Specialty Training Improvement and Expansion Project - Key Themes

Key themes we are hearing from our stakeholders

Updated 06-02-2014

Dementia and Mental Health

• Training is not long enough to be well prepared or a 'specialist". More on-the-job and refresher training is needed.
• Make the content of the training simpler and more practical, based on the behaviors that occur.
• Use more real-life examples. Helpful to relate to real-life situations from time on the job or visiting a memory care unit.
• Revisit assessment. Creates anxiety without effectively validating understanding.
• Align licensing expectations: Training needs to include licensure requirements, particularly for managers. Consider requiring that licensors attend training.
• Include training on how to work with family members and consider offering training/tools for family.
• Needs to cover more on sexuality and related behaviors
• Address generational differences as well as language/culture
• Ensure that the rules (WACs) are not actually impeding effective training, e.g., not able to use a great trainer from another facility.
• Training needs to be more focused on practical skills vs. passing the test or memorized data, symptoms, etc.  (Lots of feedback about the test and how it does not serve the desired purpose.)
• Compassion and communication are key.  Focus initial training on basic communication and behavioral skills.  Offer more detailed information as CE.  Similar themes apply to dementia and mental health.  Same problem-solving techniques, importance of baseline, redirection, etc.
• Importance of understanding baseline and recognizing changes in residents.
• Very frequent comorbidity with anxiety and depression.
• Common best practice of finding or creating videos that show real life scenarios as part of curriculum.
• Any guidelines or restrictions around class size?
• Some interest in levels of training or specialty designation – would like to see ongoing requirements, particularly refresher on communications.  But could be more confusing.  Better to offer a 'core' that focuses on communication and skills, then additional CE in specific subjects/diagnoses.
• Caregivers need to understand baseline and transitions.
• Caregivers need to understand the clients as individuals.
• Mental Health caregivers need to understand what decompensation looks like and how to react to it, and what to check.
• We need to give caregivers resources and tools.
• Caregivers need to understand how much of an influence their actions can have on preventing behaviors.
• Caregivers need to know what other triggers might be causing behaviors, such as a UTI or a transition – so they can address the underlying cause.
• Managing behaviors without medication.
• Important to have meaningful activities for residents.
• How to communicate, e.g. reducing agitation.
• Helping caregivers to deal with residents who are not accepting or respectful – roleplaying, scenarios.
• Optimal learning occurs from a combination of classroom and hands-on training environments.  As caregivers gain experience and knowledge they would benefit from different tiers (or levels) of training.
• A resource available for caregivers to call 24/7 when situations arise would be very helpful.  A pocket guide would also be welcomed.
• Training is not long enough to be well prepared or a 'specialist'.  Additionally, caregivers need more ongoing training and coaching.  Equipping care managers with the right tools to evolve training with the needs of their staff would be helpful.
• Translating training documents into the 5 main core languages and offering training in English (translated into the 5 core languages) will help caregivers that do not speak English as their first language.
• Most complaints are behavior-related or discharge-related because of an inability to mitigate behaviors.  There is a training gap to deal with behavior.
• Training for care managers should include how to recognize when they do not have the capacity to care for a person.
• Long-term care is a person's home and should focus on maximizing independence and help people live out their life.  Training should be more trauma-informed and be more experiential vs. medical.
• Resources for families looking for placement of a loved one are needed.
• There is too much information to learn in only 8 hours of training.  More time is needed to discuss each topic, ask questions, and go back and forth to ensure learning.  There is also a need for more continuing education.
• Mental illness relapse prevention training is needed.
• Too short.
• Real life experience/scenarios most valuable.  Theory doesn't translate into real life competency.  In choosing a placement, would want to see how that person would interact with residents.
• How to deal with challenging behaviors - many people in training are at basic entry level.  Behavioral examples are helpful.
• Communication training really lacking, but so important.
• Laundry list of different types of disease not helpful – particularly as test questions.
• More options/fewer barriers to training access: evening and weekend classes; have trainers come to homes.
• Would like to have online course option (with in-person assessment); may be helpful to define criteria for who is eligible for online (e.g. more experienced).
• Consider practical differences between caregivers and managers and what they need to know – tailor training accordingly (currently very similar).
• Consider differences between ALF and AFH – perhaps manager version.  (Caution: don't make it so different that workers who change facilities have to take more training.)
• Consider inviting family members to attend training classes for free – or offer online for family members.
• Include caregiver self-management training – managing own responses, dealing with death and dying, boundaries around work.
• Consider requirements for community trainers.  Can attest to capability under current WACs.
• Clarify requirements and latest versions with trainers.
• How much overlap with Core Basic?  Minimize overlap to increase time available for specialty topics.
• Material and approach to training is very outdated.  Attitudes and knowledge of care is changing all the time – need to update more often.
• Communication skills critical.
• Caregivers need help/training in understanding where the patient is coming from.
• Not enough time in either specialty class.
• Consider including material on how to pick the right caregivers in the managers training.  How to evaluate patience, compassion, communication.
• Current training is very basic.  It's an adequate starting place, but needs to be ongoing.
• Practice is important – developing hands-on skills, not just 'book' knowledge.
• Teepa Snow approach is very good because it is visual.  She demonstrates skills with elderly people and explains along the way.
• Helpful to have consistency in training, so when someone changes facilities, you know what training and skills they have.
• Need to know how to redirect.
• Need to know where to get help.
• Communication skills are critical.
• Need to know how to handle challenging behaviors.
• 'Best Friends' training with David Troxel very helpful.
• Need to be able to hire the right people – include content for managers on how to select the right people.
• Empathy is so important – need the right people, but can also 'wake them up' to be more understanding. (E.g. sensitivity training – Virtual Dementia tour – that helps them experience what the resident is experiencing.)
• Need both sides – understanding who the residents are and having technical skills to know what to do (not so much the theoretical/clinical information).
• Need to clarify direct/indirect supervision requirements related to training.
• Consider incorporating more small group discussions, based on a (better) video scenario.
• Suggested curriculum: Day One: Videos and material; Day Two: Virtual Dementia Tour (makes it real) + Group discussion of scenarios (what to do)
• Mental health and dementia material is too similar (redundant).
• Consider specialty-specific 'recertification' or ongoing education – not more cumbersome, but adding value.
• Explore how to support instructors and ensure/expand their skillset.  What are appropriate qualifications and QA?
• Would like NAC program to include DSHS specialty training.  Then they would be ready to work in many settings.
• Include coping skills and resources for caregivers (already included in core basic and dementia) consider if curriculum is working or may need to be revised.
• Beneficial for field workers/administrators/ombudsman to attend training
• Dementia modules: Recommended most emphasis on 3 and 4 – challenging behaviors and ADLs.
• Consider additional CE requirements and/or train-the-trainer requirements for trainers.  Perhaps establish ongoing network/meetings to share best practices.

