Setting Clear Expectations for DSPs

One of the most critical skills any manager must have is the ability to clearly communicate expectations. Too often we give and receive vague directives to get things done, to make something happen, to support, to facilitate, to empower…the big idea is usually communicated well. What is often missing are the details of what is expected- the nuts and bolts of a project or major task.

Managers set staff up for failure when these communication mistakes are made:

  • ASKING vs. INSTRUCTING-Failing to recognize when instruction is required prior to the individual completing the task.
  • Asking in a vague manner.
  • Asking multiple people to complete the same task.
  • Failing to recognize that staff, especially DSPs may have conflicting priorities and deadlines.
  • Failing to offer thanks and positive feedback for a job well done.

As well, many times we give orders. Orders are generally very clear.  They are for those situations where a real safety threat is present, not for the day to day communications program managers are expected to provide.

Instructions provide a much clearer view of what you are expecting your staff to do.

Managers should aim to get the main idea across, with clear, distinct points, and provide a timeline.

Clear communication includes:

  • Telling people exactly what you want them to do- provide the main idea

Examples would be ensuring MARS are updated; planning for trips for the following weekend; meal planning; implementing new ISP goals

  • Spell out exact tasks to be performed, completed- provide the detail

Too often we assume our staff understand what we want. We assume they know to pay attention to all the same details we would give attention. We should always assume our staff are not on the same plane as we are. We should provide detailed list of what needs to happen- until we are sure the staff fully understands the task at hand.

  • Provide time frames- so people know WHEN you want things done

It sounds silly- when we ask for something to get done by the weekend. But trust me. Our staff might consider Sunday night the weekend. By providing time frames, with actual dates if needed and times of day, we leave little room for failure here.

  • Summarize information and repeat back-to be sure you’re both on same page

 

Example:

Instead of saying– “I’d like you to review the MARS for accuracy before putting them the book”, be more precise.

Say This: “Please review the MARS and compare them to med scripts and bottle directions. By Monday morning, I expect that all three will match up.”

You can add in check points to the set of expectations: “At our meeting on Friday May 1, I want you to have medication information accurately reflected in the MARS. I want you to tell me where we had mistakes and summarize last months errors.”

Let’s look at some different ways communication scenarios. 

While sipping your morning coffee Wednesday morning, you notice an article about a local flower show on the weekend.  Later that afternoon you tell Sallie the Lead staff to “Lets send our clients to this– Plan it and let the weekend folks know about it”.

It all sounds pretty black and white, right? How can someone mess this up? Sallie is a great staff, who can multi task many things. You have faith she can set this trip up. Sallie does what she thinks you want her to do.  She prints directions to the exhibit location and on Friday she gets the van gassed up, prepares lunches to bring a long, packs up meds and informs weekend staff. Everyone is excited.

Come Saturday, the staff and clients get to the exhibit hall only to find out they needed tickets. At the gate, staff ask about tickets- and are told they sold out two weeks prior.

What happened here?

How did Sallie mess this up?

Question should be: HOW DID I MESS THIS UP??

You did not provide clear communication that would have provided Sallie with your expectations.

When you ask Sallie later on, what she views as normal trip organizing tasks. She walks you thru the tasks she would complete. Sallie assumed that your mentioning and asking for this trip that it was open still and had tickets been needed- you would have mentioned that. You and Sallie were not on the same page for sure.

Some people would say this is a cop out and Sallie should have known better. But let’s face it-  clear communication would have prevented this. Better planning would have as well.

Clear communication entails telling someone exactly what you want them to do. Your idea of planning for a trip, and Sallie’s idea of planning for a trip, are two very different thought processes. You see certain steps and detail as being obvious; Sallie ( and most staff) would not necessarily think of the various details and actions needed to ensure a successful outing. Think of task analysis.

Managers should provide clear expectations and direction- and not leave much open to interpretation. Of course, once a staff has successfully completed planning tasks such as MARs Management or Trip Planning a few times, managers can delegate these tasks with confidence that things will get done right.

Managers can write tools and job aides for staff to use when working on just about any tasks. A Trip Planning Check List for instance, authored by you, would have made this process much more effective for everyone.

A good idea many experienced managers maintain a Program Operations Manual in which an entire section of job aids is kept.

