ACT WorkKeys Occupational Profile Report For the Entry Level Direct Care Worker across Aging Services Better Jobs Better Care: Oregon Works! November 2006 Table of Contents Table of Contents .................................................................................................................... 1 Better Jobs, Better Care: Oregon Works! Cover Letter ..................................................... 2 Executive Summary…………………………..……………………………………………...5 Recommendations ................................................................................................................... 7 Occupational Profiling Procedure ......................................................................................... 9 Summary of Skill Levels ....................................................................................................... 12 Summary of Final Task List ................................................................................................ 14 Detailed Presentation of Final Task Lists ........................................................................... 17 Skill Analysis Documentation .............................................................................................. 24 Observation ......................................................................................................................... 24 Locating Information .......................................................................................................... 26 Reading for Information ..................................................................................................... 28 Writing ................................................................................................................................ 31 Subject Matter Expert Demographics ................................................................................ 34 Appendix A. WorkKeys Terminology................................................................................. 36 Appendix B. WorkKeys and Content Validation .............................................................. 39 Appendix C. Skill Descriptions ............................................................................................ 43 Locating Information Skill.................................................................................................. 43 Observation Skill ................................................................................................................ 45 Reading for Information Skill ............................................................................................. 48 Writing Skill........................................................................................................................ 51 Appendix D. Oregon Demonstration Project Profile - Oregon Works! .......................... 54 Appendix E. Oregon Works! Person Centered/Directed Care Philosophy Statement..59 1 Cover Letter The Better Jobs Better Care Oregon Works! coalition spearheaded the effort to develop an Occupational Profile for entry level Direct Care Workers in response to four complementary and overarching needs in the long term care field: 1. Incumbent Direct Care Workers and other employees in the field have repeatedly requested job skills upgrade training as a means to improve their job performance and job satisfaction. 2. In anticipation of the impending skills and worker shortage caused by mass Baby Boomer retirement, forward-thinking employers will use quality training programs and clearly articulated career ladders that they can offer their employees in order to become employers of choice. 3. In order to develop responsive educational and training programs, educational institutions and workforce development professionals need a clear understanding of the educational and training needs to prepare a pipeline and upgrade the skills of workers in the long term care field. 4. Long Term Care (LTC) Provider associations seek to promote member interests by improving the image of long term care in the eyes of potential consumers as well as potential employees. One means to that end is to establish long term care field-based, nationally-recognized credentials/certificates of competence for unlicensed positions such as Direct Care Workers. In order to satisfy each of the four areas of interest described above, stakeholders need to develop a common understanding of, and a common language about, the knowledge, skills, and abilities (KSA) required of incumbent workers in the long term care field. The attached Occupational Profile for entry level Direct Care Workers provides the foundation upon which to develop a common language in the field. THE PROCESS & THE TOOL WorkKeys - WorkKeys is a comprehensive employability skills assessment tool developed by ACT. WorkKeys measures generic foundation skills that are critical to job success in all jobs across all industries and fields. There are nine foundation skills: Applied Math Applied Technology Business Writing Listening Locating Information Observation Reading for Information Teamwork Writing 2 The benefits of using WorkKeys to develop job profiles and occupational profiles include: Profiles are established in collaboration with company Subject Matter Experts (SMEs) to precisely define skills and proficiencies that are commonly understood across industries. In this instance, the SMEs were 16 Direct Care Workers from more than 9 companies, including home care workers, around Oregon. Profile are based upon detailed task lists that are generated in collaboration with SMEs. The task lists provide the foundation upon which targeted training and education programs can be built WorkKeys is a nationally-recognized product WorkKeys links job profiles to criterion-referenced1 assessments, WorkKeys job profiles and assessments are EEOC compliant and have ACT’s2 full support in case of litigation, WorkKeys job profiles and assessments are regularly used as part of the hiring and promotion decision-making processes. Companies regularly report reduced personnel costs when using WorkKeys. HOW TO USE THE OCCUPATIONAL PROFILE The entry level Direct Care Worker Occupational Profile creates the common language about the tasks (what a person does), foundation skills (the generic skills everyone needs to work) and proficiency levels (how well one has mastered a foundation skill) required of someone to work as an entry level Direct Care Worker. Different stakeholders will be able to use the Occupational Profile in different ways to promote Community Based Care (ALF, RCF, Foster Care, In-Home Care, etc.) in Oregon. The following are examples of how the Profile can be, and has been, used to good effect. Individual companies – Most community based care facilities (ALFs, RCFs, etc.) lack a formal Human Resources (HR) department. Consumers/Employers can use the Occupational Profile’s detailed task list as a guideline to develop job descriptions, interview questions when hiring, and evaluation criteria for job performance. Consumers/Companies can develop their own Job Profile (i.e. an analysis of a specific job for their company – as opposed to an Occupational Profile that analyzes one job across many companies) for use as part of their hiring processes. As noted above, companies regularly report reduced personnel costs when using WorkKeys. Consumers/Employers can adopt or adapt the existing On-The-Job (OJT) training materials that were developed under the auspices of the Assisted Living Facilities Training Consortium (ALFTC). The modularized OJT materials are designed to be delivered by Competent 1 The assessment measures an employee’s ability in comparison to job expectations rather than in comparison to how other employees scored on similar assessments (called normative assessments). 2 ACT – American College Testing based in Iowa City Iowa. ACT is one of the largest testing services in the United States. 3 Persons (CPs) who can verify incumbents’ mastery of job tasks through the use of competence checklists that are attached to each OJT module. Long Term Care Provider Associations – 16 SMEs from 9 companies helped to develop the entry level Direct Care Worker Occupational Profile through a rigorous consensus-based process. Long Term Care Provider Associations can develop an entry level Direct Care Worker certification process whereby incumbents’ KSA can be verified in the workplace by designated CPs using the ALFTC’s competence checklists. Task Lists for different jobs (Resident/Client Assistant and Medication Aide for example) can be compared and contrasted in order to build career lattices. Associations can use the Occupational Profiles to precisely articulate community based care facilities (ALFs, RCFs, etc.) training and education needs to workforce professionals. The report helps to validate Person-Centered/Directed Care by creating consensus about its primary entry-level job (Direct Care Worker). Workforce Professionals – The Occupational Profiles (especially the task lists) provides all the information that pre-employment trainers, job developers, and policy-makers need to develop programs to support job seekers, job changers, employers, and incumbent workers in community based care. 4 Executive Summary This Occupational Profile was requested by the Better Jobs, Better Care: Oregon Works! (BJBC) coalition partners to use as a guideline for the adoption of voluntary standards for the Entry Level Direct Care Worker (DCW) across community-based long term care settings3. BJBC is dedicated to creating work and care environments that are personcentered and strive to support person-directed care (See Philosophy Statement adopted by the BJBC Steering and Policy Committee on page 59). To that end, BJBC encourages direct care workers, their supervisors, and their employers to view the tasks and skills from this report as a means to support person-centered care and not an end in themselves. This means Direct Care Workers (DCW) need to know preferences and values of the client/resident, focus on their strengths and abilities, honor their choices and maximize autonomy when ever possible, and develop healthy, nurturing relationship with clients/residents. This Occupational Profile report presents the results of an ACT WorkKeys®4 job analysis of the entry-level Direct Care Worker job. The analysis was conducted by Portland Community College's ACT authorized job profiler Ena Rierson to establish task lists and identify the WorkKeys skills and skill levels necessary for entry into and effective performance of the entry-level Direct Care Worker occupation throughout Oregon. Ms. Rierson facilitated three profile sessions to gather information needed for the Occupational Profile. Ms. Rierson met with the first group (Group A) of seven subject matter experts (SMEs) on July 25, 2006, met with the second group (Group B) of four SMEs on August 1, 2006 and met with the third group (Group C) of six SMEs on August 9, 2006. All seventeen SMEs are incumbent workers currently employed within aging service facilities. During the profile sessions, the groups developed task lists that 3 Community-based long term care refers to residential care facilities, In-Home Services and Assisted Living Facilities. 4 American Collegiate Testing (ACT) is an organization that provides testing and assessments nation wide. WorkKeys and it’s relation to ACT can be found at the following website: http://www.act.org/workkeys/ 5 accurately and completely describe the occupations requirements for four skills: Locating Information, Observation, Reading for Information, and Writing. Each group identified appropriate levels for occupation entry and for effective performance. Though there was not time to profile Teamwork and Applied Mathematics, the SMEs identified tasks that included language of “working in teams” as well as “budgeting”. Future profile sessions may want to include analysis of these two skills. In addition to the WorkKeys skills analyzed, the SMEs identified personal characteristics and skill sets that are significant to the Direct Care Worker occupation. These included being compassionate, patient, positive attitude, attentive, ability to multitask, problem solving, effective verbal and non-verbal communication, and working in teams. During all three profiling sessions, a sample of SMEs representing multiple organizations and experiences from throughout the state of Oregon met to determine skills and skill levels needed to enter into and effectively perform as an entry-level Direct Care Worker. The types of community-based care venues included Residential Care Facilities, In-Home Services, and Assisted Living Facilities. Previous work experience from the SMEs attending these sessions included Direct Care Work in Arizona, Missouri, California, Washington, as well as the Ukraine and Micronesia. Previous paying jobs in area of expertise included: ICU nursing, CNA, Hospital Care, Medication Assistance, Personal Care Coordinator, as well as unpaid work to provide personal care to loved ones. Over the course of their professional and personal careers, many of the SMEs have drifted across the multiple venues of care for the aging. 