Mental Health

• Need practical tools and approaches
• May be helpful to take a more modular approach, offering shorter segments and/or refreshers when caregivers need information and skills for new residents
• Need training for administrators to better understand what they can handle and how residents will interact with others
• Compared to dementia, this specialty may need more 'academic' discussion of different types and resulting behaviors
• Many/most residents will deal with anxiety and depression. Perhaps that should be covered more extensively in basic training vs. specialty training.
• Training around substance abuse is missing/lacking.
• Assessment is perceived to be very hard, but may not indicate ability to deliver appropriate care.
• The training is very broad, and does not provide enough depth to equip somebody to deal with a specific mental health issue, particularly the more challenging ones.
• While adding more time to the training would be a burden for caregivers, many admit that four hours is insufficient.
• More content related to handling challenging behaviors would be helpful to many providers.
• Demographics of residents are changing, particularly related to age. The training should reflect this.
• The treatment of residents with mental health issues may rely heavily on the use of medications, and this is not covered in any depth in the training.
• The training should prepare caregivers with tools to access additional resources as needed.
• Certain mental illnesses might make for good CE courses, particularly schizophrenia, bipolar disorder, and personality disorders.
• There is often co-morbidity with substance abuse, and this is not covered adequately in the training.
• Culture and language need more attention – not just ESL, but recognizing that owner, caregiver and resident may each have different culture and language.
• To the degree possible, include the resident in designing their own care.

Dementia

• A greater emphasis should be put on techniques for preventing and diverting disruptive behaviors, rather than on diagnoses and responses to behaviors. This includes sensitivity to environment, the use of touch, etc.
• Resident background may be one of the most important inputs to how they are cared for, and this is not adequately covered in the curriculum.
• Hands-on training would be ideal, followed by scenario-based training. Strictly academic/classroom training is the last choice for these providers.
• A "key principles" or "quick guide" document that could be kept in a pocket would provide a great resource for reinforcing the training and bringing it into the AFH or ALF.
• The assessment is overly academic.
• Revisit video components – Some instructors may not be using video curriculum or may only use parts of it, while other may rely too heavily on the video.
• The topic of Dementia is a large topic and cannot be adequately taught in just 12 hours of training.
• More training on behaviors and less on the disease itself would be helpful.  Hands on role playing would enhance the training.  Trainers that use examples from experience have a positive impact on learning.
• Understanding who the client is as a person is not covered in the training.  More training on how to approach the person, communication skills, emotional skills, and validation theory would be very helpful.
• A quality facility includes the family as part of the team.
• Cultural training is more textbook and less relevant to what caregivers and care managers need.  Additionally, the history of the person is just as important as culture.
• Brain pictures work very well to develop understanding.
• Useful videos: Naomi File is a great film (about 20 years old and $400).  Also Bathing Without a Battle.  Living with Grace.  Kennedy/Shriver's Alzheimer's Project.  From the Inside Looking Out (people with early stages talking about the experience) – Excellent scenarios included in DSHS videos and scripts.

