Maintaining Direct Support Professional's Performance in the Mist of the Staffing Crisis
As we are fresh into the 2025 year, community-based human service organizations are still facing the harrowing staffing crisis. Not only are there challenges in filling direct support professional (DSP) positions, but also in maintaining employment. The high rates of staff vacancies extremely impact the provision of services for individuals with intellectual and developmental disabilities (I/DD), including those with brain injuries. This encompasses individuals supported through Adult Long Term Residential Care (ALTR), Day Habilitation, Community-Based Day Supports, Supported Employment and more. In a 2024 Boston Globe article, the author indicated that 20% of jobs at day habilitation programs were unfilled as of October 2023. During the COVID-19 pandemic, staff shortages grew and impacted roughly 2,000 Massachusetts residents, particularly those with complex medical and behavioral needs (Laughlin, 2024).
The Association of Developmental Disabilities Providers (ADDP) issued a survey completed by over 130 community-based service organizations in October of 2023, focusing on the workforce crisis. Per the survey, vacancy rates have improved from the previous survey, but some major takeaways to note are that vacancies continue to be high (24%) with majority of vacancies being in ALTR services, waitlists for day programs are still significant, direct care vacancies are at 26%, and turnover rates are as high as 26%, including employees in clinical positions. Turnover rates for DSPs, Case Managers, and Program Managers are at 16%, 17%, and 13% respectively (ADDP, 2024).
We are facing a time where even as BCBA’s we are feeling the never-ending pressure of short staffing within our programs. While the 24% of vacancies continue to be a concern, we should narrow in on the 16% turnover rate amongst DSPs. While community-based service organizations are tasked with recruitment, BCBA’s can focus on the retention of currently employed staff. As practitioners, it is our responsibility to narrow our focus, more specifically in understanding DSPs attitudes and perceptions about data recording responsibilities, teach Applied Behavior Analysis (ABA) knowledge competencies to further support staff caring for individuals with complex behavioral needs, and finally improve supervision strategies for the sake of job satisfaction and retention.
Understanding Attitudes and Perceptions about Data Recording
Data recording is one component in clinical service delivery. It provides an objective measurement of the effectiveness of an intervention and informs decision-making. However, if data collection isn’t proficient, then BCBA’s often find themselves in a predicament in the visual analysis of data. This can be due to implementation being inconsistent, inaccurate, and/or unreliable. In the human service setting, this can be quite challenging as DSPs are held responsible for many tasks (e.g., cleaning, assisting with ADLs, transporting to doctor appointments), and data collection sometimes gets put on the back burner. Some DSPs may have certain attitudes or opinions on data collection, which in turn affects completion. This can be a result of insufficient training and complex measurement procedures (Devine et al., 2011; Fisk & Delmolino, 2012).
Ellwood et al. (2023) administered a social validity questionnaire amongst a sample of DSPs employed at a human services organization supporting both children and adults in the Northeast. The authors found the survey responses amongst respondents indicated that clarity of behavior definitions, process of data evaluation by clinicians, consistency among co-workers, and impact of competing activities were most ambiguous. Meaning, ratings from children and adults programs indicated “neither disagree nor agree” to statements in the survey that asked if respondents 1) understood data collection, 2) knew what the clinicians do with the data, 3) agreed that other staff recording data the same way, and 4) indicate their job tasks get in the way of data recording.
Furthermore, Ricciardi et al. (2020) also completed a social validity questionnaire, disbursed to DSPs employed at a human service organization for adults with I/DD. The authors did find that respondents had high approval for behavior data recording, the purpose of data recording, and the training that encompassed data recording. However, respondents in this investigation indicated that recording of behavior data may be difficult due to other competing job tasks, providers are not shown graphs of the data, and that data is collected inconsistently.
