by Demetrios Vassiliou and Mary Mercer
When this article was written in October 1997, Demetrios Vassiliou was Director of Outreach, Training, and Technical Assistance at the Minot State University Center for Persons with Disabilities. Mary Mercer was the Project Manager for the Community Staff Training Program. She is now the Community Staff Training Project Director.
North Dakota has a landmass of 70,665 square miles and a population of approximately 625,000 with a population density of nine persons per square mile. Distances between cities are vast. Community centered facilities providing services to persons with developmental disabilities are scattered throughout the state. This training program is a model that uniquely meets the needs of rural states. Using a circuit rider approach, technical assistance is provided to the designated regional trainers who work with provider staff dispersed throughout the state. The training program, with its career ladder options, is available and accessible to every community-based agency and every employee providing services to individuals with developmental disabilities in North Dakota.
Historically, individuals with mental retardation/developmental disabilities have been separated from the main stream of community life. They were often restricted in their personal freedoms and segregated in institutions without adequate treatment, education, habilitation, or medical care. At the turn of the century in North Dakota, institutions were built to protect individuals with disabilities and to alleviate the burden for their families. Although those institutions were built with the best intent, they gradually became the only service option available for individuals with mental retardation. By 1966, the population at Grafton State School and its San Haven satellite had reached an all-time high of 1400 residents. By the late 70s, North Dakota had institutionalized more persons per capita and spent less on institutional services than any other state in the nation.
In 1980, the North Dakota Association of Retarded Citizens filed a suit against state officials enumerating deficiencies in services to the state's citizens with mental retardation. In the years that have followed, hundreds of residents have moved from the Grafton State School and San Haven State Hospital to community programs located all over the state. It is this transfer of residents from the large institutional settings to smaller facilities in the local communities that has dramaticallyincreased the need for qualified and specialized direct service staff to provide programming in the areas of domestic, vocational, recreational, behavior management, and other skills.
In June 1982, the Department of Human Services began actively to pursue the development of a statewide training system for direct service staff working in community facilities serving individuals with mental retardation/developmental disabilities. One of the first activities undertaken in developing the Community Staff Training Program was to identify a competency-based training program consisting of self-contained instructional modules that would address the skills and knowledge necessary for direct service staff. After reviewing several training programs, the Kellogg Model Curriculum based on the Value-Based Skill Training Curriculum for Community-Based Mental Retardation Programs developed at the Meyer Children's Rehabilitation Institute at the University of Nebraska Medical Center was selected as the most appropriate vehicle for training.
The training program was initially federally funded for a period of 18 months. When the federal funding ended, the Department of Human Services continued its funding and contracted with Minot State University to implement it.
While similar training programs have come and gone, the North Dakota Community Staff Training Program continues to grow, adapt, and adjust to the ever-changing demands and needs of people with disabilities and those who serve them. Critical to the programâs success has been the collaborative relationships among the Department of Human Services, Minot State University, and community provider agencies.
Each of the three entities involved has well-defined objectives and responsibilities regarding the implementation of the training program. The Department of Human Services contracts with Minot State University and provides funding for the administration of the program. A person from the Department of Human Services is appointed to act as a liaison with Minot State University and community providers. The liaison attends the quarterly DD regional trainersâ meetings and provides feedback to the participants. The Department of Human Services reimburses the community agencies for the salaries of their trainer(s) and pays for printing expenses of curriculum materials and staff time spent in training activities (50 hours per year).
The North Dakota Center for Persons with Disabilities (NDCPD), a University Affiliated Program (UAP) at Minot State University (MSU), the second partner in the training endeavor, occupies a unique position in the state of North Dakota. It works very closely with allied disciplines within the university, as well as with other state agencies and organizations providing services and promoting the interests of people with disabilities. MSU with its UAP and its very strong Special Education programs provides training to trainers and on-site technical assistance. It performs needs assessments, conducts research, and develops training curricula, training videotapes, and other training materials. It maintains the centralized record-keeping system, issues degrees and certificates, and disseminates training materials to agencies and individuals serving individuals with developmental disabilities.
