. At New Life, person-centered skills and
practices need to be part of the organizational culture, and training needs to be rich and robust in
order for DSPs to meet the stakeholder goal.
Organizational culture that values knowledge of person-centered practices. New Life
needs to develop a culture that values knowledge of person-centered skills, values, and attitudes.
Knowledge, particularly knowledge of person-centered practices, is not regularly reinforced or
nurtured according to participants. Evidence indicates that most DSPs are not certain what is
expected of them regarding person-centered practices and admit they have not received concrete,
specific feedback on performance. Only three DSPs interviewed could explain VA’s DSP
Competencies and have seen the evaluation tool. Eight out of 11 DSPs interviewed could not
give specific details or examples when asked how they were evaluated on knowledge of person-
centered skills, values, and attitudes. Five out of 11 participants could not provide examples of
how supervisors recognized knowledge of person-centered skills, values, and attitudes. Six
DSPs stated they had been recognized by supervisors with a thank you, but only one of those
employees gave a concrete example of why he was recognized. Antonio explains:
I think with my supervisor, we talk a lot. We talk, text…and he asks me exactly what do
I know about PCP. What do I know about my client…I know my client. I could tell you
his social security number, date of birth, all of his brothers, mom, address, everything.
It’s because I’m invested in ensuring that he has a good quality life, and if I was just here
for a paycheck, I wouldn’t care to remember any of that stuff.
DEVELOPING QUALIFIED WORKERS 52
Antonio continued and explained a time when he was nominated for employee of the month for
going out of his way to meet the needs of his client. “We had a blizzard, and my client needed
his meds. No one was there to give them to him. I wasn’t about to drive in the snow, so I
literally walked from my house to his apartment to give him his meds.”
Antonio was the exception; no other participant was able to recall any specific feedback
from their supervisor related to person-centered skills. Some DSPs could not recall any
feedback. Erenda conveyed that they aren’t really tested on person-centered skills, values, and
attitudes, while Lynette believes she probably has a good evaluation because she does not
complain, but she is not positive. Keisha states that the evaluations are, “Basic and there’s not
enough engagement.” She continues, “They don’t know me, how can they evaluate me?”
Finally, Crystal claims that “nothing specific to PCP per say” is provided to DSPs in terms of
evaluations.
Participants indicate that specific person-centered related feedback is not given. When
DSPs do receive feedback, it is vague, not concrete. Glenda explains:
Sometimes I don’t know what they want from me. I had an eval and I didn’t agree with
it. But they didn’t explain it to me. I wanted to say, what is it that you want from me?
How can I make this better; what am I not doing?’ Then if they explained that to me, I’d
say, ‘OK, I see that now,’ but that’s not happening. We might get evals but I don’t know
what they are based on or how they get their information.
Feedback does not appear to be helpful in providing person-centered skills according to most
DSPs, and the lack of concrete feedback seems to have a negative impact on stakeholders
achieving their goal. When supervisors do give feedback as described by Antonio, it helps foster
a culture of knowledge of person-centered skills, values, and attitudes.
DEVELOPING QUALIFIED WORKERS 53
Though no interactions were observed between supervisors and DSPs, I did observe
training sessions with new hires and veteran staff. The new hires were provided an assessment
on VA’s DSP Competencies curriculum, which was created by the State. The test was open-
book and all DSPs received a passing score. No feedback was given after the administration of
the assessment. I did not observe any DSP being assessed specifically with VA’s DSP
Competencies Evaluation tool. Agendas were distributed, and the trainer was very engaging and
included many ice-breakers to attempt to involve participants. Trainings were mostly lecture
with PowerPoints; no DSPs were observed taking notes.
Evidence from interviews and observations indicated that New Life needs to enhance the
culture so that knowledge of person-centered practices is valued. The majority of DSPs were not
familiar with VA’s DSP Competencies and revealed that they did not know what was expected
of them in terms of person-centered practices. Supervisors did not consistently provide concrete,
frequent feedback to reinforce knowledge of person-centered practices, and DSPs could not
recall being rewarded for knowledge of person-centered practices. Document analysis was not
used to assess this need.
Training. Participants appear to be overwhelmed with numerous topics in each training
session and have a difficult time retaining content or clearly articulating what they have learned.
Nine out of 11 DSPs interviewed revealed that they could not recall what was covered in training
sessions or had a difficult time discriminating between training sessions. A review of New
Life’s training calendars and agendas indicated that the agency conducts various DSP training
sessions throughout the year in an effort to reach their organizational goal. This evidence seems
to indicate a commitment to training; however, data from this study indicates that training
sessions may not consider the working memory of participants. Though various training sessions
DEVELOPING QUALIFIED WORKERS 54
are offered throughout the year, a number of topics are presented at each training, many topics
seemingly unrelated to the others.
When asked about specific trainings, most New Life’s DSPs interviewed for this study
indicated that there were some portions of training sessions that they could not recall. Brenda
stated, “Some trainings are running into others; there are so many.” When asked about content
and delivery of training sessions that focused on person-centered practices specifically identified
in VA’s DSP Competencies, Brenda responded, “I don’t know. Excuse me. I am so sorry. I
don’t remember.” Other DSPs had similar trouble with recollection. Crystal’s response to the
same question, “I really can’t remember the training.” Quincy’s insight was, “We do so much
training, I be forgetting what everything is called.” Michele simply responded, “I have no idea.”
These DSPs had trouble recalling specific training content or discriminating between training
sessions. A few DSPs suggested training and retention would be better if visuals were provided.
When asked what training tools were effective for learning or retention, Antonio responded:
I’m a visual person. Being able to get a pamphlet so that I can read over it to better
understand who I’m working with, what their needs are, what I’m expected to do would
help. I like PowerPoints, but I like to be able to actually read what they’re saying as well
in case I don’t hear something or in case I misinterpret the way they meant it. Then I’m
able to go back and re-read it and understand it better.
Similarly, Glenda responded,
If you want me to be the best DSP, then give me something…They have excellent
information, but I don’t have access to it. There was nothing for me…I’m a reader, so if
I have something to take home with me, then I would have gone back and looked at it….
I don’t think you can sit through hours of training and from there, without anything in
DEVELOPING QUALIFIED WORKERS 55
hand other than the black book that has the Part Five Plan and support sheets or my time
sheets or whatever…basically, there were still so many questions, and there were no
resources.
Antonio and Glenda indicated that New Life should provide resources such as hand-outs
or manuals during training sessions to help with their learning. They both believe they would be
better DSPs with these resources. Antonio and Glenda believe that if visuals or physical
resources are accessible to them after the training sessions, the resources would assist them in
information recall and ensure their understanding of training content.
In addition to interviews, I observed two training sessions at New Life – one new hire
orientation and one veteran staff annual training session. A great deal of information was
covered in each session, possibly contributing to participants’ difficulty in recalling or retaining
training information. In both observations, person-centered practices were the last agenda items
to be addressed, following at least five other training topics. Many of the other training topics
included written assessments and reviews, and after each training topic was presented, forms
were completed by participants to verify training participation and collected for placement in
their personnel files. Though the trainer was very dynamic in his presentation style, included
several short breaks throughout the sessions, and incorporated several movement activities, it
was difficult to gauge the attention of participants. When the topic of person-centered practices
was addressed in the last hour of the second training, many participants seemed tired and anxious
to leave. Several workers yawned or even got up from their chairs to stretch or walk around the
back of the meeting room. The trainer did not specifically reference VA’s DSP Competencies
Evaluation tool in either session, though he did address some of the content included in the
assessment. PowerPoint slides were used during the trainings, but the decks were very text-
DEVELOPING QUALIFIED WORKERS 56
heavy, and the trainer often read directly from the decks. No handouts or resources were
provided to the DSPs for this part of the trainings.
For the document analysis phase, I reviewed New Life’s policies and procedures, training
curriculum, training calendar, and training agenda, all of which indicated a strong commitment to
training. A review of the calendar revealed several training sessions related to person-centered
practices scheduled throughout the year for new hires and veteran staff. Training sessions were
planned at least once a month, with each training session typically scheduled for at least four
hours. Training agendas that were reviewed indicated that person-centered practices were
grouped with several other topics during training sessions. The person-centered practices
training curriculum was provided to the agency from Virginia’s licensing board. The curriculum
is organized by sections of VA’s DSP Competencies Evaluation tool and has an accompanying
PowerPoint slide deck and an assessment. The section of the curriculum that focuses on person-
centered skills, values, and attitudes gives a definition of person-centeredness and examples of
how this looks in action when a DSP is working with a client. The curriculum and resources
provided by the State appear to be sufficient for training sessions to prepare DSPs to meet
agency and State expectations.