Developmental Disabilities

• The availability of the DD class is limited, tough to schedule, and courses fill up very quickly.  There seems to be a limited number of instructors. 
• One full day of training that focuses on the history of DD may no longer be needed.  The reallocation of time could be used to provide more specific DD training.
• An awareness of how to communicate with people with DD is important. 
• Training on 'how to' use the Washington Care Assessment as an effective to tool to communicate with the family, case manager, and care manger would improve client centered care. 
• The mandatory training for caregivers has made a big impact.  Caregivers that do not speak English as their first language are often unsuccessful in passing the test.  
• We may want to consider ways to validate instructor credentials to teach, and find ways to review and revise the curricula was we move into the future. 
• The transition for clients from their homes into a community is a challenge.  A greater training emphasis on the transitioning resident would benefit the caregiver and care manager.
• The Developmental Disability training may prepare caregivers in a more thorough way than the other two specialty trainings. This may owe to the fact that the training itself is longer. However, many also feel that this training could be shortened.
• There is common frustration around the restricted availability of the DD specialty training.
• For the DD specialty training, videos may be more useful than role playing in some cases, and may be more sensitive to the residents.
• Helping residents live full lives, and preserving those residents' rights, is at the core of what's important in this training.
• The assessment is not administered consistently.
• Language is the primary barrier to success on the DD specialty training assessment.
• Caregiver mindset is important – how they understand people with DD and their behaviors.
• Consistent quality of training delivery is important.
• Planning to revise curriculum and test this year – awaiting feedback from this process.
• Potential need for more Technical Assistance/mentoring vs. classroom training.  Getting help with specific resident issues.  (Would caregivers use an app?)
• Find opportunities in the training materials to stress the importance of non-verbal communication.
• A focus on resident rights is very important.
• Find ways for those doing the training to learn about new content opportunities from each other, as a way to keep the content engaging and up-to-date.
• The language barrier doesn't just affect a trainee's ability to take and pass the test – it also affects their ability to fully participate in the exercises with other trainees during the class.
• Experiential learning may be the key to comprehension, given the diversity of the trainee population.
• We could add a requirement that the trainee demonstrate application of what they have learned in the home environment.
• Pass rates for trainings have been slipping in recent years, possibly because of language barriers, and possibly because of a learning population that is increasingly unfamiliar with the field.  (Shifting demographics).
• Especially with DD training, there is an opportunity to discuss the differences for people who will spend the majority of their lives in a care facility.
• Resources for caregivers should be more available, and access paths to those resources should be spelled out for caregivers.
• The modules on communication and behavior should perhaps be the most-emphasized parts of the training, and the 'medical model' portions might be the least-emphasized.
• Too long and academic.
• DD training is legally incorrect.  RCW 11.88.  Only 2 kinds of guardianship – of the person and of the estate.  Can be limited or full.  DD teaching 3 types – in book, PowerPoint and instructors manual.  Then talk about least restrictive alternatives – which are not correct either.
• Training should address the individual's right to choose.  We must allow the person to be their own advocate and help the caregiving team respect that right.
• Training should include 'How to' deal with difficult issues and the tools to deal with those issues.
• Training should include more detail on the 'Dignity of Risk' and 'Individual Rights'.
• Training should be ongoing and cover how caregivers and care manager can reach out to the services around them and determine what they need to improve the quality of care for their clients.
• Training should have more emphasis on 'how to' communicate with patients with developmental disabilities.  More real life scenarios and examples are great to help learn better ways to communicate.
• To the degree possible, include the resident in designing their own care.
• Personal experience enhances classroom learning outcomes.
• The residential guideline module of training is the most applicable to the DD administration.
• English as a second language is a problem with the training.  Most complaints received highlight that translators are not provided for the DD specialty training.
• If I knew a caregiver attended the specialty training that would give me a higher level of confidence with the caregiver's ability to provide care. 
• Follow-up hands on training where caregivers learn new and advanced techniques would be very useful.
• Additional training on or related to DSM.

Additional Specialty Training Suggestions

• Traumatic Brain Injury (TBI)
• Medically-fragile
• Post-Traumatic Stress Disorder (PTSD)
• Bariatric Care
• Alcoholism and Drug Abuse
• Parkinson's
• Medications