North Dakota community-based agencies make up the third entity in the statewide training program partnership. They hire regional trainers who are responsible for the staff development in each location. Salaries for these trainers are included in the funding provided to them by the Department of Human Services. These state-certified regional trainers are linked to the University and have helped the system remain accountable to changing agency needs. They keep training records and assist MSU staff in surveys and assessments and provide feedback for curriculum development and revision. In addition, they serve on management teams and participate in committees within the local agency.
Staff trainers are responsible for preparing, providing, and/or conducting instructional inservice programs and other training activities for personnel within the agency they serve. Trainers utilize other experts within or out of the agency to train their staff and they schedule training according to the needs of individual staff. The curriculum is designed to allow for the use of a variety of training options, techniques, and methods (i.e., self-instruction, group instruction, and on-the-job training). The option to test-out is made available to staff with previous training/expertise in specific areas.
Individuals selected for the trainer's position must possess a bachelorâs degree or advanced degree in a related field, preferably special education, psychology, social work, or nursing. Teaching and work experience in the area of developmental disabilities are among the criteria considered for selection.
Trainers meet on a quarterly basis to discuss issues and problems related to the statewide training program. In addition, to the routine agenda items related to program mechanics, "Train the Trainer" sessions, workshops, and informational presentations are conducted. This is a good opportunity for the trainers to get acquainted, exchange views and information, and share ideas, questions and concerns regarding training practices.
This network of trainers provides input in curriculum development and revisions that reflect the ever-changing needs of community providers. Since the inception of the training program in July of 1983, the initial Kellogg Curriculum has been expanded and modified resulting in a very comprehensive training program consisting of 37 training modules covering a range of training competencies. Direct input by agency representatives ensures commitment to the future of the statewide training program.
The North Dakota Community Staff Training Program has been structured in such a way as to provide career ladder growth opportunities to direct service staff who have the desire and willingness to develop professionally. Seven levels of competency-based training are recognized in the mental retardation/developmental disabilities system. These are:
Level I: Orientation Training:
Community Service Providers are to provide in-service training to full-time direct service staff, prior to the staff membersâ assuming direct responsibility for the individuals they serve. Although not required, the agency is encouraged to consider this requirement in whole or in part for direct service staff who are part-time or relief.
Level II: Position-Based Competency:
Position-Based Competency is required of all positions in agencies serving individuals with mental retardation/developmental disabilities. The executive director in cooperation with the staff trainer, must develop job descriptions for each position, stating the competencies necessary for an individual to fulfill the responsibilities of the position.
Level III: Certificate of Completion:
This is issued to staff members who successfully meet the competencies established for the certificate by the Department of Human Services. It requires successful completion of nine core modules, five elective modules, and a course of supervised field experiences. The agency selects electives from the curriculum based on a staff memberâs specific job responsibilities.
Level IV: Advanced Certification:
Staff members of agency organizations who have already acquired the certificate of completion have the option to pursue the advanced certification program. It consists of ten additional modules dealing with a variety of training issues including aging, communication, leisure, behavior management, traumatic brain injury, and basic health. Staff members who successfully complete the advanced certification requirements are issued an additional certificate.
Level V: Associate of Arts in DD
: MSU will award this degree upon satisfactory completion of the designated 27 semester hours of developmental disabilities coursework and 38 semester hours of general education coursework. The A.A. degree coursework is available only to personnel employed in approved residential and day programs serving persons with mental retardation/developmental disabilities.
Level VI: Bachelor of Science in Mental Retardation (Non-Teaching)
Those who desire to pursue this degree after completion of the Associate of Arts degree in Developmental Disabilities must confirm with MSU their intent to attend the university and earn it.
Level VII: Master of Science in Special Education
: Individuals may earn this degree at MSU after successful completion of a graduate course of study in the Severely Multi-Handicapped.