The curriculum reviewed during the document analysis phase was not used during the
observed training sessions. In addition, the slide decks provided by the State were replaced with
agency-created slide decks, which did not seem to highlight the person-centered skills, values,
and attitudes that DSPs are evaluated on in VA’s DSP Competencies Evaluation tool. Though
many training sessions are scheduled throughout the year, each training session is packed with a
number of different topics which may be too much information for DSPs to process at a given
time, especially with no accompanying resources. Clark and Estes (2008) emphasize that there
DEVELOPING QUALIFIED WORKERS 57
are limitations on the amount of content learners can process at one time. Mayer (2011) affirms
that there are severe limits on a learner’s capacity to store and use knowledge in working
memory. Researchers estimate that learners can only hold between three and nine small bits of
information in their minds at a given time (Clark & Estes, 2008; Mayer, 2011). If training
sessions are packed with large chunks of information or too many different topics, DSPs will
have a difficult time retaining this information in their working memory, and the information
may be lost before it has a chance to be integrated into long term memory. Data indicates that
study participants have cognitive overload with the amount of information being given to them
during training sessions, resulting in recall issues. Observations and document analysis were
used to triangulate and confirm this finding.
Synthesis of Findings
In summary, evidence from this study indicates that New Life has some of the required
components needed to meet the stakeholder goal, though there are areas that need attention.
Recommendations follow in the next section that can be paired with existing agency strengths
and resources for goal attainment.
In terms of knowledge, interviews with volunteer DSPs revealed a deficit in conceptual
knowledge of VA’s DSP Competencies. Specifically, participants were unable to name concepts
and principles of person-centered skills, values, and attitudes. However, interviews,
observations, and document analysis also revealed that participating DSPs have procedural
knowledge of the skills outlined in VA’s DSP Competencies and consistently perform them. It
appears the knowledge gap is in labeling the skills that DSPs are already performing.
Motivation is an overall strength for the agency. Direct Support Professionals all value
person-centered practices to some degree and have strong self-efficacy. By valuing person-
DEVELOPING QUALIFIED WORKERS 58
centered practices and believing they can provide person-centered supports, DSPs are more
likely to choose, persist, and provide mental effort in this State requirement.
In terms of culture, it appears DSPs would benefit from more consistency, specifically in
terms of feedback from supervisors. Most DSPs did not feel as though knowledge of person-
centered skills, values, and attitudes was acknowledged or reinforced, but one participant gave
solid evidence of specific feedback that did help him understand what was expected in his role.
These differing views from DSPs indicate a need for a more consistent cultural model that lets all
DSPs know what is expected and a model that nurtures a culture that values knowledge of
person-centered skills, values, and attitudes. In terms of the cultural setting, evidence indicates
that New Life has a strong commitment to training. The agency has a dynamic trainer and the
materials that should help DSPs attain the stakeholder goal. Modifications in how these
resources are utilized could lead to goal attainment.
New Life has not yet reached its stakeholder goal or organization goal; however, using
Clark and Estes (2008) KMO gap analysis, this evaluation study has identified strengths that can
be used to improve identified areas of need to help lead to goal achievement. Recommendations
to close performance gaps and lead to goal attainment follow in the next section.
Solutions and Recommendations
This section will explain identified strengths and needs and provide recommendations for
the areas of need to help the agency meet its organization and stakeholder goals.
Recommendations and principles to support agency needs are identified in Table 4.
DEVELOPING QUALIFIED WORKERS 59
Table 4
Recommendations for Agency Needs
Assumed Influence Principle and Citation Context-Specific Recommendation
DSPs need to know the
principles and theories
identified in Section One
of VA’s DSP
Competencies.
(Conceptual Knowledge)
Increasing germane
cognitive load by
engaging the learner in
meaningful learning and
schema construction
facilitates effective
learning (Kirschner et
al., 2006).
Create a job aid in the form of an
advanced organizer identifying VA’s
DSP Competencies in Section One
(person-centered skills, values, and
attitudes) and practical examples in
picture and text form.
New Life needs a culture
that values knowledge of
person-centered skills,
values, and attitudes.
(Cultural Model)
Learning, motivation,
and performance will be
enhanced if participants
have clear, current, and
challenging goals. For
feedback to be effective,
it should be timely,
concrete (task focused),
and goal-focused
(Kluger & DeNisi,
1996).
Share organization and stakeholder
goals with DSPs.
Ensure supervisors provide frequent and
specific feedback to DSPs on progress.
Reward DSPs for progress.
New Life needs robust
training that provides
DSPs with resources and
direct feedback to ensure
proficiency on VA’s DSP
Competencies, Section
One (person-centered
skills, values, and
attitudes).
(Cultural Setting)
Effective organizations
ensure that policies and
procedures that govern
the work of the
organization are aligned
with organization goals
and values (Clark &
Estes, 2008).
Modify agency training schedule and
content to focus on person-centered
practices and provide DSPs practice
opportunities with debriefing and
feedback.
Across training iterations, DSPs will
keep a reflective journal of concepts
learned and practices to be carried out in
the field as well as maintain reflective
notes on weekly person-centered
activities.
Knowledge
An assumed knowledge influence for New Life to achieve its goal of 100% proficiency
on VA’s DSP Competencies, Section One (person-centered skills, values, and attitudes), was that
DSPs needed the procedural knowledge to know how to demonstrate person-centered skills.
DEVELOPING QUALIFIED WORKERS 60
Evidence from interviews, observations, and document analysis indicated DSPs have the
procedural knowledge that would help lead to the achievement of the stakeholder goal; therefore,
this is not a current need. However, interviews revealed that even though DSPs were able to
demonstrate person-centered practices, they were unable to recall or articulate the specific
theories or principles associated with person-centered practices as identified in VA’s DSP
Competencies. Table 4 identifies a recommendation that was established from research-based
learning principles to address the need to strengthen DSPs’ conceptual knowledge.
Increasing DSPs’ conceptual knowledge of VA’s DSP Competencies, Section
One. More than 70% of New Life’s DSPs had no conceptual knowledge of VA’s DSP
Competencies, Section One (person-centered skills, values, and attitudes). A recommendation
rooted in cognitive load theory has been identified to address this conceptual knowledge need.
Kirschner, Kirschner, and Paas (2006) advocate that learners benefit from germane cognitive
load when learning is meaningful and new information is organized in mental schemas. This
theory suggests that DSPs will benefit from information being presented in an organized manner
that relates to prior knowledge and experiences. The recommendation then is to create a job aid
in the form of an advanced organizer identifying VA’s DSP Competencies in Section One
(person-centered skills, values, and attitudes) including pictures and written examples of each
competency.
Mayer (2011) explains that organizing and integrating learning material into coherent
mental structures helps learners appropriately engage in cognitive processing. These strategies,
including the use of graphic organizers, lead to meaningful learning (Aguinis & Kraiger, 2009;
Mayer, 2011). This supports the use of an advanced organizer as a job aid to help DSPs
successfully learn VA’s DSP Competencies, Section One (person-centered skills, values, and
DEVELOPING QUALIFIED WORKERS 61
attitudes). Mayer (2011) also found that germane load increases when pictures are paired with
words instead of the presentation of words alone, which supports the recommendation to add
pictures and written examples of the competencies to the advanced organizer.
Maintaining procedural knowledge to demonstrate person-centered skills.
Procedural knowledge is a strength of the agency; therefore, recommendations are not included
in this study for improvement. All DSPs interviewed for this study, all DSPs observed, and all
case notes reviewed in the document analysis phase indicated participants have the procedural
knowledge to know how to demonstrate person-centered skills. New Life Administration
should, however, ensure that DSPs maintain these skills by continuing current efforts with
frequent person-centered skills practice opportunities and evaluation.
Motivation
Value and self-efficacy were assumed motivation influences for this study. Evidence
from interviews and observations suggested that New Life DSPs valued person-centered
practices, indicating a performance gap does not exist. Additionally, interview data indicated
that DSPs had strong self-efficacy in their ability to provide person-centered supports to their
clients, which also does not indicate a performance gap. With evidence indicating the assumed
motivation influences as strengths, recommendations for improvement in this area were not
necessary.
Organization
Assumed organization influences for this study are identified in Table 4. Gallimore and
Goldenberg (2001) describe cultural models as the way things should be in an organization and
cultural settings as the specific context where cultural models manifest. In this study, it was
assumed that New Life needed a culture that valued knowledge of person-centered skills, values,
DEVELOPING QUALIFIED WORKERS 62
and attitudes to meet the stakeholder goal. Evidence from interviews and observations revealed
a need in this area, indicating the agency does not have the cultural model needed to meet the
stakeholder goal since the majority of DSPs do not know what is expected of them. This study
also assumed New Life needed to establish robust training that provided DSPs with resources
and direct feedback to meet the stakeholder goal. Data collection that included interviews,
observations, and document analysis also indicated a need as the agency does not currently have
the cultural setting needed to meet the stakeholder goal. Though frequent training sessions are
offered throughout the year, they are often lengthy with multiple topics covered in each
session. Recommendations made from theoretical principles to address organizational needs are
identified in Table 4.
