As part of our ongoing series about trends that will impact the future of healthcare, we recently chatted with Natasha Fisher, Relias Product Manager for IDD. Natasha has over 15 years’ experience working with people with intellectual and developmental disabilities, serving in a variety of roles including Direct Care, Service Coordination, QA, and Administration. Natasha has served on Provider Advisory Boards, worked in Self Advocate Committee start up, and has direct experience with CARF and CQL Accreditation processes. She’s passionate about creating products that improve the lives of people with disabilities and those who support them.
How are services, specifically in the intellectual and developmental disability field, changing? What’s driving these changes?
Natasha: The requirement for community-based services – how people are living with disabilities in an inclusive community – is one of the biggest changes that’s been happening and will have more force moving forward.
We have seen this progress across states with the Department of Justice enforcing the Olmstead decision, which says that it is unlawful to segregate people based on disability. The Olmstead decision, based on the ADA, held that people with disabilities have the right to receive supports and services in the most integrated setting possible or appropriate. This supports people’s right to live, work, and play in the community and to have the supports necessary to do so.
The number one driver is the new Home and Community Based Support (HCBS) rule, which is driving change to the regulatory requirements for community based services and the outcomes that are expected from provider-service delivery. This rule changes the community definition and expectations for providers and changes what being inclusive in the community really looks like. We’re progressing community-based services to providers truly demonstrating outcomes in inclusive services.
How will providers need to adjust in response?
The most important things providers can do is to really start to build competence in their staff to be able to support people in an inclusive setting. This is going to have to be carried out at the DSP level that comes with a really diverse set of skills. Training for competence versus compliance is key –organizations are going to have to evaluate how they are training their staff now. Are you looking at check-the-box topics you have to meet, or are you truly evaluating whether your staff have the competence to deliver to help the people you support achieve outcomes?
Telling is not training! We have lots of qualified clinicians, trainers, and experts who will tell people what the job is. Where we go wrong is not making sure that we have supported competency enhancement for staff. It’s key to understand how each person learns and to recognize what truly instills a change in how you perform at work, versus “someone gave me information of which I lost 70% before I actually went in to do my job.”
Our DSPs need the necessary investments of time, training, mentoring, and so on to ensure that they hold a diverse competence level to support people with disabilities in finding and maintain employment, achieving real membership in their communities, and achieving the quality of life as desired and defined by the person receiving services.
How does technology play a role in these changes?
Technology allows support of staff across a diverse geographical setting. You may not see staff every day, so it can be very hard to coordinate the amount of needed training to develop an employee, particularly if you expect all of that to be done in one room with one trainer. Technology allows for breadth of learning, refreshers, and just-in-time training – training you need today to do your job tomorrow, and do it well.
The integration of technology also plays a role in delivering information, giving practice opportunities with that information, measuring competence, and then following up with additional needed knowledge.
It’s crucial to have the ability to look at and analyze your staff overall, at the organization and individual level. To see where your staff is competent, since you can’t see everyone on of your staff deliver services every day. Having an integrated system where you can measure what’s been delivered, what been assessed, what competencies are being met, where you are falling short, where you should do more training – all of that in one snapshot is invaluable and impossible without technology!
What types of development and training will organizations need to provide? What does the ideal staff member look like a couple years from now?
Providers are going to have to think about how they staff, write policies and procedures, and do standard operating procedures. All these things need to be reviewed!
Instead of just procedural training, organizations will have to start thinking about how to train for decision-making skills.
Also think about your first line of management. Think about developing expertise in support but also in tiered management, in leadership, and mentoring. The need to develop knowledgeable managers and mentors, and expertise in your frontline staff is crucial to being able to deliver the outcomes required for people with disabilities.
We’d love your perspectives. What changes are you seeing in the IDD care community? How are your agencies and organizations adjusting to changes in guidelines and legislation?