Developmental Disabilities Modules/Coursework
Following is a listing of the developmental disabilities modules/ coursework. Core modules are identified by one asterisk (*) and elective modules are identified by two asterisks (**) in the list which follows. Staff must complete practica that correspond to the core and elective modules submitted for their certification. All modules listed under the Sp.Ed. three-digit headings are the module content requirements for the Minot State University Associate of Arts degree coursework in Developmental Disabilities.
Sp.Ed.101 Introduction to DD Services (3SH)
*895.39 Supporting Individuals with Disabilities in the Community
*895.03 Legal Issues and Developmental Disabilities
*895.40 Team Planning
*895.41 Working with Families OR
*895.42 Job Coach Training Manual
Sp.Ed.111 Health Care in DD I (3SH)
*895.06 Medications Training
*895.07 CPR (Cardiopulmonary Resuscitation)
*895.08 First Aid
**895.45 Nutrition OR
**895.46 Sexuality and DD
**895.47 Oral Hygiene & Dental Care
**895.48 Control of Infection and Communicable Disease
**895.49 Signs and Symptoms of Illness
**895.50 Nurse Assistant Training
Sp.Ed.112 Health Care in DD II (2 SH)
**895.11 Positioning, Turning and Transferring
Sp.Ed.120 Introduction to Behavior Management(3SH)
**895.51 Introduction to Behavior Management
**895.51 Principles of Behavior and Basic Behavior Intervention Procedures
**895.52 Designing and Implementing BehaviorIntervention Programs
**895.15 Writing Behavioral Objectives and Measuring Behavior
Sp.Ed.130 Organization of Leisure (1SH)
**895.19 Recreation and Leisure Training
Sp.Ed.140 Human Development (2 SH)
**895.21 Human Development (Condensed Version)
**895.22 Human Development I
**895.23 Human Development II
Sp.Ed.221 Techniques of Behavior Management (2SH)
**895.55 Assessment and Setting Goals
*895.18 Achieving Goals
Sp.Ed.225 Assisting People with Traumatic Brain Injury & their Families (2SH)
**895.56 Assisting People with Traumatic Brain Injury and their Families
**895.57 Beyond Brain Injury: A Manual for Supported Employment Providers
Sp.Ed.250 Developing Communicative Interaction (2SH)
**895.24 The Framework of Interaction and Communication
**895.25 Recognizing and Responding to the Many Forms of Communication
**895.26 Increasing Understanding
**895.27 Increasing Communication
Sp.Ed.255 Aging and DD (3 SH)
**895.28 Introduction and Overview
**895.29 Medical and Health Issues
**895.30 Transitions and Social Adjustment
**895.31 Legal Issues
**895.32 Issues in Service Coordination
Sp.Ed.222 Supervised Field Experience in DD (4 SH)
*I Individual Program Plans
*II Medication Documentation and Storage
*III Administration of Medications
**IV Positioning, Turning and Transferring
*V Seizure Activity Documentation
**VI ABC Recording
**VII Frequency Recording
**VIII Writing Objectives
*IX Strengthening/Decreasing a Behavior
*X Individualized Instruction, etc.
** Aging and Developmental Disabilities
Compensation For Training Activities
Inservice training must be offered on a flexible schedule and at times that meet the needs of staff. The amount of reimbursable training time allotted to a full-time direct service staff is one hour during the normal work week schedule, which is to be matched by one hour outside the normally scheduled work hours. Successful completion of all modules that are required to attain certificate of completion described earlier qualifies professional and direct service staff for up to a 5% salary increase. Successful completion of an Associate of Arts degree when attained by previously non-degree direct service staff qualifies for a 7% salary increase. These allowances are not mutually exclusive. A staff member may qualify for the 5% increase and subsequently qualify for the additional 7% increase
MSU organizes at least six workshops and a number of state and international conferences to meet additional training needs of direct and other developmental disability personnel as well as primary and secondary consumers. All workshops provide the opportunity to participants to enroll for Continuing Education Units (CEUs). Some workshops may offer undergraduate and graduate credit.
Audio-Visual Media Library
MSU's Department of Developmental Disabilities maintains a central audio-visual media library equipped with a variety of videocassettes appropriate for training. Staff trainers may request to borrow and use them in their training activities.