Developing a culture that values knowledge of person-centered skills, values, and
attitudes. Evidence indicated that New Life does not have a culture that values knowledge of
person-centered practices as 73% of DSPs did not know what was expected of them, while 45%
stated person-centered skills, values, and attitudes were not rewarded. Recommendations rooted
in sociocultural theory have been used to enrich cultural practices. Kluger and DeNisi (1996)
support that learning, motivation, and performance will be enhanced if participants have clear,
current, and challenging goals. For feedback to be effective, it should be timely, task-focused,
and goal-focused (Kluger & DeNisi, 1996). This suggests that New Life will benefit if DSPs are
better informed on organization and stakeholder goals and provided incentives to reinforce
behaviors that will lead to goal attainment. The recommendations then are for New Life to share
organization and stakeholder goals with DSPs; ensure supervisors provide frequent and specific
feedback to DSPs on performance progress; and to reward DSPs for their progress.
DEVELOPING QUALIFIED WORKERS 63
Clark and Estes (2008) support that organizational change efforts are dependent on
defining and communicating clear goals, establishing work processes that will lead to goal
attainment, providing motivational support for all stakeholders, and accurately assessing
performance and results. If DSPs are not aware of the stakeholder goal established in 2016 when
Virginia instituted DSP Competencies, they are missing a valuable guidance tool and possible
motivator. Rueda (2011) explains that goals provide individuals direction in carrying out
responsibilities and can also be used as a tool for determining or changing a course of
action. Frequent and specific feedback will also impact DSP performance and ultimately the
culture at New Life. It is important for supervisors to provide direct feedback that gives workers
an opportunity to accurately apply their skills or to correct their actions when necessary (Clark &
Estes, 2008). In addition to feedback, rewards or incentives can positively impact an
organization’s culture. Behavior that is reinforced is strengthened (Tuckman, 2006), and non-
monetary rewards can facilitate job interest and motivate even the best workers (Markova &
Ford, 2011). Rewarding DSPs for demonstrating proficiency on VA’s DSP Competencies, in
addition to sharing goals and providing concrete feedback on progress, will help New Life
establish a culture that values knowledge of person-centered skills, values, and attitudes.
Establishing a cultural setting where person-centered practices are the focal point of
training, feedback, and reflection. Evidence from this study revealed 82% of DSPs were not
able to recall content from specific training sessions or discriminate between training agendas,
indicating a disconnect between the organization’s cultural setting and its current
goals. Recommendations rooted in sociocultural theory have been suggested to address this
need. Effective organizations ensure that policies and procedures that govern the work of the
organization are aligned with organization goals and values (Clark & Estes, 2008). This would
DEVELOPING QUALIFIED WORKERS 64
suggest that focused training and specific feedback addressing person-centered skills, values, and
attitudes will better equip DSPs to achieve the stakeholder goal. Recommendations, identified
in Table 4, suggest that New Life modifies its current training schedule as well as the content and
delivery format to focus solely on person-centered skills, values, and attitudes with practice
opportunities and a debriefing session to include corrective feedback.
Rueda (2011) asserts that cultural settings of an organization have a profound impact on
performance goals, even when knowledge and motivation gaps have been addressed. If
organizational structures, policies, and practices are not supportive of workers and are not
aligned with the organization’s goals, success in change initiatives is unlikely (Clark & Estes,
2008; Rueda, 2011). With New Life seeking proficiency on VA’s DSP Competencies, the
organization will need to focus their training and feedback efforts on Virginia’s expectations.
New Life has already established a consistent training schedule, offering training sessions every
month for new hires and mandatory annual training for all DSPs. However, current
organizational practices reflect a multitude of agenda items per training session, with some
training sessions lasting more than four hours. Mayer (2011) supports that due to limited
processing capacity, learners have a difficult time attending to and making sense of information
when too much content is presented to them at one time. For this reason, it is recommended that
New Life establish separate training sessions that only address the topic of person-centered
skills, values, and attitudes, in order to align organizational processes with organization goals.
In addition, it is recommended to create a flipped classroom opportunity providing DSPs
access to online resources prior to in-person classroom sessions. According to Maquivar and
Ahmadzadeh (2016), flipped classrooms allow learners to take control of their learning and
generally have positive outcomes. In the flipped classrooms, DSPs will have opportunities to
DEVELOPING QUALIFIED WORKERS 65
watch person-centered modules online at their own pace and have access to the materials outside
of training sessions. In-person classroom sessions will then check for understanding and
reinforce the learning by giving DSPs opportunities to practice and discuss what they learned
online. Supervisors can follow up after training sessions to check for application of learned
material.
Finally, it is recommended that DSPs keep a reflective journal of person-centered
practices to monitor and reinforce learning. Reflection is a form of metacognition which is
knowledge that lets a learner know when to do something or why to do it (Mayer, 2011; Rueda,
2011). Self-regulated learners with metacognitive awareness take responsibility for monitoring
their learning (Mayer, 2011). It is recommended that DSPs reflect on their use of person-
centered practices between training sessions by documenting in a journal any specific person-
centered activities practiced each week. DSPs should also reflect on their progress and indicate
any concerns in their journal to discuss with supervisors or training staff.
These specific person-centered focused training activities should provide DSPs what
Clark & Estes (2008) refer to as guided practice with corrective feedback where DSPs are given
the opportunity to perform person-centered practices with feedback from trainers and supervisors
on performance and job application. The added component of metacognition will help DSPs
take ownership in their learning and provide weekly reflective opportunities that can then be
shared with others. Making person-centered skills, values, and attitudes the focus of New Life’s
training along with feedback and opportunities for reflection will help to establish a cultural
setting that ensures the organization’s policies and procedures effectively align with the
organization’s values and goals.
DEVELOPING QUALIFIED WORKERS 66
An implementation and evaluation plan can be found in Appendix F. This plan uses the
New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) to break down the
recommendations in this solutions section and identify outcomes, critical behaviors, and required
drivers that will assist New Life in implementing these recommendations. Appendix G and
Appendix H also contain post training assessments that will help New Life follow up on training
and make adjustments as needed to better meet the needs of the agency and its stakeholders.
Limitations and Delimitations
There were limitations that impacted this study. Limitations identified include the
inexperience of the researcher, possible biasness of the researcher when observing, and the
dependability of honesty and accuracy of the researcher and participants. In addition, the
sampling size was small and included non-probability, convenience sampling. With volunteer
participants, which were not random, the findings cannot be generalized accurately to the entire
population, and there is potential bias of the participants. All interviews were conducted as
phone interviews which limited the researcher’s ability to monitor body language and other
visual cues. In addition, only a single site was used in this study. The documents reviewed for
this study site were not randomly selected; instead, client case notes were chosen and provided
by the agency. Another limitation was time constraint on the overall study. Finally, my
presence as a researcher during training sessions and possible bias was a concern and limitation.
I stayed in the back of the room during each training and did not interact with participants during
observations; however, at one point the trainer came up and asked for my input on having
participants evaluate the training. I kept the conversation short and reiterated my role as a
student and observer. My presence in the room had an impact on the context of the atmosphere,
DEVELOPING QUALIFIED WORKERS 67
but I did my best to not be involved or interfere with training or change the trainer’s approach in
any way.
The delimitations of this study include the participants and the programs reviewed. Only
DSPs in Virginia Beach, Virginia were included in this study. This study could be expanded to
include DSPs from other areas in Virginia or other states with similar competencies. Also,
interactions were not observed between DSPs and their supervisors, and supervisors were not
included in any data collection phase. This delimitation was put in place to protect the anominity
of the DSPs that volunteered in the study. In addition to these delimitations, only Home and
Community Setting Programs were included in the review of this study focusing on DSPs
working in Virginia. This study could be expanded to include other health and human service
programs that utilize Direct Support Professionals.
Conclusion
New Life has established an organization goal and a stakeholder goal revolving around
VA’s DSP Competencies Evaluation tool to comply with State licensing regulations. Currently,
the agency has not met these goals; however, research from this study indicates they have
strengths that can be used to improve needs and lead to goal attainment. Using a KMO
framework (Clark & Estes, 2008), this study identifies recommendations that can use agency
strengths in procedural knowledge and motivation to develop the conceptual knowledge and the
cultural model and cultural settings needed to help with goal attainment. With these
recommendations, New Life will be well equipped to attain their goals, fulfill their mission,
provide quality supports, and maintain State compliance.
Future research may include larger sampling sizes, probability sampling, and possibly
expand research analysis to other regions in the state. Also, to gain the perspectives of DSP
DEVELOPING QUALIFIED WORKERS 68
supervisors, it may be beneficial for future studies to include supervisors in the data collection
phase and compare their responses to those from the DSPs. Supervisors can provide input in
areas such as feedback given to DSPs, evaluation of DSPs, and other areas of communication
between supervisors and DSPs. Finally, it is recommended that further research be conducted on
other topics and sections of VA’s DSP Competencies Evaluation tool as this study focused only
on Section One (person-centered skills, values, and attitudes).