6 Recommendations Several issues must be considered before using the skill levels established by the profile to set expectations for developing curriculum and training for employees in the Direct Care Worker occupation. This Occupational Profile is to establish state-wide skill standards for the Direct Care Worker occupation, so as to assist educational institutions and training programs as they develop training materials/curriculum for the Direct Care Worker occupation. Administering WorkKeys assessments for all of the skills included in the profile will assist training/certificate programs in screening students and/or potential workforce to determine needed training or education. Better Jobs, Better Care and affiliated organizations should consider using these WorkKeys assessments to gain information about the training needs of students or potential workforce with respect to: Reading, Writing, Observation, and Locating Information. This recommendation is based on the number of tasks identified by the SMEs as requiring each skill, the criticality of those tasks to the performance of the occupation, and the profiler's examination of the SMEs' ranking of the skills. The use of assessment scores for making decisions regarding reductions in force should be avoided given the potential for litigation. Use of actual measures of employee performance such as performance appraisal results and attendance records should be taken into account when making decisions of this nature. When WorkKeys is used for training and development purposes and English as a second language (ESL) or literacy issues exist for the employees in the occupation, ACT recommends that the company consider using the WorkKeys Readiness assessment. The WorkKeys Readiness assessment is designed to determine if individuals are prepared to take the operational WorkKeys assessments that require reading and/or math skills, including Reading for Information, Applied Mathematics, Locating Information, Business Writing, and Applied Technology. The profile results show 7 that Reading for Information and Locating Information are required. Therefore, results from the reading section can be used. Ways Occupational Profile results CANNOT be used: Occupational profiling does not meet the content validation standards set by the Equal Employment Opportunity Commission because it depends on a looser linkage between the task requirements and skill requirements. Therefore, an occupational profile CANNOT be used to: Screen job applicants for a position in any company Hire job applicants for a position in any company Promote job applicants into a position in any company Select employees for training if this leads to future selection decisions Evaluate employees in terms of training performance If an interested party would like to use WorkKeys Assessments for hiring or promotional purposes, they may contact their local authorized WorkKeys Job Profiler to conduct job profiles within their facility. 8 Occupational Profiling Procedure WorkKeys Occupational job profiling is conducted by job profilers who have been trained and authorized by ACT WorkKeys Industrial/Organizational Psychologists. Occupational Profiling: Occupational Profiling identifies the skill levels required for an occupation across jobs, companies, or industries. Occupational profiling relies on the expertise of the subject matter experts (SME), those people most closely associated with how the work is performed. In Occupational Profiling, the SMEs come from different organizations and/or from related jobs within an occupation. It should be noted that the breadth of the occupation affects the ease of obtaining a profile and the generalizability of the profile. Because the direct care workforce is large, gathering information for the Occupational Profile was relatively easy. Since most of the target agencies Residential Care Facilities, Home Care, and Assisted Living Facilities (RCF, HC, and ALF) currently have Direct Care Workers, the resulting information from the Occupational profile is generalizable across the industry. The first step in conducting the Occupational profiles was to determine what types of venues were to be involved in the process. Nursing homes were not included in this profile because Certified Nursing Assistants (CNAs) provide most of the direct care work and have many certification requirements that exceed the skill levels of the Direct Care Worker. The profiling procedure is designed to systematically develop accurate profiles through a task analysis that is used to select the tasks most critical to a job, and a skill analysis that is used to identify the skills and skill levels required at the entry level and for effective performance in that occupation. Task Analysis: The first step in conducting the profile was to develop a Final Task List showing the critical tasks of the occupation. Each group worked to develop one list. To begin the task analysis, the job profiler first developed an Initial Task List using the Dictionary of Occupational Titles database in the WorkKeys profiling software, numerous company job descriptions, resources from similar job profiles, and 9 information gathered from touring two different facilities. The job profiler then met with the SME groups to tailor the Initial Task List to make sure that the resulting Final Task Lists would accurately and completely describe the occupation. The SMEs deleted any task statements they considered unrelated to the occupation, revised some task statements, and added tasks they considered necessary to the occupation. Then they evaluated each task in terms of its Importance and the time they spend on that task relative to the time they spend on other tasks (Relative Time Spent). The mean Importance rating for each task was multiplied by the mean Relative Time Spent rating for each task to produce the Criticality rating for each task. These ratings represent aggregate information rather than information reached by the consensus of the SMEs. The criticality information was used to sort the task statements, placing the most critical tasks at the beginning of the list. The groups confirmed that the tasks on their respective lists were critical to the occupation. The Final Task List for this report is an accumulated tasks list that represents all tasks identified by the SMEs and can be found in the Final Task List section of this report. The tasks listed in this section are organized based on type of task and not criticality. Skill Analysis. Each SME group completed a skill analysis to identify the on-the-job behaviors associated with the WorkKeys skills under consideration and to identify how the skills are used on the job. The skills were reviewed one at a time, and the SMEs finished the analysis for one skill before going on to the next. The job profiler gave each SME a copy of the skill definition, read the definition aloud, and then answered any questions. Once the SMEs understood the definition of a WorkKeys skill and had determined its relevance to the occupation, they independently identified the tasks on their Final Task Lists that require the skill and specified how employees use the skill to perform the tasks. The job profiler then presented detailed descriptions of the WorkKeys skill levels to the SMEs and showed them examples of problems or situations employees deal with at each level. The SMEs reviewed four WorkKeys skills: Locating Information, Observation, Reading for Information, and Writing. They determined that all four are required, and 10 they identified appropriate levels for occupation entry and for effective performance. The SMEs from the Home Care worker group (Group A) determined that a very basic/low level of Math is used for their work. The SMEs from each group also identified that a very basic/low level of Teamwork may also needed for success at this entry level stage in this occupation. Mathematics and Teamwork were not profiled due to limited time and small number of tasks identified that use the skill. Following the Uniform Guidelines on Employee Selection Procedures (1978), entry into the Direct Care Worker occupation across Oregon was defined as an employee's first day in the occupation prior to completing a training course. Employees should be expected to come into the occupation with the skills shown; they are not expected to learn these skill levels while in the occupation. The final entry-level skill requirements are recommended as cutoff scores on the WorkKeys assessments for entry into the Direct Care Worker occupation. Effective performance is the point at which an employee performs competently without continuous supervision. The length of time on the job and successful completion of specific tasks would have to be determined at individual work sites. For the purpose of the Occupational profile, effective performance was defined as an employees’ ability to complete tasks without direct supervision, which is typically after an initial orientation and training and 6 months on the job. The final results shown in the last column of Table 1 (page 13) indicate skill requirements for occupation entry. Educational and elder care settings may use these skill levels to determine needed training. The final results shown in Table 2 (page 13) indicate skill requirements for effective performance and may be used for training purposes once a Direct Care Worker has been hired. A summary of the SMEs discussion of each skill can be found in the Skill Analysis Documentation section of this report. 11 Summary of Skill Levels Each skill identified as necessary for success in the Direct Care Worker occupation is broken down into skill levels. The range of skill levels are the defined levels determined by ACT and can be assessed through WorkKeys Assessment Tools. Locating Information and Observation skill ranges are from Level 3 to Level 6. The Reading for Information range is from Level 3 to Level 7. The Writing Skill definitions range from Level 1 to Level 5. The complete descriptions are located in the Skill Level Descriptions located in Appendix C (page 43). The skill level results shown in Table 1 indicate skill requirements for occupation entry. Employees should be expected to come into the occupation with the skills shown; they are not expected to learn these skill levels while in the occupation. The profile results shown in Table 2 indicate the skill requirements for effective performance. Effective performance is the point at which an employee performs competently without continuous supervision. In this case, the SMEs identified that an employee can be considered “effective” from 2 weeks to 6 months on the job. Variations in tasks were shown between home health care (HC), small facilities (2 or less Direct Care Worker per shift), and larger Residential Care Facilities (RCF), and Assisted Living Facilities (ALF). However, the core skill and skill level for occupation entry was consistent. The different levels for entry into and effective performance reflect differences in resources available (e.g., care supplies and equipment by type and age), size of facility, skill of local workforce, and whether work was completed in a resident’s home or in a facility. It became clear in the profiles that the work settings for both Home Care Workers and those employed in smaller facilities meant working with more autonomy because less help is available to assist the Direct Care Worker to read, write, find information and make observations. The level of effective performance is typically achieved after completing six months on the job. 12 NOTE: More information describing each skill level is provided in Appendix C. “Skill Level Range” refers to the range of levels that ACT has defined and can be assessed. For many skills, levels 1 and 2 are not analyzed or assessed. *HC – Level indicated for Home Care only Skill Level Descriptions can be found starting on page 39 Table 1: Requirements for Entry-Level and may be used for Training purposes. WorkKeys Skill Locating Information Observation Reading for Information Writing Skill Level Range 3–6 3–6 3–7 1–5 Group A 3 3 4 3 Group B 3 3 3 2 Group C 3 3 3 2 Final Entry Level 3 3 3 (4-HC*) 2 (3-HC*) Table 2: Requirements for Effective Performance and may be used for Training purposes. WorkKeys Skill Locating Information Observation Reading for Information Writing Skill Level Range 3–6 3–6 3–7 1–5 Group A 3 3 4 3 Group B 3 3 4 3-4 Group C 3 3 3 2-3 Final Effective Level 3 3 3-4 3 13 Summary of Final Task List The Final Tasks Lists that follow were gathered from the three profile sessions. The first task list gives a compiled list of tasks organized by type of task. The second detail of tasks gives the skill needed in order to complete that task and in what health care venue the tasks are used in. Combined Final Task List for Group A, B, and C Personal Care Tasks: 1. 2. 3. 4. 5. 6. Assist resident with bowel/bladder needs. Assist with resident bathing in a tub/shower. Assist with special skin care to prevent decubitis ulcers. Assist resident with sponge or cloth bathing. Turn resident in bed according to proper procedures to prevent sores. Assist resident in physical activity; including walking, standing, transfer and passive range of motion exercises. 7. Assist resident with getting dressed and undressed. 8. Assist resident with grooming including shaving, combing, and nail care (non-diabetic). 