Centralized Data System
The Community Staff Training Program maintains a computerized database of training activities for every staff member participating in the training program. Staff trainers keep their own computerized data system as well.
Staff turnover appears to be a chronic problem for agencies/organizations serving individuals with developmental disabilities. Surveys of administrators of institutional and community facilities indicate that the recruitment and retention of direct service staff members are considered to be major concerns (Vassiliou, D., & Askvig, B.,1991). A high turnover rate significantly affects the availability of training staff and the costs of training for agencies and the state-funding source. North Dakota is clearly part of this national problem.
Vassiliou and Ferrara (1997) reported a 54% turnover rate in their study of staff (N=610) employed by twenty North Dakota agencies providing services to people with disabilities. There was, however, a considerable variability across categories and positions. Among administrative staff, the turnover rate was 10%. There was a great discrepancy between the rates for full-time (31%) and part-time direct service staff (88%). Part-time employees constitute 46% of the total workforce.
Wages were found to be significant predictor of staff turnover for all employee groups. There was a significant (p<.01) relationship between certification training and length of employment. The average length of employment for certified staff was 69 months versus 25 months for non-certified staff. The number of resignations varied throughout the year. The smallest number of employees (70) resigned in December and the largest number (120) resigned in June. This could be attributed to the large number of students who are part-time employees who leave when classes are over.
It appears that people who leave their jobs are divided into three groups with different characteristics:
Student employees are a temporary work force and will leave regardless of wages, unless they choose the DD services as a profession.
A second group of employees are those for whom DD service work is a job of last resort. These individuals are not particularly interested in the work and they leave when another position becomes available.
The third group of employees enjoys the work, likes their co-workers and the people with whom they work, but are forced out of DD services because of a mediocre salary.Ê Working at the community facility simply becomes a luxury they can no longer afford.
Agencies need to be cognizant of these employee differences.Ê Studentsâ turnover is predictable and agencies must weigh the benefits versus longevity. Turnover rate among less interested employees is healthy.Ê Better screening procedures may reduce the turnover associated with this group. On the other hand, losing dedicated and interested employees is detrimental to the agency and the consumer. Administrators must provide salaries and benefits that are high enough to allow them to continue their employment with the community facilities.
Fourteen years have past since the initiation of the North Dakota Community Staff Training Program. Since 1983, the training program has experienced a steady growth, maturing and evolving to keep pace with the expansion and training needs of the stateâs community-based programs and services. Using a career ladder approach, over 18,000 staff from agencies across the state has received training. Exactly 3,160 individuals have completed certification requirements since the programâs inception. Approximately 100 individuals have successfully completed the Associate of Arts degree in Developmental Disabilities. Some trainees continued their studies and graduated with a bachelors and a masters degree in Special Education/Developmental Disabilities.
Survey of graduates: Twenty-one individuals who completed the requirements for the Associate of Arts degree in Developmental Disabilities were surveyed (1994). Some of the questions and answers are listed below:
- Why did you choose to pursue the Associate of Arts degree in Developmental Disabilities?
- The opportunity was so convenient that I felt I could not pass it up.
- Having the classes offered right at my place of employment was really a big incentive.
- The price per credit was so low it was irresistible.
- It was a wonderful opportunity to get a degree. Many businesses do not offer this. I thought it would increase my chances to advance my career in this agency.
- The training helped me as a case manager. It provided very good practical information. It updated my previous coursework and made my knowledge more current and accurate.
- It made me more qualified in the field.
- I did not have to drive a long distance.
- It was a validation of my 12 years of experience in the field of Developmental Disabilities.
- It increased my knowledge and improved my job performance.
- How did the degree help you in your profession?It allowed me to keep my job.
- The training applied directly to the daily requirements of my job.
- It gave me skills to assist the population I serve and confidence to pursue a higher degree.
- The education has been very valuable.
- I've been assigned more job responsibilities.
- It provided me with a good foundation and I have been given several promotions since I completed the Associate of Arts degree.
- It opened the door to three different jobs in three different cities in the state.