DEVELOPING QUALIFIED WORKERS 69
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Appendix A: Interview Sampling and Guide
Direct Support Professionals (DSPs) that work at New Life Agency are the stakeholder
population of focus for this study. I introduced myself and the study first at a payroll session
then followed up at two separate agency training sessions. To minimize pressure and coercion to
participate in the study, after the introduction, I ensured no Administrative Team members were
present. I then requested volunteers to participate in interviews, provided they were DSPs at
New Life and had already received initial training and evaluation on Virginia’s DSP
Competencies. I believed these criteria afforded me the opportunity to seek information that led
to key components of my conceptual framework, including cultural contexts of the organization
as well as any needs in regard to the knowledge and motivation necessary for DSPs to meet the
stakeholder performance goal.
Interview Sampling Criteria and Rationale
Criterion 1. Participants had to be employed at New Life Agency, as this was the
organization of focus in the study.
Criterion 2. Participants had to be DSPs, as this was the stakeholder group within the
organization that I chose as the focus of the study.
Criterion 3. Participants had to have received the agency’s initial VA’s DSP
Competencies training and evaluation so that they were familiar with the content of the
competencies as well as the State’s expectations for proficiency.
Interview Sampling Recruitment Strategy and Rationale
I used a nonprobability or convenience sampling of DSPs to get detailed, rich information
to answer the research questions, provided they met the criteria I established for purposive
sampling. Though people who are often conveniently chosen to participate in research studies
DEVELOPING QUALIFIED WORKERS 78
are easily recruited, they do not technically generalize to the overall population (Johnson &
Christensen, 2015). For this reason, I gathered detailed information about the DSPs to provide as
complete a picture as possible for understanding. I recruited DSPs by asking during a payday
and two training sessions if they were interested in providing in-depth responses for the purposes
of this study. To keep their participation anonymous, I provided an email address for DSPs
interested in participating in interviews to email their full name, contact information, and the date
they received their agency training on State DSP Competencies. As an alternative, I provided
my personal cell phone number that they could call and provide the same information. I verified
that each participant met the interview criteria that I established before selecting them to
participate in an interview. With a population size of 90, Johnson and Christensen (2015)
recommend a sample size of 73 in a given study; however, I did not believe I would get that high
of a response rate nor did I have the time to conduct in-depth interviews for that many
participants. With the criteria set, I expected to be able to get between 8-15 participants from the
total population, which would provide rich information about the knowledge and motivation of
DSPs within New Life’s organization. Time would not allow for more than 15 participants, with
an individual interview expected to be approximately one hour; therefore, if more than 15 DSPs
volunteered and met the criteria, I planned on interviewing the first 15 DSPs to volunteer. If less
than eight DSPs volunteered, I planned on sending out a letter to all DSPs via email or payroll
insert, with assistance from New Life’s Human Resources Department offering a five-dollar gift
card as a token of appreciation for the first 15 DSPs to volunteer for individual interviews. The
gift card was only a token of appreciation as there was no compensation for participating in this
study.
DEVELOPING QUALIFIED WORKERS 79
Interview Guide
Thank you for agreeing to be a part of this study, which I hope will help other agencies
develop solid training programs. I’m interested in what you are using that’s helpful or even
challenging in your role as a DSP, as this will be helpful in providing rich material for the study.
I am conducting this study as a doctoral student at the University of Southern California, and I
will adhere to all University policies and procedures related to research. As a reminder, your
participation is strictly voluntary, and you are free to not answer any question or withdraw from
participation at any time. I intend to use a pseudonym instead of your real name when recording
and presenting any data. All data will be kept in a secure location and maintained for at least
three years following the conclusion of the study, at which time, all information will be
destroyed. May I have your permission to audio record this interview? The recording will be
password protected and deleted after I have had a chance to document its contents. This is
simply a way for me to validate my notes and ensure that I accurately document your words. Do
you have any questions before we begin?
1. Opening: Tell me about yourself. How did you get into this field? How long have you
been doing this work?
2. Thank you for sharing that. I want to say again how much I appreciate your time and
your willingness to share – please remember, all responses are anonymous. As you
know, I’m hoping to help other agencies with their training programs. Your insight will
be extremely helpful. Can you describe what the training program looks like here at New
Life? (Probes: What happens during training? Formats of delivery?)
3. How did the company prepare you to work with your client(s)?
DEVELOPING QUALIFIED WORKERS 80
4. Have you heard of person-centered planning or person-centered care (sometimes known
as PCP)? If so, what does it mean to you (use your own words to explain person-centered
care). [If no, never heard of person-centered care, explain that person-centered care is a
term and an approach used to focus on the individual and approach all care and
programming from his or her perspective. Use that as a guide for future questions
concerning person-centered care.]
5. In terms of training here at New Life, how was person-centered care introduced or used
in training? When and how was PCP introduced to you as a DSP? Any examples? (May
need to help interviewee by asking if it was via memos, training, word of mouth,
meetings, etc.). [If interviewee does not know, need to note that.]
6. Do you believe this training is sufficient to give you a strong knowledge and
understanding of PCP? What specifically has been helpful or would be more helpful?
7. Without using any names, can you walk me through a day or an activity with a client that
you use PCP skills with? What are you doing with the client now (hoping to recount
procedural knowledge)? How do you know what to do?
8. I’d like to ask you what is important to you in your job. In terms of your role as a DSP,
what do you value most? (What is important to you in being a DSP? Why is it
important?)
9. I’d like to specifically reference VA’s DSP Competencies – what is your understanding
of them? (probes: What are they? Give examples. What is their purpose?)
10. Thinking about your VA DSP Competencies training, I’d like for you to share your
thoughts regarding the initial training you received from the agency and any relationship
it may have to the supports you provide for your clients. Do you believe that the training
DEVELOPING QUALIFIED WORKERS 81
impacts quality of care? If so, how or if not, why not? What’s missing in the trainings
that would be useful, if anything?
11. Have you had annual VA DSP training yet, and if so, can you share some thoughts on
that training in terms of its impact on your ability to support your client?
12. How important or valuable is it for you to provide supports using person-centered skills,
values, and practices? (Probe: Can you explain? What specific person-centered skills and
practices do you value most, or think are the most important?)
13. With your understanding of PCP, what has been the most effective training tool or
feedback method in helping you as a DSP be proficient in person-centered skills, values,
and attitudes?
14. Anything you would like to see changed, added, done differently (specifically regarding
training or feedback and PCP? Be specific.)
15. For you personally, how do you feel about your ability to provide person-centered
supports? (probes: how much does confidence play into your ability to provide person-
centered supports? Can you be specific?)
16. What do you think influences your confidence in providing person-centered care?
17. In terms of measuring your abilities as a DSP, how are you evaluated on your knowledge
of person-centered skills, values, and attitudes?
18. Can you give me any examples of how your supervisor recognizes your knowledge of
person-centered skills, values, and attitudes, if at all? (Do they praise you or recognize
you in any way – if so, in what way specifically; do they recognize your knowledge of
PCP when you are in the field? During evals?)
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19. What about corrections or feedback if your supervisor wants to give you more guidance
on PCP or doesn’t feel your knowledge is accurate – how is this done? (How does your
supervisor inform you if you don’t know what PCP is? How does this make you feel?
What would you do differently to provide this feedback, if anything?)
20. I truly appreciate your time today. This has really helped me get a better idea of DSP
training. You’ve been amazing in sharing your thoughts and insights. Is there anything
that we haven’t covered that you’d like to add?
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Appendix B: Observation Sampling and Protocol
Observation Sampling Criteria and Rationale
Criterion 1. Participants must be employed at New Life Agency, as this is the
organization of focus in the study.
Criterion 2. Participants must be Direct Support Professionals (DSPs), as this is the
stakeholder group within the organization that I have chosen as the focus of this study.
Criterion 3. Participants must have received the VA’s DSP Competencies training and
evaluation so that they are familiar with the content of the competencies as well as the State’s
expectations for proficiency.
Criterion 4. Participants must have volunteered and participated in the interview phase
of this study so that a more complete picture of the stakeholder’s potential KMO influences can
be documented.
Observation Sampling Access Strategy and Rationale
At the end of individual interviews, I asked participants if they would be willing to allow
me to observe them in a community outing. The agency’s CEO granted permission for
observations provided there was no disruption to programming and HIPAA regulations were
followed. No data was collected on clients, and observations all took place in public settings.
The agency notified clients of the study and emphasized that DSPs were the focus of the study,
reinforcing that no data would be taken on clients.
I observed three DSPs on separate visits using the observation protocol in this Appendix.
I followed all agency policies and procedures and did not interfere with programming. In
addition to the participant observations, I observed two DSP training sessions conducted by New
Life’s Administrative staff.
