Training Practices A presentation of the Paraprofessional Healthcare Institute Profile of PAS Workers/Learners Women between the ages of 24-55 Poor educational preparation Newer immigrants with limited English- language skills Inconsistent formal work experience Single mothers with limited resources Profile of PAS Workers as Learners Personal assistance service jobs tend to attract low-income women between the ages of 24 and 55. Many haven't completed high school; many who have a diploma or GED still test out below 8th grade in reading and 6th grade in math. Understandably, with this history of educational failures, most are intimidated by the idea of being in "school." Typically, traditional teacher-centered classroom reinforces past fears and makes it difficult for them to learn. Increasingly more are newer immigrants with limited English-language skills. Many are struggling to survive and raise children as single mothers who lack sufficient income, and access to resources that help make consistent employment possible. Many need to develop an understanding of workplace behavior norms that will allow them to negotiate an unfamiliar environment-and they need an array of supports as they make the transition to becoming responsible employees. As states think about the types of changes that need to be put in place to ensure the availability of a qualified and reliable PAS workforce, it's necessary to figure out how to provide core training to this work before worker is assigned to the consumer for more specific training and development. (Stress) that this is a role to be played - whether by the consumer, government agency or other contracting organizations. As consumers, agencies or other contracting agencies who are thinking about future orientation and educational programming, you will need to better understand the unique circumstances and needs of this pool of workers as learners to ensure that this orientation to the work is both rigorous and demanding and supportive of their desire do this work. Ideally training should be designed around the unique needs of a particular type of client, so I will not focus my comments on a particular curriculum. Rather, I will speak about key components of an effective approach to developing this group of learners in a way that ensures they will possess the skills, attitudes and behaviors necessary to provide high quality services. Adult Centered Learning: Recognize, value and incorporate past experiences Create safe learning environment Whether you represent a consumer-directed or contracting agency model for orienting a new employee, you will be engaged in a teacher/learner role with the PAS worker. The overarching principle when teaching adults is keep in mind that they differ from children in their learning needs. First and foremost, we start by recognizing that adult learners bring a wealth of experience to draw upon when learning new information. Drawing on their experience demonstrates respect for them, the skills they bring to the workplace, and creates a safe learning environment in these learners can feel valued and empowered. Expand Basic Training Content Skills are never purely clinical or technical Problem-solving Communication Interpersonal/ Relational Skills Expand Basic Training Content Orientation to the PSA job today typically involves no more than 40 hours of training to enable a PSA to achieve the core competence required to effectively work within a demanding job. PSA's job in about working closely with people On the job, all clinical or technical tasks are performed in the context of the relationship between that worker and the consumer or resident. For learning to be most effective, these tasks should also be taught within this context during training. Orientation and training content needs to be expanded to ensure that workers have sufficient time to achieve basic competence not only in their knowledge of health content and personal care skills. Work orientation and training needs to be expanded to help the new worker develop and improve upon problem solving, communication, and the interpersonal/relational skills that are especially key to success in this type of work. Particularly important aspect of this particular training because entry-level healthcare jobs are often the gateway to the formal work world for many of these new labor force entrants. High Quality Service Provision: Building The Foundation Designed around learner's needs Problem-Posing Accommodates learner differences and styles Engaging /Interactive Activities Consumer-centered in content Keeping in mind, the goal of providing high quality home and community-based services for people living with disabilities, initial workforce orientation and training programs should be seen as simply laying a foundation for continuous learning and development. Center training on the learner's needs Creating sessions, materials and activities based on learner profiles rather than simply "covering content" in a book helps to begin anew a lifelong learning process that's builds on the unique strengths of that individual worker Problem-based teaching at the core a learner-centered approach. Teaching strategies that actively engage the learner in "figuring things out," rather than "providing information" to passive learners through lectures and demonstrations Trainers facilitate learning by building on what the individual already knows, engaging them in critical thinking, and making the PSA job "come alive" through role plays and other activities. Content focused who consumer is likely to be..not just in terms of the medical diagnoses, but psycho/socially and environmentally This learner and consumer-centered approach can better prepare these workers for the full demands of their job. Learner differences: Visual Experiential/ Tactile Auditory Verbal Being Aware of Learner Differences Developing Training Curricula Traditional teaching methods tend to rely heavily on individual