- The training program made me better prepared to work in programs providing services to people with disabilities than training I have received in the state where I now work. I wish they had the same program in this state.
- I got hooked on increasing my educational base. I eventually completed an endorsement in regular education, and earned a Masters Degree.
- The career ladder approach encourages staff members to learn more about their jobs.
- As staff members achieved higher levels of training, I witnessed a growth in self-esteem. They began setting goals for themselves and believed that they could learn and grow.
Marilyn Jensen is the Chief Executive Officer of Knife River Group Homes, Inc. in Hazen, North Dakota. This is an eight bed congregate care home for elderly people with developmental disabilities. When Marilyn began working as a direct care worker for Knife River Group Homes, in 1985, she was realizing a long forgotten dream of working with people with disabilities. After completing her certification in Developmental Disabilities, her family encouraged her to continue studying and complete the composite tests for college credit. She attended classes on weekends, summers, and evenings for the general education credits required and Marilyn became one of approximately 100 individuals who have successfully completed the Associate of Arts degree in DD. Over the next few years she continued to take classes here and there as they fit into her family and work schedule. In May of 1996, Marilyn graduated from MSU with a Bachelor in Social Work. Marilynâs own words: 'For the first time in my life, I feel like I am somebody, and I know it would not have happened if it had not been for the statewide training program offered by Minot State University. It was so accommodating'.
Dora Cowell began her work with children with developmental disabilities as a co-owner of a daycare in a small rural community in southwestern North Dakota.
As a substitute direct service worker for a local developmental disabilities provider, she became involved in the statewide training program. 'The training offered by Able Inc., an agency providing services to people with disabilities, allowed me to work at my own pace and gave me a variety of basic information that provided a solid beginning in the area of Special Education.' Dora ultimately devoted a year to pursuing her Bachelors Degree in Special Education and now teaches Special Education. She is enrolled in a graduate program at MSU seeking a Masters Degree in Learning Disabilities.
In the past 15 years North Dakota has experienced rapid and dramatic changes in the way it treats its citizens with mental retardation/ developmental disabilities. Since 1982, hundreds of individuals with mental retardation, who were residing in the state institutions, moved to communities throughout the state. Group homes, indiidualized apartments, employment opportunities, and rehabilitation services have been established to meet the increasing needs of these individuals. Early in this process, Minot State University was invited by the Department of Human Services to develop and implement a statewide community staff-training program.
A 'train the trainer to train the staff' approach has been used on a statewide basis, to train the staff of community facilities providing services to individuals with lifelong disabilities. The training program is a model that uniquely meets the needs of rural states. Using a ãcircuit riderä approach, technical assistance is provided to the designated regional trainers, who work with provider staff dispersed throughout the state. The training program, with its career options, is available and accessible to every agency and every employee providing services to individuals with developmental disabilities in North Dakota.
The success and the longevity of the training program has greatly depended on the collaboration and synergy that has gradually developed between the Department of Human Services, Community Facilities, and Minot State University. Utilizing the combined expertise, roles and responsibilities, trust, teamwork, and collaboration developed through the years, the collaborative endeavor continues to grow, by assimilating and accommodating the ever changing training needs of staff members and the consumers they serve.
Mitchell, D. & Braddock D. (1994). Compensation and turnover of direct-care-staff in developmental disabilities residential facilities in the United States II: Turnover. Mental Retardation, 32, 34-42.
Vassiliou, D., & Askvig, B. (1991). Factors related to staff longevity and turnover in a facility serving persons with DD. North Dakota Center for Persons with Disabilities, Minot State University.
Vassiliou, D., and Mercer, M. (1994). Career ladder approach to training for community facilities personnel in North Dakota. New Directions: The Newsletter of the National Resource Center for Paraprofessionals in Education and Related Services, Center for Advanced Study in Education, City University of New York, Vol. 15, No. 1.
Vassiliou, D., and Ferrara, J. (1997). Factors related to staff longevity and turnover in facilities serving North Dakota Citizens with Developmental Disabilities. North Dakota Center for Persons with Disabilities, Minot State University.