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Observation Protocol
Date:
Time Start: Time End:
Location:
Observer:
KMO Influences to Observe
Knowledge:
● K-C: Conceptual – observe DSPs providing supports. Review behaviors for examples of
knowledge of key conceptual information of Virginia’s DSP Competencies.
● K-P: Procedural – observe DSPs providing supports; document activities,
communication, engagement. Observe if DSPs demonstrate person-centered skills and
practices and look for evidence of the necessary methods, techniques, or steps.
Motivation:
● M-V: Value – observe DSPs’ behaviors to assess the level of engagement (choice,
persistence, effort) in person-centered practices.
Organization:
● O-CM: Cultural model – observe interactions and monitor setting activities to identify if
agency has a culture that values knowledge of person-centered skills, values, and
attitudes.
● O-CS: Cultural setting – observe and record interactions, if any, between DSPs and
supervisors related to feedback on DSPs’ demonstration or articulation of person-
centered skills, values, and attitudes.
Physical Space (describe and/or provide diagram):
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Field Notes [record time every 5 minutes]
Time Observation – who, what, where/setting, reactions,
engagement, communication, behaviors, choices, etc.
Observer Comments
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Brief Summary of Observation:
Observer Role:
What am I doing and where?
Any interactions with others? If so, note and be specific.
How did my presence affect observation participants?
Reflection:
What’s next? (Any unfinished business or unanswered questions?)
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Appendix C: Document and Artifact Sampling and Protocol
Document and Artifact Sampling
Merriam and Tisdell (2016) note that documents can be valuable tools for a researcher in
providing descriptive information to answer research questions. Agency training policies and
procedures, VA’s DSP Competencies training schedule and curriculum, and client case notes
align with the conceptual framework of this study. Reviewing these documents provided insight
to answering the research questions of this study.
Document and Artifact Access Strategy and Rationale
New Life’s CEO granted written permission for access to agency policies and procedures
and the curriculum used for VA’s DSP Competencies training. Though these documents were
not confidential, I only reviewed the documents at the agency’s work site. In addition to these
documents, I reviewed client case notes chosen and provided by the agency. Case notes
provided valuable data on assumed KMO influences to help answer research questions.
Permission was granted by New Life’s CEO to review client case notes, provided client
information was de-identified and documents did not leave the agency’s work site. I traveled to
the work site to review the de-identified case notes and used the Document Protocol in this
Appendix to record notes and analysis. All case notes were de-identified by New Life’s staff per
HIPAA regulations using the Safe Harbor method. Safe Harbor is one method of de-identifying
private health information per federal guidelines (USDHHS, 2015).
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Document Analysis Protocol
Date:
Start Time of Analysis:
End Time of Analysis:
Location:
Observer:
Document(s) Reviewed:
Conceptual Framework/KMO
Evidence of Procedural Knowledge
[demonstrate PCP]:
Evidence of Robust Training for PCP
in Cultural Setting:
Other Influences:
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Appendix D: Credibility and Trustworthiness
To be effective and valuable to the field of practice, it is critical that this study, the data
collection, analysis, and findings, as well as the researcher are found to be credible and
trustworthy. Merriam and Tisdell (2016) emphasize the value of credibility and trustworthiness
in qualitative research, since an objective truth can never be determined. Validity strategies
enhance a study’s credibility, convincing others the findings are accurate (Creswell & Creswell,
2018). I employed several validity strategies to support the accuracy of my research, including
collecting rich data, an extensive literature review, member checking, peer debriefing, and
triangulation.
Rich data was collected during each phase of data collection. Rich data provides readers
with detailed descriptions of settings, allowing them to experience the setting on a deeper level
(Creswell & Creswell, 2018; Maxwell, 2013). An extensive literature review is also provided in
this study to validate assumed influences and to present knowledge of specific content related to
the topic. Another validity strategy that lent to the credibility of this study was member
checking. Also known as respondent validation, member checking gives participants a chance to
review themes or conclusions that the researcher has gathered from data collection to confirm or
clarify if needed (Creswell & Creswell, 2018; Maxwell, 2013; Merriam & Tisdell, 2016).
Merriam and Tisdell (2016) describe member checking as an opportunity to solicit feedback
from participants to ensure that researchers have captured participants’ perspectives and not
recorded their own words with their bias. I took emergent themes back to participants and asked
if my descriptions of shared information were accurate, based on information they gave me.
Maxwell (2013) identifies member checking as a vital step in a qualitative study to ensure that
participants’ words are not misinterpreted and to identify possible researcher bias. Peer
DEVELOPING QUALIFIED WORKERS 90
debriefing is a strategy often used in qualitative research projects to enhance the accuracy of the
researcher’s findings (Creswell & Creswell, 2018). I asked a colleague to review collected data
and findings to determine if the findings were plausible, which is a validity strategy
recommended by Merriam and Tisdell (2016). Creswell and Creswell (2018) claim that peer
debriefing allows for the research to resonate with someone other than the researcher and adds
credibility to a study. The colleague agreed with the findings and acknowledged the study to be
plausible.
Triangulation strengthened support for this research and the findings. Triangulation is
the collection of multiple sources and even multiple individuals and settings (Creswell &
Creswell, 2018; Maxwell, 2013; Merriam & Tisdell, 2016). Maxwell (2013) reports that
triangulation reduces the danger of chance associations that may emerge based on a single
method. The collective use of rich data, literature review, member checking, and peer debriefing
are effective representations of triangulation and together lent to the credibility and
trustworthiness of this study.
I kept field notes throughout my research process, noting my thoughts and reactions to
what was seen and heard. I marked these as Observer Comments or “OC” in a journal and
reflected on them throughout the data collection phase as well as during data analysis. Merriam
and Tisdell (2016) explain that researchers should document thoughts and speculations while
recording field notes as this equates to preliminary data analysis, which is key in qualitative
research.
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Appendix E: Ethics
Merriam and Tisdell (2016) emphasize that a researcher must carry out his or her study
with integrity and maintain an ethical stance throughout the study. To honor these expectations,
I employed ethical practices outlined in this section as I engaged in data collection, data analysis,
and reporting activities for my study.
As a doctoral student, I complied with the University of Southern California’s
Institutional Review Board (IRB) and followed all policies and procedures. Rubin and Rubin
(2012) explain that institutions receiving federal funding are required by the federal government
to have an IRB or a policy on file ensuring ethical research by constituents, including students.
Before collecting any data, I obtain informed consent from all participants. Informed consent
entails participants’ awareness of any risks involved with participating in the study,
understanding that the study is voluntary, and knowing that they can withdraw from the study at
any time they choose (Glesne, 2011; Krueger & Casey, 2009; Rubin & Rubin, 2012). I
respectfully asked participants’ permission to audio record all interviews so that I could validate
the notes I took during the interviews. In an effort to protect privacy, participants were given an
opportunity to choose a pseudonym, and all notes and audio recordings were linked to the
pseudonym, not participants’ actual names. All notes and recordings were stored in a locked file
drawer when not in use to ensure security and confidentiality.
The study site was New Life Agency, a health and human service organization providing
home and community-based supports to individuals with developmental disabilities in a
neighboring city from where I currently work as a Vice-President. The CEO at New Life is a
former colleague of mine. I do not personally know any of the Direct Support Professionals
(DSPs) at New Life nor their direct supervisors. I made it clear to all DSPs that their
DEVELOPING QUALIFIED WORKERS 92
participation in the study was voluntary and the information they provided was confidential. At
no time have I shared actual names or confidential information with the CEO, and participants
were free to withdraw from the study at any time they felt any type of pressure or coercion or for
any reason. As a Vice-President at a similar agency, I am interested in the results of the study
and how they may apply to future professional development practices; however, my role in this
study was as a researcher. Prior to the study, I emphasized to the participants that I was not
providing any incentives for participation because I did not want DSPs to feel pressured or
coerced into participation. However, for those that did share their time and insights to inform the
study during the interview phase, I will send a personal letter thanking them for their time along
with a five-dollar gift card to a local gas/food mart as a token of appreciation.
As a Vice-President of a health and human service organization, a former supervisor of
DSPs, as well as a former DSP in a similar agency, I may have had biases and assumptions as I
embarked on data collection, analysis, and reporting activities for this study. I may have a
different understanding of State training protocols or best practices for DSPs than that of the
participants, but as the researcher, I did my best to stay objective and record what was said and
observed and not let my biases or assumptions interfere with the data collection, analysis, or
reporting.
To minimize potential for participants to feel coerced or pressured to participate, I
reinforced that their participation was voluntary and that they could opt out of the study at any
time. Since I was a former colleague of the CEO of the agency, to minimize any risk of
coercion, I assured all participants that I would protect their anonymity and that only
pseudonyms would be used in reporting the data. I am aware that participants were at a certain
risk by sharing information during this study, and as the researcher, I tried to minimize these
DEVELOPING QUALIFIED WORKERS 93
risks. Participants may be embarrassed after sharing personal information or may be afraid of
their identity being exposed or possible repercussions if they shared negative feedback about
supervisors or their work setting. I assured participants that their information would be protected
and reminded them that a pseudonym was being used, not their real names. Also, all interviews
were conducted via telephone, minimizing the chance of others seeing who participated in the
study.