In taking this information, these attitudes can be mitigated. While the majority of the following can be addressed during pre-training, we can also ensure current staff we support are continuously trained on the process of creating operational definitions for behavior, which helps shed light on one aspect of clinician’s responsibilities. More often, DSPs are not shown behavior graphs demonstrating improvement (or lack thereof) that inform the clinician's decision making. Not only is this a critical training component but just a general practice BCBA’s should be instituting on a consistent basis, especially during staff training. In addition, being shown graphs may reinforce providers behavior, knowing that their diligent work in applying high treatment integrity is of value. Finally, the most noteworthy of findings is the abundance of job responsibilities. We must always be mindful that DSPs are frontline workers. Their job responsibilities may at times be so overwhelming that in turn, leads to attrition. As practitioners, we must not only work with the DSPs but also the Program Managers who oversee the programs to help mitigate this problem. For example, investigating if one person’s responsibilities are substantial to another, or establishing more delegated responsibilities equally. If one person is expressing feelings of being overworked, we must support the individual in mitigating the issue for the greater benefit of services. While at times BCBA’s site visits and clinical supervisions include overseeing data collection and completing interobserver agreement (IOA), we may want to consider setting aside one task that we (the practitioners) can be of assistance. This can include helping with carrying groceries into the program, taking up a cleaning task, or even completing a daily skill acquisition program (which doubles as an observation opportunity for staff). It’s our responsibility to show our DSPs that we value their hard work.
Teaching ABA Knowledge Competencies
Following understanding staff’s attitudes towards data collection and clinical applications, BCBA’s can also dedicate their time in teaching ABA knowledge competencies to DSPs. We can systematically train staff in understanding measurement systems, contingencies of reinforcement, teaching procedures, and other aspects of behavior support that can be consequential to current DSPs. Luiselli, Bass, and Whitcomb (2010) developed a systematic training program aimed at increasing ABA knowledge amongst staff in I/DD adult service organization. The authors initiated didactic instruction, practice exercise, and video demonstrations to teach measurement, behavior support, and skill acquisition content. Indicated by the comparison of pre and posttests, the training groups scores increased significantly. This is of great value during pre-training for DSPs. However, it’s important that the training not only generalizes but maintains across time. BCBA’s may want to dedicate their time to training currently employed DSPs on ABA competencies, in addition to evaluating performance on a continuous basis to offer positive reinforcement for performance. We may be able to alter the attitudes and perceptions of clinical practice and data collection if we address knowledge competencies.
Improving Supervision Strategies
In addressing attitudes and providing knowledge comes training supervisors to provide performance feedback. Consistent performance feedback is an effective aspect of staff-training as it aids in maintaining treatment integrity and the correction of errors (Parsons & Reid, 1995; Reid et al., 2012). In human service agencies, more specifically programs supporting adults with I/DD, the direct supervisor of DSPs is the program manager/director. BCBA’s have learned to provide effective feedback through coursework, and as required per the BACB Task list, however some program directors may not have acquired such learning. Carroll, Preas, and Paden (2022) in a two-part study used video modeling with voiceover instructions (VMVO) to train supervisors to provide performance feedback to confederate therapists and demonstrate the effectiveness of supervisors feedback to therapists in clinic settings. Given these findings, the use of VMVO has shown effectiveness in performance.
In addition, Saunders (2023) evaluated the effects of a supervisor training curriculum developed by Reid et al. (2011), assessing improvements in treatment fidelity, with behavior technicians. The curriculum “Supervisor Training Curriculum: Evidence-Based Ways to Promote Work Quality and Enjoyment Among Support Staff” includes modules consisting of activity sheets and competency checks, aimed at supervisors to make improvements in directing and motivating staff supporting individuals with I/DD. Not only was this curriculum effective, but also increased job satisfaction, a critical area of focus amidst the staffing crisis. Given these two investigations, Massachusetts BCBA’s can consider replicating these findings, and provide exampled interventions to program managers, given that performance feedback is critical in the retention of DSPs.