Organizing Program Books

Program Management Book

This should be your Go-To Book! Get a large 3” binder and label it “Program Management Book”; divide into sections: Budget, Staffing, Supplies, Food/Meals, and Inspections/Maintenance, whatever else you want. Print out monthly budget reports, staff reports, meal count forms and whatever other agency budget related documents and file in your book. Make it point, and schedule time, to review your program’s monthly expenses at least once a month if not more often. Staying on tops of costs is the best way to avoid budget shortfalls. Keep grocery receipts in a top loading sheet protector. Keep a running list of all staff working in the programs, and have their phone numbers listed as well. Always have a list of guardian names and numbers.

Client Meeting Book

A larger binder with dividers for each client in your program. In each section, keep copies of relevant docs you might need to reference at meetings (Service Agreements, Protocols, MARS, etc.). Add in sheets of lined paper for note keeping. This book should be with you at all times so you have access to it for unplanned meetings that get scheduled on a moments’ notice.

Client Books

Residential programs must have client training binders. The purpose of these books is to give staff the info they need to work with their assigned clients. Client books should contain all pertinent information on the client:

  • Demographics- name, age (DOB), guardian info and contact
  • Diagnoses
  • Medications
  • History/Most Recent physical
  • Health care proxy/DNR if applicable
  • Copies of all programs, protocols and services staff are expected to deliver

Managers can set this system up in two ways:

  •        Have one big binder, with a section for EACH client. This method saves shelf space and manager      time with book management, however it might limit staff ability to review info on clients.
  • Individual binders for each client:

Set them all up the same! Makes audits easier. Assign staff to maintain books- to do monthly paperwork turnover and keep copies in the book.

At the end of each month, paperwork is removed from binders, reviewed, progress notes written, MARS and QA reports completed and the documents filed away by the 5th of the next month.

Purchase expandable files to hold previous month paperwork- one for each client. A 5” file will hold a years’ worth of documents. Purchase cardboard document/file boxes to store all the old paperwork- an average file box with hold 2-3 years’ worth of paperwork.

Color Coding Books

In many group homes I have managed, client books are COLOR CODED. Client A will have all blue books. Client B would have all Green Books. And so on. In many homes, each client has a MEDICAL INFO book, a CLIENT INFO book and a MAR. Color coding the books to a client helps staff find information quickly. Remember, we’re not managing books for ourselves. We are providing staff with tools to do their job effectively. We are not doing this to make our jobs easier. However, if we can combine both goals to a workable and efficient system, all the better for everyone!

NEVER KEEP MARS in Client Books. MARS SHOULD BE KEPT IN A SEPARATE BOOKS.

 

DSPs & Communication

Welcome to the Direct Care Worker Network’s First Newsletter. We hope for this to be a weekly post filled with useful and relevant information for direct care workers and front line supervisors.
This week’s theme is COMMUNICATION.

The NADSP defines Communication as:

“The Direct Support Professional should be knowledgeable about the range of effective communication strategies and skills necessary to establish a collaborative relationship with the participant.”
Human beings use communication to share our thoughts, ideas, feelings, observations and knowledge. People with disabilities have the same needs to communicate- they might have limited abilities to use voices or hear spoken language and words. Modern technology has virtually eliminated the need for an actual voice.

 

Feature: Question of the Week—Gene from New York asks:

Hello from New York! I have a question about communicating with co workers who speak a different language. Several people I work with are from African nations and speak several different languages. They have difficulty speaking English but it seems like they understand English. How can I help these co workers feel more welcome and share important information with them? More importantly how can I be sure they understand my requests for help, or for info?

Answer:

Thanks Gene for your question. You bring up a timely and super important question. I really like how you are approaching this situation as well- in the effort to help people feel welcome. This tells me some of the folks you are struggling to understand are recently hired by your agency. One of the responsibilities of your management team to ensure all employees understand treatment plans, Service Agreements, documentation logs and so forth. During the hiring process the new employees must have passed some sort of screening process that proved to management that they have the basic competencies of reading and writing English. Normally it should not be up to the DSP to figure out how to communicate with co workers. I would recommend you speak with management to discuss expectations they have on you and peers to help new hires learn to work for your agency. Is there an expectation that you not only assist with training on client programs and protocols, but also to help them navigate the English language as well?

In this situation though, it is important and vital that the new hires have basic speaking skills and ability to recognize dangerous situations and get help. One thing you could do, or better yet is ask your  manager to do is set up a binder with pictures of situations  and practice the proper spoken phrases, For example, a picture of FIRE would have an associated word, “FIRE” next to it, and maybe even a picture of a fire alarm pull station and photo of someone on a phone calling 911.