For this study, I tried to maximize the benefits for the participants. By asking
participants their opinions during the interview stage of this study, I gave them an opportunity to
have their voices heard. I believe this was a benefit that many appreciated. Also, the
information participants provided could lend to the field of practice to better train other DSPs
leading to better quality work and quality care. I believe participants were pleased to contribute
to the field they work in and to possibly improving training practices.
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Appendix F: Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
Performance improvement efforts must establish a means by which to support the change
and evaluate effectiveness to be successful (Clark & Estes, 2008). This study uses the New
World Kirkpatrick Model as a basis for implementation and evaluation of change efforts. The
New World Kirkpatrick Model expands on the four levels for evaluating training programs first
introduced in the 1950s by Don Kirkpatrick: Level 1, Reaction; Level 2, Learning; Level 3,
Behavior; and Level 4, Results (Kirkpatrick & Kirkpatrick, 2016). With the New World
Kirkpatrick Model, training programs focus on the original four levels in reverse order, at least
during the planning phase, to ensure that program outcomes are the central focus of initiatives
during implementation and evaluation (Kirkpatrick & Kirkpatrick, 2016). Starting with Level 4,
the internal and external outcomes realized from training initiatives, the New World Kirkpatrick
Model then moves to Level 3, participants applying training on the job. Level 2 is next,
measuring if participants gained the knowledge, skills, attitude, confidence, and commitment
from training. The evaluation then moves to the original Level 1, which focuses on participants’
reaction to the training, or how engaging relevant, or favorable participants found the training.
Organizational Purpose, Needs, and Expectations
New Life’s mission is to provide quality supports to individuals with developmental
disabilities (DD) so that they may live with dignity as productive citizens in the
community. Direct supports and services focus on daily living skills training, social skills
development, adaptive behavior skills acquisition, safety awareness, and other skills identified as
important to and for individuals. In order to provide services in Virginia, New Life needs to
maintain State licensure. To stay in compliance with State regulations, the organizational goal is
DEVELOPING QUALIFIED WORKERS 95
that Direct Support Professionals (DSPs) will be 100% proficient on the State mandated
competencies evaluation tool by July 2019. A recent review of State audit reports indicates that
New Life is not currently in full compliance, as some DSPs do not currently have a proficient
rating on VA’s DSP Competencies.
New Life’s Administrative Team determined the stakeholder’s goal of being 100%
proficient on VA’s DSP Competencies Evaluation tool, Section One (person-centered skills,
values, and attitudes) by April 2019 as a milestone towards becoming proficient on the entire
evaluation tool. This goal was chosen because in September 2016, Virginia mandated that all
DSPs providing supports at State licensed agencies must be evaluated and deemed to be
proficient on the newly established VA DSP’s Competencies Evaluation tool (Waivered Services
Regulations, 2016). The stakeholder goal was determined to be an appropriate first step towards
completion of the agency goal, and that Section One (person-centered skills, values, and
attitudes) would be an appropriate focus since the State has emphasized person-centered
planning for all clients.
New Life will maintain State licensure and provide the highest level of service to
individuals with DD so that they may live with dignity as productive citizens in the
community. This study evaluated DSPs’ knowledge and motivation related to achieving the
stakeholder goal as well as influences or possible organizational barriers that may be impacting
goal attainment. Recommendations are presented including learning and reinforcing
opportunities, rewards for progress, and a systematic evaluation plan to help DSPs become
proficient on VA’s DSP Competencies Evaluation tool, Section One (person-centered skills,
values, and attitudes).
DEVELOPING QUALIFIED WORKERS 96
Level 4: Results and Leading Indicators
Table F1 identifies the Level 4 external and internal outcomes, grouped by outcome,
metric, and method, that should be realized if recommendations are put into practice. If DSPs
are successful in providing person-centered supports, an internal outcome, then it is likely that
the external outcomes will also be realized.
Table F1
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Method(s)
External Outcomes
1. New Life
receives
“compliant” rating
on State audit.
100% compliant rating on all
State audit measurements.
Virginia’s Licensing Department
conducts annual licensing audit, which
includes a review of agency policies,
procedures, and practices.
2. New Life clients
are satisfied with
supports.
Client satisfaction rating of
each DSP providing supports.
New Life Administrative Team
contacts clients on a monthly basis
(phone call, visits, and/or meetings),
discussing and documenting clients’
level of satisfaction on each DSP.
Internal Outcomes
1. DSPs provide
supports using
person-centered
practices.
1A. Proficient rating on VA’s
DSP Competencies Section
One (articulates person-
centered skills, values, and
attitudes).
1A. Supervisors use VA’s DSP
Competencies Evaluation tool and
interview DSPs on knowledge of
person-centered practices.
1B. Proficient rating on VA’s
DSP Competencies Section
One (demonstrates person-
centered skills, values, and
attitudes).
1B. Supervisors use VA’s DSP
Competencies Evaluation tool and
observe DSPs during service delivery,
rating them on the use of person-
centered practices.
Level 3: Behavior
Critical behaviors. Direct Support Professionals are the focused stakeholder group for
this study, and three critical behaviors are relevant to achieve identified outcomes. Direct
DEVELOPING QUALIFIED WORKERS 97
Support Professionals will need to articulate principles from Section One of VA’s DSP
Competencies so that supervisors can mark them proficient on the evaluation tool. These
principles include explaining the value of choices in a client’s life, describing the value of natural
supports for clients, describing the value of community integration, and articulating that people
with disabilities have unique needs and preferences and need supports tailored in different
ways. In addition, DSPs need to convey an understanding that behavior is a means of
communication and be able to explain what is “important to” and “important for” the clients they
serve. A second critical behavior is demonstrating the principles outlined in Section One of
VA’s DSP Competencies. Direct Support Professionals need to offer clients choices in various
ways, facilitate interactions with others in natural settings, particularly with non-paid staff and
others without disabilities, support clients in identifying community activities that reflect the
client’s interest, and record new learning by the client. The third critical behavior that DSPs
must demonstrate is to use a physical copy of the evaluation to understand expectations and
monitor their own progress on each principle. This tool will be helpful when DSPs meet with
supervisors to review person-centered practices and DSP progress. These Level 3 critical
behaviors, along with recommended metrics, methods, and timing are outlined in Table F2.
Table F2
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s) Method(s) Timing
1. DSPs articulate
principles of person-
centered practices as
outlined in VA’s DSP
Competencies.
Number of DSPs
proficient on
articulating proper
person-centered skills,
values, and attitudes.
Supervisors will interview
DSPs and assign a rating of
basic understanding,
developing, competent, or
proficient on VA’s DSP
Competencies.
Quarterly
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2. DSPs demonstrate
person-centered
practices as outlined in
VA’s DSP
Competencies.
Number of DSPs
proficient on
demonstrating proper
person-centered skills,
value, and attitudes.
2A. Supervisors will observe
DSPs and assign a rating of
basic understanding,
developing, competent, or
proficient on VA’s DSP
Competencies.
Quarterly
2B. Data documentation staff
will review DSPs’ client case
notes and provide feedback to
the DSPs and DSPs’
supervisors on the presence or
absence of person-centered
practices.
Semi-
monthly
3. DSPs use VA’s DSP
Competencies
Evaluation tool.
Number of DSPs
familiar with and
using VA’s DSP
Competencies
Evaluation tool.
DSPs meet with supervisors to
review VA’s DSP
Competencies Evaluation tool
and DSPs’ progress.
Quarterly
Required drivers. Direct Support Professionals will need support from their
supervisors, other mentors (trainers), and each other to effectively demonstrate person-centered
practices. Organizational practices that include reinforcing and rewarding these practices will
continue to maintain a sense of value in the practices and encourage continual practice of the
concept. Finally, regular, consistent, and concrete feedback will let DSPs know what the
organization values and will likely motivate DSPs to continue the practice of person-centered
skills, values, and attitudes. Table F3 highlights recommended drivers that will reinforce,
encourage, reward, and monitor the critical behaviors that were previously identified.
DEVELOPING QUALIFIED WORKERS 99
Table F3
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors
Supported
Reinforcing
1. Job aid (advanced organizer identifying VA’s
DSP Competencies in Section One along with
practical examples in picture and text form) are used
as a tool to provide person-centered supports.
Ongoing; Given to
DSPs and explained at
New Hire Orientation;
used and distributed to
DSPs during quarterly
training sessions on
person-centered skills,
values, and attitudes.
1, 2
2. New Life Human Resources/Training Personnel
distribute reminder notices in employee paychecks
notifying DSPs when evaluations are due and
training sessions are available.
Ongoing 3
3. Supervisors keep a list of all trainings scheduled
and remind employees during informal
meetings/observations of upcoming sessions and the
importance of attending.