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The staffing crisis has continued, and there’s no clear indication of when it will end. Taking the above literature reviewed, we can do our due diligence and apply our science to retain the staff we currently have. DSPs are of great value to the individuals we provide services to. Without DSPs, we can’t provide the long-term care and day habilitation supports many of our individual’s needs. While our training and supporting our staff is of great importance, we must also advocate for increasing the salaries for DSPs, so they are making livable wages. In February of 2024, The Arc of Massachusetts held a briefing focused on the outcome of the staffing crisis and many individuals called on state legislators to maintain Chapter 257 and fund higher wages for DSPs in the 2025 state budget. The briefing also included parent advocates sharing their perspective of the staffing crisis and how this has affected the support systems for post 22 years services, which is a contrast to services provided before 22 years of age. Click here for more information on the February 2024 briefing, including videos.
References
ADDP Workforce Survey Highlights Industry Challenges (2023, October). Association of Developmental Disabilities Providers. https://www.addp.org/news/addp-workforce-survey-highlights-industry-challenges
Carroll, R.A., Preas, E.J. and Paden, A.R. (2022), Training supervisors to provide performance feedback using video modeling with voiceover instructions: A replication. Journal of Applied Behavior Analysis, 55(2), 603-621. https://doi.org/10.1002/jaba.908
Devine, S. L., Rapp, J. T., Testa, J. R., Henrickson, M. L., & Schnerch, G. (2011). Detecting changes in simulated events using partial interval recording and momentary time sampling III: Evaluating sensitivity as a function of session length. Behavioral Interventions, 26, 103–124. https:// doi. org/ 10. 1002/ bin. 328
Ellwood, G., Voltz, A., Howell, S., Bly, L., Hirst, H., & Luiselli, J. (2023). Assessment of data recording practices among direct service providers of persons with intellectual and developmental disabilities: Implications for training and supervision. Advances in Neurodevelopmental Disorders. https://doi.org/10.1007/s41252-023-00359-w
Fiske, K., & Delmolino, L. (2012). Use of discontinuous methods of data collection in behavioral intervention: Guidelines for practitioners. Behavior Analysis in Practice, 5(2), 77–81.
Katerina. (2024, February 22). The Arc’s Government Affairs Team Hosts Briefing for Legislators on the Workforce Shortage Crisis, Need for Supporting Governor’s Historic Chapter 257 Funding. The Arc of Massachusetts. https://thearcofmass.org/post/the-arcs- government-affairs-team-hosts-briefing-for-legislators-on-the-workforce-shortage-crisis- need-for-supporting-governors-historic-chapter-257-funding/
Laughlin, J. (2024, January 1). State investment this year helped, but didn’t solve, long waiting lists at programs for people with complex disabilities. Boston Globe. https://www.bostonglobe.com/2024/01/01/metro/day-hab-developmental-disabilities- massachusetts-masshealth/?s_campaign=breakingnews:newsletter
Luiselli, J. K., Bass, J., & Whitcomb, S. (2010). Training knowledge competencies to direct-care service providers: Outcome assessment and social validation of a training program. Behavior Modification, 34, 403–414. https://doi.org/10.1177/0145445510383526
Parsons, M. B., & Reid, D. H. (1995). Training residential supervisors to provide feedback for maintaining staff teaching skills with people who have severe disabilities. Journal of Applied Behavior Analysis, 28(3), 317-322. https://doi.org/10.1901/jaba.1995.28-317
Reid, D. H., Parsons, M. B., & Green, C. W. (2012). The supervisor’s guidebook: evidence- based strategies for promoting work quality and enjoyment among human services staff. Habilitative Management Consultants, Inc.
Ricciardi, J. N., Rothschild, A. W., Driscoll, N. M., Crawley, J., Wanganga, J., Fofanah, D. A., & Luiselli, J. K. (2020). Social validity assessment of behavior data recording among human services care providers. Behavioral Interventions, 35, 458–466. https://doi.org/10.1002/bin.1730
Saunders, M. S. (2023). Supervision Strategies for Treatment Fidelity and Job Satisfaction in Applied Behavior Analysis Services. International Electronic Journal of Elementary Education, 15(3), 291–306. https://www.iejee.com/index.php/IEJEE/article/view/2064