Other job aids could be pictures of a properly made bed; a safe way to don a gait belt onto a client; another good one is a photo of a dinner plate with the proper amount of food.  The idea is to give them a picture of a task or an idea or a process, and have them use the right English Words/Phrases to use. It takes time for people to really learn and understand a different language. You should not expect people to understand things overnight. Your best way to help people would be to be patient, allow for practice and even set up practice sessions. It’s a lot of work but well worth it.  Time spent teaching people new skills, including speaking English is a daunting task. Your small contributions are very much appreciated.

 

Peer-to-Peer Communicating for DSP’s
Many times, when a DSP is upset or angry they try not to communicate; they ignore others or pretend they can’t hear others speaking. But not communicating is not an option. In fact the more we try not to communicate, the more we do! By not ignoring others or playing deaf, we are communicating something: perhaps that we are shy, perhaps that we are angry or sulking, perhaps that we are too busy. Ignoring others is communicating with them, we might not tell them we’re ignoring them but through non-verbal communication we hope to make that apparent.

Uses of Interpersonal Communication

Interpersonal communication is a key life skill and a key work skill for DSPs- and can be used to:
• Give and collect information.
• Influence the attitudes and behavior of others.
• Form contacts and maintain relationships.
• Make sense of the world and our experiences in it.
• Express personal needs and understand the needs of others.
• Give and receive emotional support.
• Make decisions and solve problems.
• Anticipate and predict behavior.
• Regulate power.

Here are some strategies for DSP’s to use when communicating with peers and FLS:

  • Watch your body language. Don’t yawn, roll eyes, fold arms in front of yourself;  DO sit up straight, pay positive attention, take notes if needed. Smile.
  • Maintain Personal Distance: Personal distance is considered to be the most appropriate for people holding a conversation. At this distance it is easy to see the other person’s expressions and eye movements, as well as their overall body language. Sitting together on a bench, or couch is a good example. The use of a desk or table between people is okay for FLS/DSP relationships. Peer-to-peer should be barrier free settings.
  • Allow the other person to speak, without interrupting them. Not only is interrupting rude, it shows the other person you don’t want to or need to hear what they have to say. It defies the meaning and purpose of effective communication. Avoid distractions such a ringing phones and email alerts.
  • Listen well. Use listening skills such as maintaining eye contact, smiling, focusing on what is being said, reserving judgement, and if needed, taking brief notes on key points.
  • Explore details. Ask relevant questions and that help to clarify what the speaker has said. By asking relevant questions the listener also helps to reinforce that they have an interest in what the speaker has been saying.
  • Summarize: Repeating a summary of what has been said back to the peer validates what has been stated; it also shows that you have an understanding or not of the issue. Summarizing involves taking the main points of the received message and reiterating them in a logical and clear way, giving the speaker chance to correct if necessary. Many times the person will correct certain ideas or concerns. Come to Agreement and Set Next Steps: Coming to an agreement is a skill, is the end result of good communication. Setting next steps requires attentive communication and follow up, as outlined below.
  • Follow up: This is often the most missed step in any communication process. For DSP’s it is very important to follow up on conversations, especially those that may involve assigned tasks to complete. If you met with your FLS for example and she charged you with meeting a goal, it is important that you take steps to ensure you can meet and complete that goal. Following up with expectations and deadlines is always a good idea. Following up by checking in with a peer about the relationship or concern is probably the single most important task one can do.

Here are some strategies for DSP’s to use when communicating with people who have disabilities:

  • Always speak to the person directly. Never ask the person’s caregiver, or other a companion or sign language interpreter. If the individual speaks another language you do not know, it is okay to ask an attending interpreter to speak to the person.
  • Identify yourself. “Hi, my name is Patti and it’s nice to meet you!” said, with a smile and outreached hands is the normal greeting we all use for people without disabilities. We can and should use this for ALL PEOPLE.
  • If the person is sitting, crouch down to meet their eye level.
  • Don’t presume the person is hard of hearing. Don’t shout or speak loudly. Use your normal tone. If the person is hard of hearing they will let you know.
  • Listen attentively when talking with people who have difficulty speaking and wait for them to finish. If necessary, ask short questions that require short answers, or a nod of the head. Never pretend to understand; instead repeat what you have understood and allow the person to respond. Take your time, don’t rush communication.
  • Check with the person that you understand what they are saying e.g. “the TV isn’t working? Is that right?”
  • If the person wants to take you to show you something, go with them.
  • Consider yourself and how often you communicate your needs and wants through any given day. Think about all the things you do without thinking about it: Getting up in the morning, deciding to shower, what clothing to wear, what food to eat for breakfast and so on. Offer your disabled people you care for the same opportunities for communicating needs and wants.
  • If the person has Speech Devices, learn how to use them. Become an expert with the use of, care of and accessing repairing of the device. Consider the device to be the person’s voice because it really is. If the person has a schedule system with built in opportunities for communicating choices, use it daily. Involve the person in setting up any daily schedules, and offer as many choices as possible.
  • Many clients are taking advantage of apps on I Pads and cell phones. Communication apps, schedule apps, and choice apps are very popular, easy to learn and effective ways for people to communicate. Much more realistic that older models of Dinavox and other devices, you can ask for a SLP assessment of your clients ability to use an I Pad. Of all the tech out there, we are finding that most disabled people can use these devices much easier than we thought they could.