Ongoing 3
4. DSPs are given practice opportunities during
training sessions to demonstrate person-centered
practices after New Life trainers model skills based
on field observations and client case studies.
Quarterly 1, 2
5. Supervisors will check-in with DSPs during field
observations and provide on-the-job training to
reinforce person-centered practices, incorporating
feedback provided by data document specialists on
client case notes.
Monthly 1, 2
6. Training staff will develop flipped classroom
materials for DSPs to watch prior to classroom
instruction and develop job aids to extend learning
to the field; all content is shared with supervisors to
check for understanding in the field.
Ongoing 1, 2, 3
7. DSPs keep a journal of concepts learned and
practices to be carried out in the field. Once back in
the field, DSPs will note in their journal weekly
activities where they carried out specific person-
Ongoing 1, 2
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centered skills, values, and attitudes. In addition,
they can write down questions or concerns to review
with their supervisors as well as self-reflection of
person-centered skills, values, and attitudes
practiced in the field.
8. Supervisors review journal entries with DSPs
during field visits and check-ins to respond to any
concerns and give feedback on person-centered
practices and encourage continued use of strategies.
Ongoing 1, 2
Encouraging
1. Supervisors meet with DSPs to review VA’s DSP
Competencies and provide coaching on person-
centered practices as needed.
Quarterly 1, 2, 3
2. CEO adds a section in the monthly employee
newsletter where he recognizes DSPs nominated by
supervisors who have demonstrated progress on
stakeholder goal or demonstrated exceptional
person-centered practices. The list can also include
examples of person-centered practices to share ideas
with other staff in addition to DSP recognition.
Monthly 1, 2
Rewarding
1. Supervisors nominate DSPs who have made
significant progress on VA’s DSP Competencies or
who demonstrate high level of performance
providing person-centered supports for agency
employee of the month recognition.
Monthly 1, 2, 3
2. Supervisors praise DSPs during observations for
demonstrating and/or articulating person-centered
practices.
Ongoing 1, 2, 3
Monitoring
1. New Life Administrative Team surveys all staff
(supervisors, DSPs, and trainers) to determine if
agency practices including reminders, job aids,
evaluations, and training sessions are addressing
their concerns and meeting their needs.
Semi-annually 1, 2, 3
2. CEO will post organization and stakeholder goals
on a bulletin board in the main office, with a visual
display of monthly progress towards goal
attainment.
Monthly 1, 2, 3
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3. Supervisors observe DSPs as an accountability
method to ensure person-centered practices are
being used.
At least one
unannounced
observation every
quarter and one
scheduled observation.
1, 2, 3
Organizational support. It is critical that the organization supports the identified
critical behaviors and ensures that the required drivers are implemented. New Life’s
Administrative Team will conduct an agency-wide meeting to share the organization goal and
the stakeholder goal with DSPs. It is then vital that the leaders support the initiatives
recommended in this study in order to lead to goal attainment. Training should then be
conducted as recommended in this study and described in the Program section below. Once
supervisors are provided guidelines and a job aid to conduct frequent, concrete, and specific
feedback, supervisors will reinforce and reward DSPs for progress on the stakeholder goal. With
this organizational support, DSPs should gain the conceptual knowledge required to meet State
requirements, continue to demonstrate procedural knowledge, and maintain a high level of
motivation necessary to achieve the established goal.
Level 2: Learning
Learning goals. Following the recommendations in this study, DSPs will know the
following learning goals and be able to perform the critical behaviors identified above in order to
provide person-centered supports and ensure compliance with state regulations:
1. Remember and understand the principles and theories identified in Section One of VA’s
DSP Competencies (Conceptual Knowledge).
2. Remember stakeholder goal and monitor and evaluate own progress on VA’s DSP
Competencies (Cultural Model).
DEVELOPING QUALIFIED WORKERS 102
3. Apply person-centered skills learned in flipped classroom training sessions (Cultural
Setting).
4. Create person-centered activities with mentors and peers and analyze feedback during
debriefing to ensure proficiency on VA’s DSP Competencies, Section One (Cultural
Setting).
Program. The program that is recommended for DSPs to attain the learning goals
identified above can be incorporated into existing training opportunities and feedback loops
offered at New Life with modifications. New Life currently has a calendar of training
opportunities that suggest the agency is committed to training. The program proposes that the
agenda items and length of training sessions be modified to focus specifically on person-centered
practices and to keep in mind learners’ cognitive load capacity. This program recommends that
training sessions be no more than three hours in length and include practice opportunities with
feedback from mentors and peers, with person-centered practices being the sole topic covered
during training sessions. New Life already has an orientation training for new hires; the
recommendation is that person-centered practices have its own training session.
Another recommendation is that training staff create online modules for DSPs to watch
prior to coming to the training sessions, as in a flipped classroom model. Online modules will
give DSPs ample time to review materials at their own pace and have the resources available
after training. The classroom sessions are then designed to practice and apply what was learned
with feedback from training staff and supervisors with opportunities to clarify any questions or
concerns. Learning continues in the field after the classroom session. Job aids will facilitate
learning for new hires as well as experienced DSPs to ensure the conceptual knowledge of VA’s
DEVELOPING QUALIFIED WORKERS 103
DSP Competencies and will ensure extended learning in the field. Modeling and monitoring by
supervisors and training staff will ensure the proper use of the job aids.
Direct Support Professionals will be given a journal during training to support reflective
practices and help regulate learning. Direct Support Professionals will be encouraged to note
what they learned from each training session and to reflect on their own person-centered
practices on a weekly basis. The journal can also be used to document questions or concerns to
review with their supervisors during check-ins.
Supervisors will make at least one unannounced observation and one scheduled
observation of DSPs in the field per quarter. Supervisors will provide specific and concrete
feedback on person-centered programming, using their own experience as well as feedback from
the data document specialists who reviewed DSPs’ client case notes. Feedback focused
specifically on person-centered programming will help establish a cultural model and cultural
setting that values person-centered programming.
New Life’s Administrative Team will contribute by ensuring that policies and procedures
reflect the agency’s focus on compliance and person-centered practices. A rewards system will
include recognizing employees in the existing agency newsletter and continuing to recognize
employees of the month, specifically ones making progress on VA’s DSP Competencies or ones
demonstrating person-centered skills, values, and attitudes. Training schedules will be modified,
and reminders of upcoming training sessions will be sent to all DSPs. With agency leaders
sharing the organization goal and stakeholder goal with DSPs, a visual on a bulletin board
highlighting progress towards each goal will motivate DSPs and reinforce the agency’s
commitment on the value of meeting the goals.
DEVELOPING QUALIFIED WORKERS 104
Evaluation of the components of learning. Effective evaluation of this program will
include components that check for DSPs’ declarative knowledge, procedural knowledge,
attitude, confidence, and commitment. These components are based on the New World
Kirkpatrick Model and are necessary to evaluate learning of participants in a given training
(Kirkpatrick & Kirkpatrick, 2016). When DSPs know person-centered skills, they have
knowledge; when DSPs are able to perform person-centered skills, they have skill. When
workers believe it is important to take what they learned from training and implement it in the
field, Kirkpatrick and Kirkpatrick (2016) consider this attitude. Confidence according to this
model is participants believing they can perform what they learned in the field. Finally, when a
worker commits to applying the learned knowledge and skills when in the field, this is known as
commitment. These five components of the New World Kirkpatrick Model are identified in
Table F4 along with the methods and the timing of each as applicable to DSPs and person-
centered skills, practices, and values.
Table F4
Evaluation of the Components of Learning for the Program
Methods or Activities Timing
Declarative Knowledge “I know it.”
Knowledge checks during training sessions. Throughout training sessions.
Self-declarative journal on person-centered learning and
training session takeaways.
Weekly; after training sessions.
Knowledge checks through formal supervisor observations and
reviews.
Quarterly
Procedural Skills “I can do it right now.”
Feedback given to DSPs by peers and trainers on their
demonstrations at training sessions.
Quarterly during training
sessions.
Each DSP demonstrates person-centered practices using job
aids during training sessions.
Quarterly during training
sessions.
DEVELOPING QUALIFIED WORKERS 105
DSPs comments to supervisors during informal and formal
check-ins/observations.
Ongoing
Attitude “I believe this is worthwhile.”
DSPs’ comments on the value of person-centered practices
during discussions.
During quarterly training
sessions and informal/formal
check-ins.
Survey responses after training sessions and comments
regarding the value of providing person-centered supports.
Quarterly after training sessions.
DSPs’ comments to supervisors during formal and informal
check-ins/observations.
Ongoing
Confidence “I think I can do it on the job.”
Discussions following practice and feedback. Quarterly during training
sessions and after
demonstrations/practice
opportunities.
Survey responses after training sessions regarding DSPs’
confidence in providing person-centered supports to clients.
Quarterly after training sessions.