9. Provide support to resident by responding to requests for lifting, transferring and escorting. 10. Provide transport support by using multiple person lifting techniques. 11. Redirect resident that are wandering. 12. Assist resident with the use of elastic stockings. 13. Assist resident with care and use of eye glasses. 14. Assist resident with care and use of hearing aides. 15. Provide transport support by using the Gait Belt. 16. Assist resident with dental care including teeth brushing and denture care. 17. Encourage resident in the nutritional needs by encouraging a balanced diet or adherence to a special diet. 18. Prepare, serve and clean up after meals. 19. Assist with planning, buying, storing, preparing and serving meals (HC only) 20. Make an occupied or unoccupied bed. 21. Assist resident with all housekeeping including empty garbage, laundry, vacuuming, mopping, making beds, and cleaning of bathrooms. 22. Provide transfer support by using the Hoyer lift. 23. Assist resident with gathering, loading, folding and putting away of laundry. 24. Provide reading support to resident by reading letters, medical bill/information and calendars. 25. Assist resident with care of personal belongings by placing items in designated areas. 26. Provide resident with back and leg rubs per resident need/request or as stated in service plan 27. Provide support to resident by answering phone calls and taking messages. 14 28. Assist resident with transportation needs and indicated in the care plan (HC only). 29. Provide transfer support by using EZ lift. Emotional Care Tasks: 30. Uphold confidentiality and residents privacy at all times (adhere to HIPAA of 1996). 31. Promotes resident independence by encouraging them to remain independent and the areas they are self sufficient. 32. Honor the rights and the resident for privacy, respect, diversity, dignity and home like environment. 33. Provide emotional support by providing “active listening” to residents regarding their cares/concerns, celebrating important events (birthdays, etc.) and by remembering personal information. 34. Prevent abuse and neglect by being aware of signs and symptoms of abuse. 35. Recognize signs of “burnout” in self and others. 36. Cue resident by encouraging and reminding them to participate in activities. 37. Encourage socialization amongst residents by introducing them to others who share common interest. 38. Report abuse and neglect by filling out an incident report, alerting the immediate supervisor, and/or call Ombudsman. Health Related Tasks: 39. Provide pericare according to residents’ preferences and service plan. 40. Remind resident of medication times. 41. Accurately measure and record vitals, including; temperature, oxygen saturation, weight, pulse, respiration and blood pressure and required. 42. Assist resident with the changing of bandages or dressing as needed. 43. Assist resident with use of oxygen tank. 44. Assist with the use of condom catheters and daily catheter care once delegated. 45. Record food/water intake and body output as required by the care plan. 46. Collect routine urine, stool and sputum specimens according to proper procedures. 47. Accurately measure, record and assist with specialized skilled nursing duties (vitals, wound care, catheter care, GI tubes, colostomies, tracheotomy, drainage, etc.) as delegated by the RN. (HC only) Verbal Communication and Problem Solving: 48. Offer input to changes in the “activities of daily living” (ADL) by verbally communicating to RN or Case Manager and writing changes in the Nurses Log, communication Log, tenant Service Notes, ADL assignment sheet, and/or Shift Change Report. 49. Establish and maintain constructive working relationships with resident, co-workers, families, visitors and other service providers by using communication skills, problems solving skills, and conflict resolution techniques. 50. Promote teamwork in providing services to residents by sharing helpful hints on residents needs to co-workers. 51. Assess the health, emotional state, or needs of the residents by reading body language. 52. Talk with co-workers about tasks and to residents about needed activities, discuss problems, create solutions and get help when needed. 53. Gain insight into resident needs and preferences by using listening skills, open ended questions and paraphrasing with residents and co-workers. 15 54. Suggest improvements to work methods or processes by communicating verbally desired changes. 55. Ask for help in correctly completing a procedure or delegated task. Written Communication: 56. Obtain updated information about resident status by Reading incident report, alert charting, service notes, shift change notes, communication log, 24 hour report 57. Read and find information in the ADL flow sheet, activity schedule or communication log to find out what activities /tasks were completed and what is left to complete for each resident. 58. Read and make entries in notebook/journal/message board to track resident status, daily needs, or changes in services from previous shift. 59. Observe, record and report skin conditions in Service Notes/Communication Log/shift change report. 60. Read the resident care plan to become familiar with needs, personal information and medical issues. 61. Fill out ADL flow sheet to indicate what activities and tasks have been completed for residents. 62. Read memos and postings to be aware and keep updated on safety issues and first procedures. 63. Update other care givers on resident status by writing events down in Communication Log, 24 hour report, alert chart, and/or shift change report. 64. Fill out Incident Report and Tenant Service Notes to document any unusual incident by writing type of event, residents’ description, witness comments, name, date, time, location of the incident and any follow up items. 65. Participate in trainings or updates as requested by resident or determined by resident needs (RN’s, CNA’s, Physical Therapist, Home Health, Hospice, Occupational Therapist, and/or Medical Equipment Suppliers). 66. Fill out forms as needed for supplies. Safety: 67. Handle bodily fluids and properly clean or dispose of materials soiled by body fluids according to proper Universal Precautions procedures. 68. Practice safety in working around and with equipment used for resident daily activities, including oxygen tanks, wheelchairs, walkers, canes, Hoyer lift, gate belts, and electric scooters. 69. Work safely to prevent injuries by adhering to proper lifting techniques. 70. Know proper first aid and CPR procedures in order to assist with incidents. 71. Monitor safety of the residents by clearing hazards to avoid injuries from slips, trips and falls. 72. Respond to resident emergencies by notifying appropriate staff or, if alone, call emergency services. 73. Respond to resident emergencies by providing first aid/CPR assistance. 74. Monitor, check and test Life Line Paging System to ensure safety of residents and answer calls as pages. 16 Detailed Presentation of Final Task Lists The Final Task List for the Occupational Profile is shown in the table below. The tasks below are listed by type of task, what skill is used to complete the task and what facility identified the task as needed in their work setting. A check mark () in a skill column means that, according to the SMEs in the profile session, the task on that row requires that skill. The names of the WorkKeys skills have been abbreviated to save space, as follows: Locating Information (LI), Observation (OB), Reading for Information (RI), and Writing (W). The names of the Health Care Venues are abbreviated to save space are as follows: Home Care (HC), Residential Care (RC), Assisted Living Facility (ALF). LI OB RI W Tasks HC RC ALF Personal Care Tasks Assist resident with bowel/bladder needs. Assist with resident bathing in a tub/shower. Assist with special skin care to prevent decubitis ulcers. Assist resident with sponge or cloth bathing. Turn resident in bed according to proper procedures to prevent sores. Assist resident in physical activity; including walking, standing, transfer and passive range of motion exercises. Assist resident with getting dressed and undressed. Assist resident with grooming including shaving, combing, and nail care (non-diabetic). Provide support to resident by responding to requests for lifting, transferring and escorting. 18 LI OB RI W Tasks HC RC ALF Provide transport support by using multiple person lifting techniques. Redirect residents that are wandering. Assist resident with the use of elastic stockings. Assist resident with care and use of eye glasses. Assist resident with care and use of hearing aides. Provide transport support by using the Gait Belt. Assist resident with dental care including teeth brushing and denture care. Encourage resident in the nutritional needs by encouraging a balanced diet or adherence to a special diet. Prepare, serve and clean up after meals. Assist with planning, buying, storing, preparing and serving meals (HC only). Make an occupied or unoccupied bed. Assist resident with all housekeeping including empty garbage, laundry, vacuuming, mopping, making beds, and cleaning of bathrooms. Provide transfer support by using the Hoyer lift. Assist resident with gathering, loading, folding and putting away of laundry. Provide reading support to resident by reading letters, medical bill/information and calendars. Assist resident with budgeting, bill pay and balancing expenditures with income (HC only). Assist resident with care of personal belongings by placing items in designated areas. Provide resident with back and leg rubs per resident need/request or as stated in service plan. 19 LI OB RI W Tasks HC RC ALF Provide support to resident by answering phone calls and taking messages. Assist resident with transportation needs as indicated in the care plan. Provide transfer support by using EZ lift. Emotional Care Tasks Uphold confidentiality and resident privacy at all times (adhere to HIPAA of 1996). Promote resident independence by encouraging them to remain independent in the areas where they are self sufficient. Honor the rights and the resident for privacy, respect, diversity, dignity and home like environment. Gain insight into resident needs and preferences by using listening skills, open ended questions and paraphrasing with residents and co-workers. Prevent abuse and neglect by being aware of signs and symptoms of abuse. Recognize signs of “burnout” in self and others. Cue resident by encouraging and reminding them to participate in activities. Encourage socialization amongst residents by introducing them to others who share common interest. Report abuse and neglect by filling out an incident report, alerting the immediate supervisor, and/or call Ombudsman. Health Care Tasks Provide pericare according to residents’ preferences and service plan. Remind resident of medication times. Accurately measure and record vitals, including; temperature, oxygen saturation, weight, pulse, respiration and blood pressure and required. 20 LI OB RI W Tasks HC RC ALF Assist resident with the changing of bandages or dressing as needed. Assist resident with use of oxygen tank. Assist with the use of condom catheters and daily catheter care once delegated. Record food/water intake and body output as required by the care plan. Collect routine urine, stool and sputum specimens according to proper procedures. Accurately measure, record and assist with specialized skilled nursing duties (vitals, wound care, catheter care, GI tubes, colostomies, tracheotomy, drainage, etc.) as delegated by the RN. (HC only) Verbal Communication and Problem Solving Skills Related Tasks Offer input to changes in the “activities of daily living” (ADL) by verbally communicating to RN or Case Manager and writing changes in the Nurses Log, communication Log, tenant Service Notes, ADL assignment sheet, and/or Shift Change Report. Establish and maintain constructive working relationships with resident, co-workers, families, visitors and other service providers by using communication skills, problems solving skills, and conflict resolution techniques. Promote teamwork in providing services to residents by sharing helpful hints on residents needs to co-workers. Assess the health, emotional state, or needs of the residents by reading body language. Talk with co-workers about tasks and to residents about needed activities, discuss problems, create solutions and get help when needed. Listen to residents and co-workers to gain insight into resident needs and preferences. Suggest improvements to work methods or processes by communicating verbally desired changes. Ask for help in correctly completing a procedure or delegated task. 21 LI OB RI W Tasks HC RC ALF Written Communication Related Tasks Obtain updated information about residents’ status by Reading incident report, alert charting, service notes, shift change notes, communication log, 24 hour report Read and find information in the ADL flow sheet, activity schedule or communication log to find out what activities /tasks were completed and what is left to complete for each resident. Read and make entries in notebook/journal/message board to track resident status, daily needs, or changes in services from previous shift. Observe, record and report skin conditions in Service Notes/Communication Log/shift change report. Read the resident care plan to become familiar with needs, personal information and medical issues. Fill out ADL flow sheet to indicate what activities and tasks have been completed for residents. Read memos/postings to be aware and keep updated on safety issues and first aid procedures. Update other care givers on resident status by writing events down in Communication Log, 24 hour report, alert chart, and/or shift change report. Fill out Incident Report and Tenant Service Notes to document any unusual incident by writing type of event, residents’ description, witness comments, name, date, time, location of the incident and any follow up items. Participate in trainings or updates as requested by resident or determined by resident needs (RN’s, CNA’s, Physical Therapist, Home Health, Hospice, Occupational Therapist, and/or Medical Equipment Suppliers). Fill out forms as needed for supplies. Safety Related Tasks Handle bodily fluids and properly clean or dispose of materials soiled by body fluids according to proper Universal Precautions procedures. Practice safety in working around and with equipment used for resident daily activities, including oxygen tanks, wheelchairs, walkers, canes, Hoyer lift, gate belts, and electric 22 LI OB RI W scooters. Tasks HC RC ALF Work safely to prevent injuries by adhering to proper lifting techniques. Know proper first aid and CPR procedures in order to assist with incidents. Monitor safety of the residents by clearing hazards to avoid injuries from slips, trips and falls. Respond to resident emergencies by notifying appropriate staff or, if alone, call emergency services. Respond to resident emergencies by providing first aid/CPR assistance. Monitor, check and test Life Line Paging System to ensure safety of residents and answer calls as pages. 