reading, lectures and other large group presentations such as films and video, and extensive note taking. While there are four basic learner styles: visual, experiential, auditory and verbal - we tend to be dominant in one or two ways. Using teaching methods that largely play to the strengths of visual and verbal learners, especially with individuals who have been unsuccessful learners, will continue to set them up to fail. As you consider strengthening curriculum to be more effective with the non-traditional learner, varied techniques to address these differences will need to be incorporated as part day-to-day teaching (e.g using charts for visual learners, experiential games and other hands-on activities, small group discussions etc. for auditory learners etc.) One way public agencies or consumer organizations can help self-directing consumers strengthen their teaching role might be to create simple guides on learning difference for their members and provide ideas about different ways to help a new employee learn critical information. Integrate critical-thinking and problem solving within the context of teaching health content and clinical/personal care skills. Integrate critical-thinking and problem solving within the context of teaching health content and clinical/personal care skills. Classroom trainers and consumers can further develop PSA workers problem solving ability by posing situations/questions as they focus on a teaching a specific technique, or health content topic. E.g. When teaching bed bathing, pose the problem: Just as you begin preparing for your client's bed bath, he tells you his wife bathed him the prior evening and he doesn't need you to provide this service today. However, just before the wife left for work, she specifically stated that the client should receive a bath and that he wouldn't allow her to bathe him the night before. How would you attempt to manage this situation? (Or a family member orienting a new worker): My mother is quite suspicious of strangers, and really doesn't want anyone but me caring for her. When she becomes confused she say mean things and strike out. Have you had a similar experience in your life with someone you've worked with or personally? How does/would this situation make you feel? How would you try to handle it? Strengthen Skills Paraprofessional care is about building relationships Challenge assumptions Establish high standards and support to learn from failures Requires more time and different teaching techniques Staff and consumer member development Strengthen Interpersonal, Problem-Solving and Communication Skills Like all human service jobs, paraprofessional care is about relationship building. When developing your orientation or training sessions, don't assume that individuals who often have never held a full-time job, will necessarily know the "rules" of building a relationship within this specific workplace setting. Or that practices they may have used successfully in one situation are immediately transferable. Do assume that with adequate support and understanding, they can become committed services providers and valuable employees within this unique situation. Learners need high standards AND clear, appropriate and regular feedback to reinforce success and help them learn from failure. Agencies and contracting organizations have one advantage to developing worker development programs: they can can expand on the minimal training requirements to add more time to develop interpersonal problem-solving and communication skills. The most effective teaching strategies to develop and refine these skills, such as the use of role plays, small group discussions, and case studies, and interactive presentations will require more time for learners to absorb new material and practice new techniques. Will also require an investment on part of supporting or contracting organizations in staff development to enable typical trainers to begin to become competent in the use of these methods. Continuous Learning & Improvement (CLI) Intensive support during initial probationary period build upon initial learning experiences Regular post-employment sessions in safe environment to: - Discuss issues faced - Reinforce workplace on the job rules and policies - Foster peer learning - Teach additional skills Provide (Intensive) Continuous Learning Opportunities for Newly Trained Caregivers No one masters their job in one week or one month. Continuous investment in the PSA workers' learning and development not only allows them to refine their craft; it also reduces isolation many feel in doing their jobs and allows opportunity to connect with and learn from peers. Once basic skills are learned, the newer worker needs support over an initial probationary period to reflect on and build upon their "on the job" learning experiences. More experienced workers need opportunities to recycle their knowledge and learn newer approaches. Once again, agencies and contracting organization are in a more advantaged position to provide a structure for this continuous learning. Trainers can design regular post-employment sessions to provide caregivers with a "safe" environment to discuss issues they face on the job, and for trainers and other agency staff to foster peer learning, reinforce work place rules and procedures, and teach additional skills. Where possible, on-site observation and support visit during the initial weeks of employment can be extremely helpful also - especially for the new entrant to the world of formal care giving. Upgrading experienced PSA workers to a "peer mentor" roles is both rewarding for the mentor, and can provide the new worker with the informal connection they will need to make a successful transition. If resources don't exist to create an upgraded position, consumer organizations or contracting agencies might create a "peer-to-peer" support network and provide mentoring training and a stipend for interested PSA workers.