Commitment “I will do it on the job.”
Discussions following practice and feedback. Quarterly during training
sessions and after
demonstrations/practice
opportunities.
DSPs keep a journal documenting what was learned at each
training; DSPs make a written commitment or action plan to
implement the use of person-centered supports in the field;
DSPs log a daily example of person-centered supports
provided.
Daily
DSPs reflect on the use of person-centered supports at the end
of each week and note areas of progress or need for
improvement, re-committing each week to provide person-
centered supports. Journals can be reviewed with supervisor,
trainer, or peers during check-ins or training sessions.
Weekly
Level 1: Reaction
Level 1, as stated earlier, measures how engaging the training was to participants, to what
degree participants felt the training was relevant to their jobs, and whether or not as “customers,”
DEVELOPING QUALIFIED WORKERS 106
participants were satisfied with the training. Table F5 identifies tools that can be used to
evaluate each of these three areas: engagement, relevance, and customer satisfaction along with
the recommended timing of each method. The components of reaction are based on the New
World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016).
Table F5
Components to Measure Reactions to the Program
Methods or Tools Timing
Engagement
Maintaining DSP records for development and training; trainer
feedback; and attendance log.
Ongoing during training
sessions.
Asking meaningful questions - during supervisor contacts. Ongoing during supervisor and
DSP informal and formal
discussions.
Asking meaningful questions - during training sessions. Ongoing during training
sessions.
Pulse-checks by trainers. Ongoing during training
sessions.
Relevance
DSP feedback - post-training survey. Immediately following training
and one month after training.
Customer Satisfaction
Customer satisfaction inquiry during training - ask questions of
DSPs throughout training to determine if there are barriers to
learning, and if possible, make adjustments.
Ongoing during training
sessions; formative
evaluations.
Pulse-checks by trainers to ensure DSPs are satisfied with
training and content.
Ongoing during training
sessions; formative
evaluations.
Evaluation Tools
Immediately following the program implementation. Immediately following a
program, it is helpful to distribute surveys asking participants to rate the relevance of the
program content to their job, their level of engagement throughout the program, and to what
DEVELOPING QUALIFIED WORKERS 107
degree they were satisfied with the program (Kirkpatrick & Kirkpatrick, 2016). An evaluation
instrument, rating components of Level 1 and Level 2 of the program, is in Appendix G. This
survey will be distributed to DSPs immediately following each training session. Personnel from
the Human Resources department will distribute the survey, collect and tabulate responses, and
provide the results to the Training Department to modify training as needed based on the results
of the surveys.
Delayed for a period after the program implementation. Approximately one month
after the initial program implementation, a delayed survey will be distributed to DSPs. This 30-
day period will give ample time for the required drivers to be engaged and for participants to
apply new skills in the field (Kirkpatrick & Kirkpatrick, 2016). Personnel from Human
Resources will distribute surveys to all DSPs who participated in training programs. As an
alternative, a survey can be set-up on SurveyMonkey’s website with a link to the survey
distributed to each DSP. The delayed program survey is in Appendix H. This delayed program
survey asks DSPs to rate components of each of the Kirkpatrick and Kirkpatrick (2016) four
levels of evaluation: Reaction (Level 1), Learning (Level 2), Behavior (Level 3), and Results
(Level 4).
Data Analysis and Reporting
Analyzing data, reporting results, and acting upon the results give an organization
opportunity to make adjustments throughout an implementation plan if needed to reach program
outcomes (Kirkpatrick & Kirkpatrick, 2016). These activities should be done continuously
throughout the program, not only at the end (Kirkpatrick & Kirkpatrick, 2016). Once surveys are
collected from DSPs, Human Resources personnel will tally the ratings of each identified
component and provide the training staff with a dashboard as seen in Figure F1. A similar
DEVELOPING QUALIFIED WORKERS 108
Figure F1. Dashboard for survey results.
dashboard will be created for the delayed assessment to capture results of all four evaluation
levels and shared with trainers. The training staff will use this information to modify training as
needed to better meet the goals of the program and the needs of participants and the agency. To
assess progress on internal and external outcomes, Human Resources personnel will gather
information from the surveys as well as from reviews of agency reports and personnel charts to
create dashboards to share with the entire agency (Figure F2). While it is recommended that
Human Resources personnel gather the information for the dashboards, the CEO will be the one
to post, update, and report on progress in order to demonstrate leadership support of organization
and stakeholder goals. Reports needed to review and create the dashboards include data from
DEVELOPING QUALIFIED WORKERS 109
Figure F2. Dashboard of progress on external and internal outcomes.
annual State audits; results from monthly client satisfaction contacts; and results of DSP
proficiency on VA’s DSP Competencies Evaluation tool. The dashboard can be posted on the
bulletin board in the main office and updated monthly or as dictated by each report.
Summary
The implementation and evaluation plan for this study utilized the New World
Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) to make recommendations and help New
Life reach its organization and stakeholder goals. According to Kirkpatrick and Kirkpatrick
(2016), it is important to first establish the intended results of any training program so that
participants and leaders are aware of what is expected and the improvements in the field or on-
the-job are the main focus. These outcomes are outlined in Level 4 results as leading indicators
and desired outcomes. The plan then calls for a focus on participants’ behavior (Level 3), or in
DEVELOPING QUALIFIED WORKERS 110
this case, DSPs articulating and demonstrating person-centered practices when back in the
field. Level 2 is the actual learning phase, followed by Level 1, Reaction. These levels as
outlined above will facilitate the agency’s implementation and evaluation of the
recommendations of this study.
DEVELOPING QUALIFIED WORKERS 111
Appendix G: Training Survey Immediately Following Program
New Life – Training Feedback Form – Immediately Following Program
Employee Name (optional):
Date:
Training Title:
Trainer:
If applicable, please mark the number for each question
that matches the corresponding “smiley” face:
1 – strongly disagree 2 – disagree 3 – agree 4 – strongly agree
1. This program held my interest:
1 2 3 4
2. My participation was encouraged by the trainer/facilitator:
1 2 3 4
3. What I learned from this program will help me with my
client:
1 2 3 4
4. I am clear about what is expected of me when I get back
to my job:
1 2 3 4
5. I will recommend this program to my co-workers:
NO YES
6. How could this program be improved?
7. What are the major concepts you learned during this session?
8. Which parts of the program did you find most valuable? Why?
DEVELOPING QUALIFIED WORKERS 112
1 – strongly disagree 2 – disagree 3 – agree 4 – strongly agree
9. I believe it will be worthwhile for me to apply what I
learned today in the field:
1 2 3 4
10. How would you rate your level of confidence on the
topics covered BEFORE this training? 1 2 3 4
11. How would you rate your level of confidence on the
topics covered AFTER this training?
1 2 3 4
12. I am committed to applying what I learned in the field
with my client: 1 2 3 4
13. What additional supports will you need to implement what you learned?
14. What barriers do you anticipate could limit your success at applying what you have
learned?
Additional comments:
DEVELOPING QUALIFIED WORKERS 113
Appendix H: Delayed Training Survey Form
New Life – Delayed Training Feedback Form
Employee Name (optional):
Date:
Training Title:
Trainer:
If applicable, please mark the number for each question
that matches the corresponding “smiley” face:
1 – strongly disagree 2 – disagree 3 – agree 4 – strongly agree
1. I have had occasion in my job to use what I learned in the
training program:
1 2 3 4
2. What information from the course has been the most relevant to your job?
3. What information should be added to this course to make it more relevant to your work?
4. Looking back, taking this course was a good use of my
time:
1 2 3 4
5. Looking back, what would you change about this course?
DEVELOPING QUALIFIED WORKERS 114
6. I have successfully applied on the job what I learned in
training: 1 2 3 4
7. Describe any challenges you are experiencing in applying what you learned to your work
and possible solutions to overcome the challenges:
1 – strongly disagree 2 – disagree
3 – agree 4 – strongly agree
8. I have received support to apply what I learned
successfully:
1 2 3 4
9. I am already seeing positive results from the training:
1 2 3 4
10. My efforts have contributed to the mission of the agency:
1 2 3 4
11. Please give an example of a positive outcome you have experienced since attending this
training:
Additional comments:
Abstract (if available)
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Asset Metadata
Creator
Morlino, Regina M.
(author)
Core Title
Developing qualified workers to support individuals with intellectual and developmental disabilities in home and community settings: an evaluation study
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Organizational Change and Leadership (On Line)
Publication Date
04/23/2019
Defense Date
03/19/2019
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
competencies,developmental disabilities,DSPs,OAI-PMH Harvest,person-centered practices
Format
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Language
English
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Electronically uploaded by the author
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Advisor
Hirabayashi, Kimberly (
committee chair
), Green, Alan (
committee member
), Sigler, Susan (
committee member
)
Creator Email
morlino@usc.edu,ReginaMorlino@gmail.com
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https://doi.org/10.25549/usctheses-c89-140855
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Tags
competencies
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