23 Skill Analysis Documentation The WorkKeys skills are presented in order, from those most critical to job performance to those least critical. This Skill Analysis represents the rationale for what skills are used to complete the tasks and what levels employees must have in order to successfully complete the required tasks. OBSERVATION The WorkKeys Observation skill is an employee’s skill in paying attention to and remembering work-related instructions, demonstrations, and procedures and in noticing details among distractions. The SMEs in each group were asked to highlight any task on their Final Task List that used the profiled skill, in this case Observation. Group A highlighted 80% of their tasks, Group B highlighted 71% of their tasks and Group C highlighted 83% of their tasks. The SMEs indicated that most of the tasks on their task lists require some level of Observation because Direct Care Workers are required to pay attention to specific and important details when working with residents or clients. They do this by 1) providing for the daily needs of the resident, 2) observing changes in mental, social and physical health status and 3) participating in training and delegation. Examples of training and delegation include using lifting equipment and correct techniques, First Aid/CPR, procedures for Universal Precaution, how to document resident changes, how to take vitals, and training for specific procedures/techniques or processes to meet the daily needs of the resident. The SMEs were shown Observation skill Levels 3 and 4. In determining the level of skill necessary for the tasks of the occupation, the SMEs considered the following five characteristics: the complexity of the procedure, how fast the information is presented, 24 the availability of hints or reminders, the amount of distractions, and the subtlety of the differences in details that they must notice. All 17 SMEs indicated that Level 3 is necessary for entry into and effective performance of the Direct Care Worker occupation. The Direct Care worker may not have to complete all trainings and delegations in order to be successful. At level 3, employees must pay attention to and remember a straightforward procedure. Details are presented at a slow pace, over which the employee has control. Reminders are present and there are minimal distractions. For example, training on how to properly bath a resident is considered a straightforward procedure, done at a slow pace, with residents often reminding employees as well as the final tracking sheet on whether the task has been completed. Once these tasks are learned there is not much effort on the part of the Direct Care Worker to remember steps and they can always ask for help in difficult situations. A situation where an entry level Direct Care Worker may ask for help is in bathing a resident with dementia or a resident in pain. In these cases, bathing can be quite complex demanding that the worker be flexible and change steps or routines as needed by the resident or client. The Level 3 tasks identified were: Looking for and being aware of changes in health and cognitive status of residents. For example, does the resident seem either quieter or more agitated than normal? Has the gait changed? Is there new swelling? Completing Activities in Daily Living (bathing, pericare, cleaning rooms, taking care of personal belongings, glasses and hearing aides, food handling, changing ted hose) consistent with the needs of the resident (Consider such things as are glasses clean? Hearing aids in working order? Are preferred bathing products available? How well is the resident managing his/her food compared to last week?) 25 Training on Documentation procedures (What kinds of observations need to be noted? How can you communicate concerns effectively?) Asking questions when needing clarification or assistance Delegate authority to another more qualified/trained person How to follow Fire Drill Procedures Observing signs of abuse Use of Universal Precautions How to Take vitals Training on Safe Lifting techniques How to use the Gait Belt How to use the Hoyer Lift How to use the EZ Lift Training on First Aid/CPR/Heimlich HIPPA training Buying food for client (Home Care only) Preparing/serving foods to ensure nutritional needs are met Mental health of residents (working with differing mental capacities of residents) Spending and balancing budgets for residents (Home Care only) Specific training from hospice or manufacturer of certain health care products LOCATING INFORMATION The WorkKeys Locating Information skill is defined as an employee’s skill in using information taken from workplace graphics such as diagrams, maps, floor plans, tables, forms, graphs (including bar charts, pie charts, and line graphs), flowcharts, and instrument gauges. Employees use this skill when they find information in a graphic or insert information in a graphic. They also use it when they compare, summarize, and analyze information found in related graphics. 26 The SMEs in Group A, B and C indicated that 70%, 12% and 27%, respectively, of their tasks required Locating Information skill. The difference in the percentage from the 1st to the 3rd group are due to the changes in the number of tasks on each final task list within each group. The final task list in the first session had only 48 tasks with many tasks being grouped together. By the second and third sessions the final task lists were developed more fully and tasks were flushed out into a more detailed and complete list of about 75 tasks. The actual duties/tasks were not significantly different between all three groups, but the lower total number of tasks in Group A meant that identifying only a few tasks increased their percentages quite dramatically. The Direct Care Worker must use this skill when finding and/or inserting names, dates, times, locations, vitals, and relevant information on or into the following forms and log books: Resident Care Plan Daily log books/24 hour book/Memory care logs Tracking forms for ADL’s (including shower forms, meals, INO – intake and Output chart, etc.) Incident reports Supply forms Temperature gauges Vitals from gauges (scale, blood pressure cuff, temperature, watch, etc.) and then form to insert data Oxygen tank gauge Alert Charting Cups scales for urine/stool measuring Time cards Shift change check off sheets Mileage reimbursement sheet (HC only) Shopping lists 27 Budget sheets Diabetic meal planning form (HC only) The Locating Information skill level required for a occupation is determined by the complexity of the graphic(s) used to accomplish a task, and the complexity of the task(s) performed. The SMEs compared the tasks of their occupation to WorkKeys Locating Information skill levels 3 through 4. The SMEs in all three groups agreed that Locating Information skill Level 3 is necessary for entry into and effective performance for the Direct Care Worker occupation. At Level 3, the employees must read elementary graphics, forms, tables, maps, and instrument gauges. They must also find one or two pieces of information in these types of graphics and/or insert one or two pieces of information that are missing in these graphics. The Direct Care Worker must complete tasks using numerous tracking forms, gauges and log books. The nature of information to find and enter into the logs/forms/gauges is simple and short, often leaving only time/date/value/and initials. Tasks representing this level would include reading a thermometer, weight scale and oxygen tank and entering that information on a vital sheet. There is often only one gauge and one piece of information to gather from this gauge and only one place to insert this information into. Another Level 3 example includes finding information from an ADL chart to determine activities completed and inserting check marks/date/time/initials onto an ADL tracking sheet once completed. READING FOR INFORMATION The WorkKeys Reading for Information skill is an employee’s skill in reading and understanding work-related written texts. The SMEs in Group A, B and C indicated that 53%, 21% and 25%, respectively, of their tasks require the Reading for Information skill. The Direct Care Worker uses this skill most often when finding information regarding the Activities of Daily Living of the Resident. The Direct Care Worker must be able to read Resident Care Plan, Log books and related notes in order to verify what ADL’s are 28 requested, check ongoing resident health status and find out the interests, preferences, values and hobbies of the resident. When evaluating the level of the Reading for Information skill necessary for the tasks of the occupation, the SMEs considered the difficulty of the written texts employees must read and how hard it is for employees to find and make use of the information they need in them. The SMEs evaluated their work situation in comparison to WorkKeys Reading for Information skill Levels 3 through 5. The SMEs in group B and C determined that Level 3 is necessary for entry into and effective performance of the Direct Care Worker occupation. At Level 3, reading materials are short and simple. All the information they need is stated clearly and directly, using easy words and straightforward sentences. An example of the most common reading was that of the 24 hour log book/communication log. Comments might look like: “Room 14 - walks with a cane now in room. For longer distances may use 4 wheel walker”. “Resident is incontinent. Needs to be toileted every 2 hours, talking about animals helps reduce anxiety while toileting.” “Incontinent supplies needed.” Again, the sentence structure is short, words are easy and the meaning and follow up is easily understood. SMEs in Group B and C identified that some materials are at Level 4, but that Direct Care Workers can ask for help in understanding the materials. In some cases where employees are non-native speakers, the employee would seek out help from another co-worker who speaks both English and their native language. Example materials needing to be read: Vouchers (HC only) Comments on ADL flow sheets Communication Book; 24 hours book, nurses log, etc. Progress Notes Alert Charting DNR sheet 29 Incident report Resident Care Plan Activity schedule Notes from family or co-workers Appointment book Shift Change Notes Training materials – first aid/CPR/Heimlich/delegation materials all related quizzes Union or Agency memos and letters Safety Memos Directions to and from residents home and to and from doctors office (HC only) Medication and instructions for medications (HC only) Topical and OTC medications and supplements Reading done for residents: emails, online research for medicines, bills, letters, manuals/appliance instructions, household chemicals/hazards, voter catalog, newsletters, newspaper, etc. Instructions for cooking certain dishes (HC only) The SMEs in Group A (Home Care) determined that Level 4 is necessary for entry into and effective performance of the Direct Care Worker occupation for Home Care settings. At Level 4, the materials are straightforward, but have longer sentences and contain a number of details. These materials use common words, but do have some harder words, too. They describe procedures that include several steps. When following the procedures, employees must think about changing conditions that affect what they should do. An example