Implementation of a program to support direct support professionals to promote a healthy lifestyle for people with moderate to profound intellectual disabilities

Background There is a lack of theory-based interventions for direct support professionals (DSPs) to support a healthy lifestyle for people with moderate to profound intellectual disabilities (ID) despite their major role in this. This study aims to evaluate the preparation, implementation, and preliminary outcomes of a theory-based training and education program for DSPs to learn how to support these individuals. Methods The program consisting of e-learning, three in-person sessions, and three assignments was implemented. The implementation process was evaluated with a mixed method design with the following components: preparation phase, implementation phase, and the outcomes. These components were measured with project notes, questionnaires, interviews, reflections, assignments, food diaries, Actigraph/Actiwatch, and an inventory of daily activities. Results Regarding the preparation phase, enough potential participants met the inclusion criteria and the time to recruit the participants was 9 months. The program was implemented in four (residential) facilities and involved individuals with moderate to profound ID (n = 24) and DSPs (n = 32). The e-learning was completed by 81% of the DSPs, 72–88% attended the in-person sessions, and 34–47% completed the assignments. Overall, the fidelity of the program was good. DSPs would recommend the program, although they were either negative or positive about the time investment. Mutual agreement on expectations were important for the acceptability and suitability of the program. For the outcomes, the goals of the program were achieved, and the attitudes of DSPs towards a healthy lifestyle were improved after 3 months of the program (nutrition: p = < 0.01; physical activity: p = 0.04). A statistically significant improvement was found for food intake of people with ID (p = 0.047); for physical activity, no statistically significant differences were determined. Conclusions The theory-based program consisting of a training and education section for DSPs to support a healthy lifestyle for people with moderate to profound ID was feasible to implement and, despite some barriers regarding time capacity and mutual expectations, it delivered positive changes in both persons with moderate to profound ID and DSPs. Thus, the program is a promising intervention to support DSPs.

Improving Service through a Digital Assistant for Direct Support Professionals: Exploratory Focus Groups

Direct Support Professionals (DSPs) who assist adults with autism spectrum disorder sometimes find it difficult to keep up with administrative tasks including the documentation of important data needed by others who also provide support to their clients (e.g. behavior analysts, physicians, other DSPs). Existing technologies, such as cameras, smart speakers and smart medication dispensers, could potentially be leveraged to help capture some of the data that DSPs are asked to report as part of their work responsibilities. However, it is not currently known whether DSPs would be amenable to using these technologies ‘on the job’. This paper presents preliminary results from two exploratory focus groups where DSPs were asked to discuss the possibility of using different types of technologies to facilitate capturing and reviewing data about clients they serve.

Risk Perception and Coping Strategies among Direct Support Professionals in the Age of COVID-19.

The spread of novel coronavirus (COVID-19) across the globe and its associated morbidity and mortality has impacted and challenged society in many ways, which resulted in adapting to a new way of life. One underrecognized and unaddressed area is the mental health of essential employees providing services to people with intellectual and developmental disabilities (IDD). Direct support professionals (DSPs) serve an important function in the daily supervision and care of clients with IDD. It is not clear, however, how these essential workers perceived their own risk of contracting COVID-19 while working during this pandemic. Our research presents results of a national survey of 478 DSPs that focused on perceptions of risk and ways of coping with COVID-19. Using an online survey, we examined DSPs’ perception of risk and on the emotional and problem-solving strategies they used to cope with the global crisis. We found that DSPs engaged in higher problem-focused strategies rather than emotion-focused strategies in coping with the virus. As such, we show that it is critical for IDD provider organizations to assess DSPs’ needs to provide coping supports during the age of COVID.

Direct Support Professionals' Perspectives on Workplace Support: Underappreciated, Overworked, Stressed Out, and Stretched Thin

The Direct Support Professional (DSP) workforce has experienced a multidecade period of disinvestment in the field leading to DSPs being in high demand, while efforts to recruit, train, and retain these professionals pose challenges. To gain a better understanding of the needs of DSPs themselves, 440 survey responses and 24 interviews of DSPs were analyzed to understand what would help DSPs do their jobs better and ensure they feel more supported by their agencies. Results revealed six distinct support needs: (a) ensure quality participatory management practices, (b) provide fair compensation and recognition, (c) enhance access to training opportunities, (d) assure reliable and quality staffing, (e) adequately fund basic needs of both programs and people receiving support, and (f) maintain reasonable job expectations.

The Effects of Aggression Subtypes on Burnout and Caregiver Instability in Direct Support Professionals

Aggression is a known contributor to burnout and caregiver instability among direct support professionals (DSPs) caring for adults with developmental disabilities. However, few studies have explored the differential effects of aggression subtypes on caregivers and what implications these may have for intervention planning. This longitudinal study examined whether different types of aggression were associated with greater burnout and instability in DSPs. Ninety DSPs reported on their experiences working with aggressive clients with developmental disabilities at baseline and at a 3-month follow-up. Participants were roughly representative of the population of DSPs in the United States. Verbal aggression and reduced length of time knowing the aggressive adult significantly predicted caregiver instability, with participants who had stopped working with the aggressive adult experiencing significantly worse verbal aggression than participants who were still working with the adult at follow-up. Hostile affect significantly predicted burnout. Verbal aggression and hostility, which are less frequently targeted for intervention as more dangerous forms of aggression, pose risks for caregivers and therefore warrant active attention through intervention. DSPs would benefit from training on how to diffuse and redirect verbal aggression and hostility, as well as use coping strategies to mitigate against the negative emotional effects of aggression.

Meeting the need: Creation of an online infection prevention course by the Golisano Institute for Developmental Disability Nursing for direct support professionals during COVID-19

The Center for Disease Control (CDC) recommended that direct support professionals (DSPs) take additional steps to protect people with disabilities during COVID-19 and receive training on the use of personal protective equipment and infection prevention. The Golisano Institute for Developmental Disability Nursing identified this as an unmet need and created an online asynchronous course for DSPs on infection prevention and use of personal protective equipment to reduce transmission of COVID-19 among individuals with disabilities and DSPs. Constructivism, experiential learning theory, and active learning theory guided content development. The course used games to break-up dense information into more manageable chunks as a means to increase learner engagement and motivation. The course was delivered on a dynamic Learning Management System to allow for a variety of content authoring tools to be utilized. After evaluation, the course was disseminated to DSPs. Future directions include a broader infection protection course for DSPs, without a direct focus on COVID-19.