Here’s some ideas for encouraging clients to communicate with peers and others during the routine day to day time frames:

  • Ask clients to make choices for condiments on meals
  • Ask clients to decide and share when they want to eat meals, snacks
  • Get clients involved in conversations that have meaning to them. Younger clients might really enjoy talking about modern music, bands and pop stars. Older clients might prefer to talk about recent political events, international news and sport teams. People of all ages enjoy selecting meals for a menu, selecting activities the **house** can all take part in, and in deciding who their staff will be on nay given day/shift.

That’s all for this week’s newsletter. Let us know if there are subjects you would like for us to address and research in the newsletter.

 

Two Week Notices Are Very Important

We have seen high turnover for years in Long Term Care; not just DSP’s, but program managers, Coordinators, Administration… The work is hard and there are few benefits to sticking it out. DSP’s in particular have a very high rate of turnover. It’s not uncommon to hear of DSP’s leaving an agency to go work down the road at another organization for a dime more per hour. This is leads into this topic of this article: Giving proper notice.

In most lines of work, across all the various industries, people give 2 week notices. They do this in order to give the employer a chance to replace them. In human service organizations, there are often several openings for direct care staff to begin with. When another DSP leaves, it just compounds staffing issues even more. If an DS is scheduled to work many shifts but suddenly quits, it leaves ALL those shifts open and often unfilled. Who suffers? The clients fist and foremost. Then the DSP’s left behind to do the extra work. Management has to fill the position and do all the human resource things associated with this: Background checks, abuse registry check, hiring, orientation, mentor-ship if there is any, and on the job training.

I understand the reasons for wage shopping in jobs in this field. Money is tight and people need to make a living. Some people would laugh at a dime an hour increase in pay but when you’re living paycheck to paycheck every dime counts. Still, it is so important to leave on good terms. When an DSP or anyone else quits without a notice, they almost always end up on the “No-re-hire” list- which is important if one wants to get a decent reference. Trust me- a bad reference is not a good thing in this work. And very often, the Director of one human service provider agency is friends with many directors of many provider agencies- they usually have a network. They warn one another about staff who quit without notice as well as staff who are placed on LOA pending an abuse investigation.

Some other reasons for two week notices:

In the future at another agency, you might end up working with some of the program managers and DSP’s of the facility you left. One of those former program managers could be a Director of an agency you want to work at.
You may want to come back to this facility in the future. Now you think I’m truly crazy. You’d never want to work for this horrible organization again! Well, remember that whole turnover thing? 5 years down the road, the new management of the facility may very well increase pay rates and offer better benefits. You would love to go back now. But you can’t because there’s that “No Re-hire” comment attached to your SS number.
There are financial benefits to giving notice. If you have any vacation time accrued you may lose it if there is a policy about giving two week notices. Also, consider any health insurance facts as well. You will lose coverage.

As well there are some valid reasons to NOT give any notice:

An employee has been physically abusive.
A supervisor has sexually harassed you.
Your mental health is being seriously endangered by job stress.
You have not been paid the agreed-upon wage or wages have been withheld for an unreasonable length of time.
You have been asked to do something which is clearly unethical or illegal.
Personal or family circumstances are such that you need to leave the job.
A crisis has happened in your life, and there is no way you can continue on the job.

Remember it WILL be the residents who suffer the most when you leave. If you have relationships with them, cutting out without notice will be especially painful for them. It will feel like a death in their family. Only you can decide but it seems to me there are better reasons to give the 2 week notice than there are to just walk off the job.