give was that of materials for describing medications. Medications will often have “if, then” sentences associated with potentially dangerous side effects. A Direct Care Worker in this setting must be able to read and understand what side effects to look for and decide what resulting action to follow up with. Other examples of Level 4 materials included: Medication info and instructions; Research info for medications and illnesses; 30 Correspondence from doctor, health care agency, union, and Medicare/Medicaid information. For the Direct Care Worker in a smaller facility, the issue that became clear was that there is not access to someone who can read or interpret the materials for the worker. The most common materials include the Communication Log, Nurses notes, Incident Reports, Progress Notes, and medication information. Many times in smaller facilities the Direct Care Worker will be working with one other supervisor, but that supervisor is not available to assist with reading. In this case, the worker must be able to read and understand what needs to be done from the written materials. WRITING The WorkKeys Writing skill is an employee’s skill in writing messages that relay workrelated information between people. The Writing skill level required by a job is determined by considering the importance of the writing mechanics (i.e. punctuation, capitalization, grammar, and spelling) and writing styles (i.e. choppy or smooth) prior to using a spelling checker, grammar checker, or review by others. The SMEs were shown skill Levels 1 through 4. The SMEs in Group A, B and C indicated that 50%, 21% and 20%, respectively, of their tasks required the Writing skill. The SMEs in Groups B and C determined that Level 2 is necessary for entry into the Direct Care Worker occupation. At Level 2, the writing is generally understandable, but has many errors. The sentences are not always complete and may use casual language rather than standard written English. The SMEs agreed that folks starting the occupation must be able to write understandable notes, but need not worry about grammar and spelling. An example of common writing is often 1-3 lines long, with incomplete sentences and would look like the following: “resident out of building, has not returned – Swing shift, phoned Father Dan 31 looking for resident. Still not found”. “resident doesn’t like breakfast, just leave in bed until ready to rise”. The SMEs in Group A determined that Level 3 is necessary for entry into the Direct Care Worker occupation (description of Level 3 to follow). The overall split level of the entry level occurred because there are work circumstances that contribute to the differing skill level between Home Care settings and RCF and ALF settings. The group believed that because of the autonomy of the employee within the home setting, they must be able to communicate effectively and completely on their own from the first day. The SMEs in Group A, B and C determined that Level 3 is necessary for effective performance. At Level 3, the written materials may include incorrect sentence structure and a few errors in grammar and punctuation. The example of Writing Level 3 included the Incident Report. In this report, an employee must use mostly complete sentences and must be organized to convey the order of events, the location of injuries and soreness and finally what follow up occurred and what others need to do for additional follow up. Often this report must be filled out without help from other co-workers. Some examples of writing in the incident report narrative include: “Resident had non-injury fall today. Vitals signs P120/80, resp. 80, temp. 98.6. Family and physician notified. ROM within normal limits. Continue to monitor every 4 hours.” This example is fairly short for a narrative. Many narratives with injuries can take ½ to a full page to write down. The employee does not or cannot go back to correct spelling or organization. Examples of Writing given included filling out the following forms: Message boards Notes to RN, co-workers, and case workers Adding or editing in resident care notes Communication: 24 hour book, communication log, nurse log, progress notes, tenant service notes and/or shift change notes. 32 Incident Report or Alert Charting; narrative portion of this form (Level 4 without help, Level 3 with help) ADL flow sheet or tracking form: small area for quick notes Assignment sheet: start of shift fill this out Notes to family, friends or service providers Maintenance request forms 33 Subject Matter Expert Demographics Three occupational profiling sessions were conducted. Group A met on 7/25/06, Group B met on 8/1/06 and Group C met on 8/9/06. Group A had seven SMEs, Group B had four SMEs and Group C had six SMEs. SME demographic information is provided below. Female 7 Ge GrJob Status Gr Gr Ov nd ou ou ou era er p AIncumbent p Bp C ll Group A Group B Group C Overall 7 0 2 2 4 2 13 4 Supervisor Years in Profiled Job Group A Group B Group C Overall Average Highest Lowest 10.4 25 1.5 2.2 5 0.25 13 18 6 7.5 25 0.25 Years with Company Group A Group B Group C Overall Average Highest Lowest 7 17 1.5 1.2 2 1.5 4.6 18 1.5 4.3 18 1.5 Age Group A Group B Group C Overall Average Highest Lowest 3 50 60 36 20 27 22 38.5 59 28 36 60 22 34 6 17 Male 0 1 0 1 Racial/Ethnic Group Group A Group B Group C Overall African American/ Black, Non-Hispanic Asian-American or Pacific Islander Caucasian/White, Non-Hispanic Other I prefer not to respond 6 1 4 1 1 3 1 1 13 1 1 1 35 Appendix A. WorkKeys Terminology This information is presented in the order that it typically appears during a job profile. WorkKeys Skills Applied Mathematics Applied Technology Business Writing Listening Locating Information Observation Reading for Information Teamwork Writing Job Profiling Job Profile A procedure to determine the most critical tasks for a job and to determine the WorkKeys skills and skill levels required to perform these tasks. The result of conducting one or more job profiling sessions which shows the most critical tasks for a job and the WorkKeys skills and skill levels required to perform a job. An individual who has completed ACT's WorkKeys Job Profiling training program successfully. An ACT authorized profiler has been trained to: (1) Facilitate the job profiling process while using the SkillPro software (2) Generate a report of the profile results Subject matter experts are employees currently performing the job or people knowledgeable about the job being profiled (e.g., supervisors or people who have been recently promoted from the job). A focus group meeting facilitated by an ACT authorized job profiler. The job profiler meets with SMEs to perform a task analysis and skill analysis. Prior to the profiling session, the profiler develops an Initial Task List using information compiled from databases (e.g., Dictionary of Occupational Titles and O*NET), job-related documentation (e.g., job descriptions, resources from similar job profiles, training materials), and information gathered from the tour of the facility. A task analysis consists of three parts: (1) The job profiler meets with the SME group to tailor (i.e., add, edit, and delete tasks) the Initial Task List, making sure that the Final Task List accurately and completely describes the job. (2) The SMEs independently rate each task for Importance and Relative Time Spent. (Definitions are shown below.) Profiler SME Profiling Session Initial Task List Task Analysis 36 (3) The profiler calculates the criticality of each task using the SME ratings, and sorts the task statements by placing the most critical tasks at the beginning of the list. The SMEs review and confirm the order of the tasks. The product of the task analysis is the Final Task List. Importance Relative Time Spent Criticality The importance of the task to the job. The amount of time spent performing a task relative to the amount of time spent on all the other tasks. The extent to which a task is critical to the job. To calculate Criticality, the profiler multiplies the mean Relative Time Spent rating by the mean Importance rating for each task. These ratings represent aggregate information rather than information reached by the consensus of the SMEs. A list specifying the critical tasks for a job in statements that have been reviewed and edited by SMEs and then placed in criticality order using SME ratings. A skill analysis occurs after a task analysis is completed and consists of two parts: (1) The SME group identifies the on-the-job behaviors (i.e., tasks from the Final Task List) that are associated with the WorkKeys skills under consideration. (2) The SME group compares detailed descriptions of the WorkKeys skill levels to the tasks that require the specified skill. The job profiler seeks to bring the group to a consensus regarding the skill levels required at job entry and for effective performance. Entry-Level Following the Uniform Guidelines on Employee Selection Procedures (1978), WorkKeys defines entry as an employee’s first day performing the job. The entry-level skill requirements are recommended for use as cutoff scores on the related WorkKeys assessments. Effective performance is the point at which an employee performs competently without continuous supervision. Effective performance levels are provided for use as training goals. Replication sessions are additional profiling sessions with different groups of SMEs. Replication sessions are used to make sure that the results are consistent from one group to another, especially when there are a large number of incumbents on the job. Final Task List Skill Analysis Effective Performance Level Replication 37 Reconciliation When SME groups do not agree on skill requirements (generally for job entry) the profiler meets with representative SMEs from each group to resolve the differences in a reconciliation session. A summary generated by the profiler that includes the Final Task List, detailed descriptions of the session discussions of each skill, and recommendations for using the results. A test used to evaluate individuals' performance in a skill area. Scores on the WorkKeys assessments can be compared to the WorkKeys skill levels identified in a profile. The difference between the profiled level and a score indicates the need for training. When the profiled skill level is higher than the assessment score, the difference is referred to as a “skill gap.” A WorkKeys Value-Added Reseller provides a variety of workforce development services including profiling, assessment, and training to support employers in the local area. ACT Centers support workforce development through a comprehensive set of distance-delivered and site-based services such as guidance, testing, and training. An ACT Center may also be a WorkKeys Value-Added Reseller. Profile Report Assessment Skill Gap Value-Added Reseller (VAR) ACT Center™ Network 38 Appendix B. WorkKeys and Content Validation Recommendations Regarding Validation In developing the WorkKeys system, including WorkKeys assessments and job profiling, ACT has and will continue to be guided by professional documents such as the Standards for Educational and Psychological Testing (1999; developed by the American Education Research Association, American Psychological Association and National Council for Measurement in Education), the Principles for the Validation and Use of Personnel Selection Procedures (2002, Society for Industrial and Organizational Psychology); and the Uniform Guidelines on Employee Selection Procedures (1978), which has been adopted by the Equal Employment Opportunity Commission (EEOC) and various other federal agencies (Ref: 29 C.F.R. Part 1607). ACT believes that use of the WorkKeys assessments that is consistent with ACT’s guidelines will meet the standards set forth in the professional standards. An effective selection system and its components can predict an applicant’s likelihood of success for a particular job. To be legally defensible against charges of disparate treatment or adverse impact, an employer must be able to establish a credible link between the job and the measures used to select employees. In other words, the validity of a test for selection purposes is generally based upon (1) the development of the test, and (2) the relationship between the test and the job. Validation is a process of determining whether the procedure or instrument is effective in distinguishing individuals who will perform well on the job from those who will not perform well on the job. The Guidelines support using one of the following strategies: Content validation: requires evidence that the selection procedure is representative of the content of the job 39 Criterion-related validation: requires statistical evidence of the relationship between performance on a selection procedure and job performance Construct validation: requires evidence of the relationship between a construct measured by the selection procedure and the related work behavior(s) for the job Validation is not determined by only testing job incumbents and comparing their scores to the profile. Though this may be useful for determining individual employee training and development needs, it is not thorough enough to qualify as validity evidence according to the professional standards contained in the Guidelines, Standards, and Principles. While there are many reasons for this, it is primarily because there needs to be a way to compare test scores for a group of incumbents to their job performance before drawing a conclusion. WorkKeys Test Development The development of the WorkKeys assessments was guided by professional standards for testing contained in the Guidelines, Standards, and Principles. For example, the items on the WorkKeys assessments go through a series of screens before the test development process is completed. Below is a description of characteristics of the WorkKeys tests to ensure that they are job related and fair to test takers: A. The assessments are criterion-referenced (they use job requirements as the reference). B. The test specifications are well defined. C. People who are familiar with various work situations and have insight into the use of a particular skill in different employment settings write the items. D. Items measure a particular workplace skill. E. Prior to construction of the released assessment, content and fairness experts review the items to determine possible differences in responses among racial groups and between men and women. F. Statistical analyses at the item and test level are conducted to monitor the performance of various subgroups. For example, a DIF (Differential Item Functioning) analysis, a statistical procedure for identifying bias for specified groups (e.g., race, gender) is run for each item. 40 Paper-and-pencil tests that are intended to replicate a work behavior are most likely to be appropriate when work behaviors are performed in paper-and-pencil form (e.g., editing and bookkeeping). Paper-and-pencil tests of effectiveness in interpersonal relations (e.g., sales or supervision), or physical activities (e.g., automobile repair), or ability to function properly under danger (e.g., firefighters) generally are not close enough approximations of work behaviors to show content validity. For these behaviors, a different validity strategy would be more appropriate. In order to demonstrate the content validity of a test of job knowledge, the following requirements must be met. There must be a defined, well-recognized body of information and knowledge, and the information must be prerequisite to performance of the required work behaviors. The work behavior(s) to which each knowledge is related should be identified on an item-by-item basis. The test should fairly sample the information that is actually used by the employee on the job, so the level of difficulty of the test items should correspond to the level of difficulty of the knowledge as used in the work behavior. Additional technical information regarding the development of the WorkKeys assessments is available from ACT. Relationship Between WorkKeys and the Job The WorkKeys system employs the content validation strategy to show the WorkKeys assessments reflect the content of the job. This allows employers, regardless of their size, to establish legally defensible validity evidence. First, WorkKeys test items are developed from samples of a variety of work situations so items on the assessment reflect situations that might be found on the job. Next, the job profiling process establishes a link between tasks performed on the job, the WorkKeys skills needed to perform the tasks, and the skills and skill levels measured with the WorkKeys assessments. During job profiling, groups of subject matter experts are convened to describe the tasks performed on the job and the skills required for completing the tasks. SMEs are knowledgeable about the job and are representative of the job incumbents in terms of such 41 characteristics as age, race, gender, national origin, and religion. Using definitions and sample items that match the specifications of the assessment, they then match the levels of skill needed for the job with the levels of skill measured by the WorkKeys assessments. In order to establish a legally defensible employment selection system, as described by the Guidelines, employers must conduct a job analysis to establish both critical work behaviors and the knowledge, skills, and abilities needed for fulfilling these work behaviors. The WorkKeys job profiling procedure was developed to meet this requirement by determining the critical tasks of a job (based on Importance and Relative Time Spent ratings) and their skill requirements. This is an essential component of the WorkKeys system. 42 Appendix C. Skill Descriptions LOCATING INFORMATION SKILL The WorkKeys Locating Information skill is the skill people use when they work with workplace graphics such as charts, graphs, tables, forms, flowcharts, diagrams, floor plans, maps, and instrument gauges. Employees use this skill when they find information in a graphic or insert information into a graphic. They also use it when they compare, summarize, and analyze information found in related graphics. There are four levels. Level 3 is the least complex and Level 6 is the most complex. At each new level, employees need more demanding skills in addition to the skills used at the previous levels. For example, Level 5 includes the skills used at Levels 3, 4, and 5. At Level 3, employees look for information in simple graphics and fill in information that is missing from simple graphics. At Level 6, employees may use the information in one or more complex graphics to draw conclusions and make decisions. The complexity can also increase as the quantity and/or density of the information increases. When considering the level of Locating Information skill needed for the tasks employees complete on the job, you should think about the difficulty of both the graphics and the task. You might consider the following questions: How difficult are the graphics? That is: How many graphics are used? Are the graphics simple or complicated? Do the graphics use elementary, common language or do they include unfamiliar, technical terms or symbols? How many extra details are included? How complicated is the employee’s task when using the graphics? That is: Is it only necessary to use information that is stated clearly? Does the information in the graphics need to be summarized or compared? Is the information in the graphics used to draw conclusions or make decisions? Locating Information Level 3 Level 3 workplace graphics are elementary. They may be simple order forms, bar graphs, tables, flowcharts, maps, instrument gauges, or floor plans. At Level 3, employees use one graphic at a time. When employees use Level 3 Locating Information skills on the job, they can: Find one or two pieces of information in a graphic. 43 Fill in one or two pieces of information that are missing from a graphic (for example, they might fill in a bill number on a form). Locating Information Level 4 Level 4 workplace graphics are straightforward. They may be basic order forms, diagrams, line graphs, tables, flowcharts, instrument gauges, or maps. At Level 4, employees may work with one or two graphics at a time. When employees use Level 4 Locating Information skills on the job, they can use the skills described at Level 3, and they can: Find several pieces of information in one or more graphics. Understand how graphics are related to each other (for example, they might use a parts table and shipping ticket together). Summarize information from one or more straightforward graphics (for example, they might find how many oak trees in an inventory table are taller than four feet). Identify trends shown in one or more straightforward graphics (for example, they might use a line graph to find how sales of a product change from one month to another). Compare information and trends shown in one or more straightforward graphics. Locating Information Level 5 Level 5 workplace graphics are complicated. The graphics are sometimes in a less common format (such as a three-dimensional bar graph). They may be detailed forms, tables, graphs, diagrams, maps, or instrument gauges. At Level 5, employees may work with one or more graphics at a time. When employees use Level 5 Locating Information skills on the job, they can use the skills described at Levels 3 and 4, and they can: Sort through distracting information (that is, information in a graphic that may not be useful for the current task). Summarize information from one or more detailed graphics (for example, they might find the maple trees in an inventory table that are taller than four feet, are less than $50, and are in the sales region). Identify trends shown in one or more detailed or complicated graphics (for example, they might use a detailed line graph to find how sales of five separate products changed form March to July). Compare information and trends from one or more complicated graphics. 44 OBSERVATION SKILL WorkKeys Observation is the skill people use when they pay attention to and remember workrelated instructions, demonstrations, and procedures. There may be distractions or other information competing for the employees’ attention. The details observed will differ depending on the job, the task, and the situation. There are four levels. Level 3 is the least complex and Level 6 is the most complex. The levels build on each other, each incorporating the skills assessed at the previous levels. For example, Level 5 includes the skills used at Levels 3, 4, and 5. The skill level is determined by the complexity of the procedure(s) being observed and the task(s) that employees are asked to do based on their observations. At Level 3, employees must notice and recall straightforward information, which moves slowly, with very strong hints or reminders. There are few distractions, and differences are obvious. At Level 6, employees remember details after they have been shown a complex situation with many distractions. The information moves quickly, and hints or reminders are minimal. Details are subtle, and differences are not easy to notice. A videotape shows examples of situations that belong at each skill level. When you consider what skill level is needed for the tasks that employees complete on the job, think about the following things: How complex is the procedure being observed and remembered? Is it logical or illogical, familiar or new, commonplace or unique, straightforward or complicated? How much information is involved, and are the procedure’s parts independent or interactive? How fast is the information presented? Does it move quickly or slowly? Can the employee control the speed, or does the employee have to keep up with a set pace? How much distracting information is there? How difficult is the task that employees are asked to do? Is it clear what employees must pay attention to, or must they work hard to pay special attention to important details (selective attention)? Are there obvious hints or reminders that the task needs to be done; how to complete the task; when the task should be completed; or whether the task was done correctly? How subtle are the details or differences in the procedure to be noticed by employees? Are these differences significant? 45 Observation Level 3 At Level 3, employees watch a straightforward procedure and remember it. The task is performed at a slow pace, generally under the employees’ control, and in a routine, predictable manner. There are no extra details or distractions. Obvious hints or reminders prompt employees that the task needs to be done, how and when it should be completed, and whether it is done correctly. When employees use Level 3 Observation skills on the job, they can: Pay attention to the basic parts of a straightforward procedure that is done at a slow pace. Remember a few strongly prompted details. Remember instructions and reminders that give them strong cues. Remain focused on the important parts of a procedure shown without distractions or irrelevant information. Notice clear differences. Observation Level 4 At Level 4, employees pay attention to and remember a straightforward procedure that involves more than one part. The tasks are performed at a moderate pace, and some extra details and distractions are present. The procedure is normally routine and somewhat under the employees’ control, but employees must watch for important details and use their judgment to decide which information to pay attention to. The employees’ attention is directed toward important details. When employees use Level 4 Observation skills on the job, they can use the skills described at Level 3, and they can: Select and pay attention to parts of a straightforward procedure with some details that are hard to notice. Pay attention to details that are shown at a moderate pace. Remember a few important details that are reinforced. Remain focused on the important details when there are some extra details or distractions. Notice less obvious differences. 46 Observation Level 5 At Level 5, employees pay attention to and remember work procedures that include several tasks that may occur at the same time and that may be outside of their control. The tasks, which are performed at a moderate pace, often interact with each other and may change from one situation to another. Several important details are presented, most of which are not strongly prompted. The employee must examine differences and figure out if the differences are important to note (for example, detect differences from standards and figure out if the differences are big enough to report). There are often several extra details or distractions that make it difficult for the employee to pay attention to the important points. When employees use Level 5 Observation skills on the job, they can use the skills described at Levels 3 and 4, and they can: Focus their attention on and remember several important details from a work procedure that includes several tasks that may occur at the same time and at a moderate pace. Maintain attention to important details with little prompting. Remember relevant aspects of the information presented. Remember several important details about unfamiliar material. Ignore irrelevant background information or distractions and pay attention only to important points. Recognize several differences that are presented at the same time. Examine a subtle difference and decide whether or not it is acceptable. 47 READING FOR INFORMATION SKILL WorkKeys Reading for Information is the skill people use when they read and use written text in order to do a job. The written texts include memos, letters, directions, notices, bulletins, policies, and regulations. It is often the case that these workplace communications are not necessarily well written or targeted to the appropriate audience. Reading for Information materials do not include information that is presented graphically, such as in charts, forms, or blueprints. There are five levels of difficulty. Level 3 is the least complex and Level 7 is the most complex. The levels build on each other, each incorporating the skills assessed at the preceding levels. For example, at Level 5, employees need the skills from Levels 3, 4, and 5. The reading materials at Level 3 are short and direct. The material becomes longer, denser, and more difficult to use as readers move toward Level 7. The tasks also become more complex as readers move from Level 3 to Level 7. At Level 3, readers begin by finding very obvious details and following short instructions. At the more complex levels, tasks can also involve more application and interpretation. When you consider what level of Reading for Information skill is needed for the tasks employees complete on the job, you might consider the following questions: How difficult are the materials? For example: Are the sentences short, simple, and clear; or are they complex and possibly even confusing? Do the materials use only common words; or do they include difficult words, jargon, and words used in unfamiliar ways? How much extra information is included? How complicated is the task? For example: Is it only necessary to use information that is stated clearly? Is it necessary to draw conclusions based on the reading materials before using the information? Do the employees need to apply the information to a situation exactly like the one described in the materials or to one that is quite different? 48 Reading for Information Level 3 Level 3 reading materials include basic company policies, procedures, and announcements. They are short and simple, with no extra information. Employees read the materials to find out what they should do. All the information they need is stated clearly and directly, using easy words and straightforward sentences. When employees use Level 3 Reading for Information skills on the job, they can: Pick out the main ideas and clearly stated details. Choose the correct meaning of a word when the word is clearly defined in the reading. Choose the correct meaning of common everyday and workplace words (such as employee, timecard, office). Choose when to perform each step in a short series of steps. Apply instructions to a situation that is the same as the one they are reading about (such as knowing what button to push first after reading instructions on how to run a copy machine). Reading for Information Level 4 Level 4 reading materials include company policies, procedures, and notices. They are straightforward, but have longer sentences and contain a number of details. These materials use common words, but do have some harder words, too. They describe procedures that include several steps. When following the procedures, employees must think about changing conditions that affect what they should do. When employees use Level 4 Reading for Information skills on the job, in addition to using Level 3 skills, they can: Identify important details that may not be clearly stated. Use the reading material to figure out the meaning of words that are not defined for them. Apply instructions with several steps to a situation that is the same as the situation in the reading materials. Choose what to do when changing conditions call for a different action. For example, they can follow directions that include “if-then” statements. 49 Reading for Information Level 5 At Level 5, policies, procedures, and announcements have many details. The information that employees need to finish a task is stated directly, but it is hard to understand because of the way it is worded. The materials include jargon, technical terms, and acronyms or words that have several meanings. The employee must consider several factors in order to identify a course of action that will accomplish their goals. When employees use Level 5 Reading for Information skills on the job, in addition to using the skills described at Levels 3 and 4, they can: Figure out the correct meaning of a word based on how the word is used. Identify the correct meaning of an acronym that is defined in the document. Identify the meaning of a technical term or of jargon that is defined in the document. Apply technical terms and jargon and relate them to stated situations. Apply straightforward instructions to a new situation that is similar to the one described in the material. Apply complex instructions that include conditionals to situations described in the materials. Reading for Information Level 6 Level 6 materials include elaborate procedures, complicated information, and legal regulations found in all kinds of workplace documents. They use complicated sentences with difficult words, jargon, and technical terms. Most of the information is not clearly stated. When employees use Level 6 Reading for Information skills on the job, in addition to using the skills described at Levels 3, 4, and 5, they can: Identify implied details. Use technical terms and jargon in new situations. Figure out the less common meaning of a word based on the context. Apply complicated instructions to new situations. Figure out the principles behind policies, rules, and procedures. Apply general principles from the materials to similar and new situations. Explain the rationale behind a procedure, policy, or communication. 50 WRITING SKILL The WorkKeys Writing skill is the skill people use when they write messages to relay workplace information between people. There are five levels of difficulty. Level 1 is the least complex and Level 5 is the most complex. At each new level, employees need to demonstrate more competency than they do at the previous levels. For example, Level 3 builds upon the skills used at Levels 1 and 2. With the increased skill required at each level, the writing that employees produce communicates more clearly as they move to Level 5. When you evaluate a job to see what skill level employees need for completing their tasks, consider the following questions: How important are the writing mechanics and grammar? Is it important for all the grammar, punctuation, and spelling to be correct, or are errors acceptable as long as the message gets across? How important is the writing style? Does the writing have to flow smoothly, or can it be choppy if the message is communicated? Is it necessary to have a professional tone? Does the writing need to be formal, or is it all right to be casual? When measuring the WorkKeys Writing skill, we focus on the writing a person can produce without help from a dictionary, a spelling or grammar checker, another person, or any other aids. As you make your decision about the writing skills employees need on the job, you need to consider what kind of writing they must produce. The assigned level will be higher if the writing must be polished and formal, but the writer does not have the chance to get help from a dictionary, a spelling or grammar checker, another person, or any other aids. The assigned level will be lower if the final product must be polished and formal, but the writer has the chance to use writing aids. The assigned level will also be lower if the important thing is to convey the message, and what the message looks like is not as important. 51 Writing Level 1 Level 1 writing is in English. The writing attempts to communicate information, but a large number of errors make it very difficult to understand. When employees use Level 1 Writing skills on the job, they produce writing: That consists of incorrect sentence structures the majority of the time. That includes a large number of major mechanical, grammatical, and word usage errors. That has rude or overly casual language that is not consistent with standard business English. That has no organization. Writing Level 2 Level 2 writing is generally understandable. When employees use Level 2 Writing skills on the job, they produce writing: That has some correct sentence structure, although some sentences may require further clarification. With enough correct mechanics, word usage, and grammar to convey an idea, although many errors may interfere with comprehension. That may use casual language or slang rather than standard business English. That contains information that is on topic but lacks connections that would make it flow easily. Writing Level 3 Level 3 writing is clear. The writing may include incorrect sentence structure and a few errors in grammar and punctuation. When employees use Level 3 Writing skills on the job, they produce writing: With most of the sentences complete. With few mechanical, grammatical, and word usage errors so that the information is adequately conveyed. That may be more casual than standard business English but never uses slang or is rude. That exhibits some organization but may have inappropriate transitions and/or some information out of logical order. 52 Writing Level 4 Level 4 writing is clear, with almost no errors. When employees use Level 4 Writing skills on the job, they produce writing: With all sentences complete. With very few mechanical, grammatical, and/or word usage errors. That is professional in tone and consistent with standard business English most of the time. With adequate writing style but that may be somewhat choppy. That exhibits good organization with only minor transition or logical order problems. 53 Appendix D. Better Jobs Better Care: Oregon Works! Project Description To following pages provide a profile of the Better Jobs, Better Care: Oregon Works! Demonstration Project. 54 Oregon Demonstration Project Profile Oregon Works! Building a Workforce for the 21st Century Background As in other parts of the country, Oregon faces a severe shortage of long-term care direct care workers (DCWs), nurses and administrators. Unlike other states, however, Oregon’s Seniors and People with Disability (SPD) serves the majority of its clients through home care workers employed by clients (43 percent) and in 24-hour community facilities ( 40 percent--adult foster care, residential care, assisted living, and specialized living settings). Only 17 percent of SPD clients are served in nursing facilities. Oregon’s challenge is to recruit and retain staff, including direct care workers, in all of these settings. Fortunately, Oregon also has a history of collaboration and partnership among the wide range of stakeholders. Beginning with the Medicaid Waiver in 1981 which allowed use of Medicaid funds to pay for community-based care, coalitions built the community-based care system, addressed regulatory myths in nursing homes and community-based care, implemented Best Friends programs, developed person-centered care initiatives, and addressed multiple quality care issues. The Oregon Consortium for Nursing Education (OCNE), composed of both baccalaureate and associate degree institutions, developed a statewide nursing curriculum that is changing the way nurses are educated. The BJBC project continues to benefit from and to build on all these statewide efforts. Project Practice - The BJBC project in Oregon, called Oregon Works!, aims to improve recruitment and retention of direct care workers through intensive workplace change efforts at eight participating long-term care sites (called Leadership Sites: four nursing homes, two assisted living facilities, one residential care facility, one home care agency) and the state’s independent home care workers through the Service Employees International Union (SEIU) local. Each leadership site has a designated site coordinator and team, (including DCWs), who plan and implement changes within their sites. Site coordinators and teams form the Practice Committee, which meets monthly. BJBC staff and the Practice Committee coordinate efforts to: Improve relationships between DCWs and their supervisors through skill-building activities, communication programs and development of a nurse leadership/supervision curriculum. Facilitate opportunities for relationship development between DCWs, those in their care and family members, using person-directed care approaches. Provide opportunities for DCW career advancement, for example through peer mentor programs. Increase the diversity of the DCW and nursing long-term care workforce. The project sponsored LEAP (Mather Lifeways) training for nurses and DCWs to further integrate culture change into the leadership sites. They are also working with OCNE to develop simulation learning activities related to nurse delegation and teamwork with DCWs. The tradition of Oregon coalitions continues: BJBC Project staff are involved in creating an Oregon Pioneer Network affiliation (called MOVE) and are participating in The Leading Edge, the initiative of Oregon’s Quality Improvement Organization (QIO) to promote culture change and workforce practice development through its contract with the Centers for Medicare and Medicaid (CMS). Policy - Advocacy for policy changes to support workplace-based changes is conducted through the project’s policy committee. The committee has drafted a philosophy statement about person-centered care to be adopted by BJBC coalition members (including the State’s Seniors & People with Disability agency, the Oregon Health Care Association, the Alliance for Health & Senior Services and many others). The BJBC Policy Committee is developing an occupational profile and a set of standard core competencies for an entry level DCW across community-based care settings that will be endorsed statewide by BJBC coalition partners. The goal is that the occupational profile and core competencies will be a voluntary statewide standard to be used in the recruiting, hiring and training of direct care workers. The Oregon Health and Science University/Hartford Center for Geriatric Nurse Excellence is conducting an intensive process/qualitative and quantitative evaluation to inform the project’s development and elucidate how and why changes occurred. Focus groups have been held with supervisors, direct care workers and family members and feedback is given to each of the practice sites. Survey data is also being collected to determine the project’s success in promoting person-directed care Coalition Partners The project represents a collaborative partnership of more than 20 organizations, including state agencies, trade organizations, providers, educational institutions, seniors with disabilities, and family members. Those with a major role in project implementation include: 2 Oregon Department of Human Services/Seniors and People with Disabilities Oregon Alliance of Senior and Health Services Oregon Health Care Association Oregon Health and Sciences University, John A. Hartford Foundation Center of Geriatric Nursing Excellence Oregon State Board of Nursing Leadership sites: Adams & Gray Home Care, Avamere-Hillsboro facility, Cedar Sinai Park (ALF & NF), Good Neighbor Care, Mennonite Village, Providence Benedictine Nursing Center and Rogue Valley Manor SEIU Local 503 Contact Information Diana White Oregon Works! Building a Workforce for the 21st Century Institute on Aging, Portland State University PO Box 751 – IOA Portland, OR 97207 firstname.lastname@example.org (503) 725-2725 Fax: (503) 725-5100 Suanne Jackson Project Coordinator Jobs to Careers Portland Community College email@example.com (503) 533-2778 (503) 358-4240 June 2008 Better Jobs Better Care is a four-year $15.5 million research and demonstration program, funded by the Robert Wood Johnson Foundation and The Atlantic Philanthropies. Its goal is to achieve changes in long-term care policy and practice that help reduce high vacancy and turnover rates among direct care workers in long-term care and contribute to improved workforce quality. Technical assistance is provided in partnership with the Paraprofessional Healthcare Institute (PHI). Better Jobs Better Care is directed and managed by the Institute for the Future of Aging Services (IFAS), American Association of Homes and Services for the Aging (AAHSA). For more information about Better Jobs Better Care, contact Robyn Stone at (202) 508-1206, firstname.lastname@example.org or visit www.bjbc.org. June 2006 2BJBC Policy Goal: Better interpretation of Oregon Revised Statutes regarding Seniors and People with Disabilities ORS 410.020 Oregon citizens can be justifiably proud of the system of care that has developed over the past twenty-five years. The number of community based care choices, and the availability of home care, hospice and other services have been at the forefront of national efforts to develop a diversified system. However, recent fiscal challenges have slowed system development efforts and the state now faces the looming challenges of a growing population of elders and disabled citizens and an environment of limited resources. To continue to improve the system of care and the ability of that system to recruit and retain front line workers, a coalition of 19 organizations sought and received funding as a Better Jobs Better Care (BJBC) demonstration project from the Robert Wood Johnson Foundation, Atlantic Philanthropies, and the Northwest Health Foundation. BJBC has focused significantly upon policy development to continue to promote Oregon’s system development and to promote the culture change to a personcentered care model which has emerged as a key underpinning of the project’s efforts. The language of Oregon Revised Statutes focused on interpreting state policy may be interpreted as supportive to the philosophy of person-centered care and with the values of independence and personal responsibility (e.g. 410.020 Section 2. “Assure that older citizens and disabled citizens retain the right of free choice in planning and managing their lives… maximize self care and independent living within the mainstream of life.” Section 10. “Involve older citizens and disabled citizens in the decision making process for programs affecting their lives.” Section 16. “Recognize that older citizens who retire should be able to do so in honor and dignity.”) However, the state policy for seniors and persons with disability as enacted in Oregon Revised Statutes, while not inconsistent with the culture change now occurring in long-term care, does not speak directly to some important concepts. The opportunity now exists to better interpret state statutes to reflect this culture change of person-centered services and personal responsibility. Oregon's Department of Human Resources has assembled a Task Force on Long-Term Care, which is a public policy forum endorsed by the Governor, to examine and recommend system change. The BJBC coalition believes that the goal of a fully-integrated long-term care system in the future should be the product of a public-private partnership and should reflect person-centered care and personal responsibility. If this common goal can be agreed upon by the members of the Task Force and the public and private partners in the BJBC coalition, it can lead to statutory and administrative rule changes that promote person-centered services. The development of workforce competencies related to person-centered care will also be crucial to this policy change. Definitions A fully developed system of care is a continuum of services including: family education and support; case management; personal capacity building; in-home care; community based care services (day services, foster care, residential care, assisted living); intermediate and skilled nursing. Person-Centered Care (PCC). PCC is a philosophy recognizing the inherent value of each individual and is focused on supporting strengths and abilities; capacity for social contribution; unique values, preferences and living habits; and autonomy and choice. Quality is measured in terms of both physical and emotional care. PCC recognizes that quality of care is built on healthy relationships and strives to create systems that support relationships between care receivers and direct care workers. It requires an intentional approach of relationship building between people giving and receiving services and recognizing the importance of direct care workers to these relationships. It requires organizational commitment to the adaptation of treatment plans, organizational protocols, and policies and practices to enhance relationship and autonomy so that decision making can occur to meet individual needs and goals. It necessitates the adaptation of both living and treatment environments and staff orientation and training. Person-Directed Care (PDC). A philosophy of PDC strives to implement and support the choices that the person being assisted makes and to keep all decisionmaking as close to them as possible. It recognizes that some individuals lack the physical or cognitive abilities to tell us with words what their wishes are, but that within their past choices and present behaviors lies the key to what will most honor their current wishes. In these cases, those who work with them on a daily basis (the family or other direct caregivers) need to have the ability to adapt routines to fit their expressed and implied wishes. It recognizes the inherent value of each individual focused on supporting their strengths and abilities, capacity for social contribution, unique values, preferences and living habits, promoting autonomy and choice. Promotion of Personal Responsibility – Helping people to maximize their knowledge, skills and abilities in order to foster independent lives and decision making ability; bolstering support systems which promote the capacity to continue to operate with as much autonomy and self sufficiency as possible. Public Private Partnership – A philosophy of collaboration of governmental, private for profit and not for profit providers of service, foundations, philanthropists, advocates and faith based organizations to develop resources, programs and facilities to achieve agreed upon social goals. Policy Proposal The BJBC coalition recommends that the state and its partners develop and sustain a private public partnership to fully develop a system of care with an emphasis on person centered and person directed care and services and promotion of personal responsibility. To implement the proposed partnership DHS should include person centered care and workforce development in current planning efforts regarding the Future of Long Term Care in Oregon. DHS should collaborate with private providers, long term care workers, advocates, consumers, philanthropic and faith based organizations to develop and promote common goals for person-centered care, person-directed care, personal responsibility and capabilities, and family support. Collaborative efforts should focus on workforce development and training. Partnerships should be strengthened and this statement endorsed through other organizations such as Acumentra Health, MOVE, the Oregon Alliance for Senior and Health Services, Oregon Health Care Association, AARP, Home Care Commission, colleges and universities, and labor unions. Roles While all partners shall seek to develop and mutually fund innovative services to fully develop the continuum of care, specific roles for public and private sector partners merits clarification. Public Sector: Develop and implement regulatory standards reflecting PCC and PDC values. Develop policies balancing health and safety concerns within a context promoting personal responsibility, independence and individual choice. Allocate resources to support staff training and development regarding PCC and PDC. Allocate resources to fund concrete services to assist elders and disabled Oregonians to remain autonomous. Private Sector: Develop the continuum of housing options, services and care system for elders and disabled Oregonians within the PCC and PDC standards. Develop proactive strengths based early intervention and support services that foster elder and disabled friendly communities and promote PCC and PDC goals. Implement workforce development strategies and programs to assure competency in delivering PCC and PDC services. Provision of health promotion, planning assistance, education and fitness services to clients to support the goals of individual planning and personal responsibility. Solicitation of private philanthropy and resources to further the implementation of the continuum of care and PCC and PDC innovations. Educational Sector: Conduct research to establish evidence-based best practices consistent with PCC and PDC goals in long-term care. Facilitate translation of research into practice. Educate and train the long-term care workforce. Incorporate PCC and PDC concepts into educational curricula. Philanthropy, Advocates, Consumers and Faith Based Community: Active participation in planning and development of PCC and PDC service innovations and service development that fosters personal responsibility. Financial participation in program and project development. Participation in qualitative assessment of efforts to implement system improvements. Labor: Promote education and implementation of programs promoting PCC and PDC standards and workforce issues for individuals represented by organized labor.
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