Managing a Day Program for People with Developmental Disabilities
Since the closing of many state-run facilities for those with disabilities many years ago, the care and education of people with developmental disabilities rests with independently run care homes and agencies dedicated to serving people with developmental disabilities. This also means that people with developmental disabilities are with us out in the community, and there has been a need for community integration programs to ease the process of consumers (clients) becoming part of the community.
It is a relatively new field of work, community-integration programs. It involves aiding consumers in understanding the community as well as the community understanding consumers. Life skills, social skills, vocational skills and many other skills are taught in these programs, and many consumers have behavioral issues which make the operation of the programs very challenging. Staff carry a heavy load, and consumers are challenged to face a world that sees them as very different.
It can also be challenging to run community integration programs, or day programs. Program coordinators, or program managers, must balance the needs of staff and consumers. In addition to considering issues about funding sources, management must handle issues concerning parents, care home management and staff, transportation issues, and various other issues from abuse to discrimination, in addition to managing conflicts and problems consumers have inside and outside of program. It really runs the gamut, as far as what kinds of issues arise from the day program.
Here we will examine how management can better run community integration programs for people with developmental disabilities. I have many years of experience as direct care staff for people with developmental disabilities, working for different agencies as instructor in day programs and as an instructional aide in elementary and secondary schools. I understand the structure of the day programs and have encountered multiple problems with how they are run. While what I say may sound like a critique of the programs, what I offer are suggestions for improvement.
The Structure of the Programs
The day program is run by the Program Coordinator, or Program Manager, who answers to the Executive Director of the agency under which the program is a part. Under the Program Coordinator, typically, there are one or more first-line supervisors to work with staff and consumers. The program takes place in an open facility or all day out in the community. I personally, spent most of my time working in a community-based day program, out in the community all day, using the buses, going to shops, teaching street safety while walking through town, taking consumers to classes, taking them to volunteer sites, and other things. When the program takes place at a facility, activities are centered at the facility itself with periodic trips out into the community. The main difference is that holding the program activities at a center can be intense because you have all consumers in one place for long periods of time, increasing the massive stimuli of everyone involved, and increasing the potential for conflicts and behavioral issues. Being out in the community, your groups can be smaller, dispersed and on the go. This decreases chances for certain behavioral issues and conflicts, but creates its own problems too.
Typically, there can be between a dozen to 20 staff in the program, with consumers split up into groups of 3 to 6. Some consumers require their own staff, known as the 1 on 1 ratio; meaning there is one staff for this one consumer, because he or she has special needs and behavioral issues that require more attention. Other consumers are on a 3 to 1 ratio, meaning staff with these consumers can't have more than 3 in their group. They require less attention and care compared to 1 on 1 consumers, while 4 to 1 consumers who are higher functioning and more independent require less attention. And so on, with the ratios, I think you get the idea.
So, as you can imagine, staff might have 3 consumers, all with rather difficult behavioral issues or necessary care issues, and be dealing with these issues simultaneously from multiple consumers. It can become stressful. This is a primary issue we will consider as we go along: The care of staff.
I started working as direct care staff in a day program back in the year 2000. At that time, my pay was around $7 an hour. That was about minimum wage at the time. Over the course of two years, I eventually made $8 an hour. Back in 2010, I was at $8.50 an hour and when I left that company, the new company I worked for paid me a bit better at $9.60 an hour.
So, as you can imagine, if you have more than one mouth to feed, you are really stuck. Your home life suffers, you suffer, you are tired and stressed because the pay you receive does not sufficiently take care of your needs and you are under pressure to make ends meet.
In other words, generally, the case is that staff are not taken care of; it has been my contention for years that you must take care of the care-takers. Or else, the whole thing fails.
It is my suggestion that staff are paid at least a living wage.
Staff Rest Breaks
Generally, staff do not get breaks. You work at least 6 hours with consumers, chasing them, breaking up fights, making sure they don't run into the street, teaching them various skills, making sure they don't wander away, and then when consumers go home, you're expected to do anywhere between 1 to 2 hours of paperwork: All without ever taking a break.
It is my suggestion that at points during the day, staff are relieved, have a place where their consumers can go to be attended by relief staff, and have a place for staff to take a break that is well-removed from any work-related activity. Actually, this is the law, that workers are to get breaks in this manner. Just to let you know.
Those years working as a day program instructor, I wrote up all the documents for the program related to my consumers. I wrote up service plans, which included information about the consumer and his or her goals. I wrote progress reports, which were documents on the consumers' progress on goals. I tracked progress on consumers' goals. I wrote daily documentations, incident reports, made phone calls, registered consumers for college courses, kept contact with consumers' parents or care home staff and college faculty and staff.
In other words, though I was direct care staff, I was also doing the job of case manager and program coordinator. And still getting paid as direct care staff. Not too fair.
So, I advise that direct care staff maximum administrative duty should be daily documentation and tracking daily progress on goals. After sufficient breaks are taken, of course.
Listen to Staff
Direct care staff, as the title implies, are in direct contact with consumers every day of the day program. They listen to what consumers say, see what consumers do, should understand what they feel and think, and so are most aware of what is happening with consumers. Therefore, direct care staff are equipped to know what to do with consumers, know what consumers want, and know what consumers do. It stands to reason that direct care staff can be trusted with understanding these things and what they say, think and feel should be heeded by management.
Staff are out in the elements, out in traffic, on the bus, get attacked by consumers, are sometimes attacked by community members. This should be taken into account when taking administrative actions, including removing staff from situations that are unsafe in regards to consumers and environment.
Management should be conscious of violent consumers or consumers who are in some way a danger to others. Consequences should be administered for repeated violent and disruptive behavior. These behaviors put staff and consumers both at risk and increase levels of stress.
An obvious consequence for consumer violence is to remove or suspend them from the day program.
It is unwise to put two or more consumers who don't get along in the same group. This can lead to violent confrontations and perpetual stress. This has an obvious detrimental effect on staff, consumers and community.
Management at one time were convinced that consumers who don't get along should be put in the same group to teach them to "get along". It never works and leads to on-going and multiple problems.
Also, it is unwise to put more than one consumer in a group that are particularly problematic and in ways that make them completely incompatible with each other. For instance, I once was staff for a group in which one consumer often attacked others while the other one often ran off from group, and another one liked to antagonize his peers. In other words, I was constantly trying to manage one consumer who was antagonizing the violent one, the violent one scaring the runaway, while I was simultaneously trying to keep the runaway from running off and getting lost. Management really laid a heavy load on me. Typical.
Along these lines, it should be stated that if a consumer becomes an excessive danger to himself or herself, staff, or the community in terms of stress or physical safety, management should seriously consider requesting from the regional center (funding source and case manager of all consumers' programs of their area) to give a ratio of 1 on 1 for that particular consumer so that one staff can be dedicated to that consumer's special needs, and thus relieve staff and peers of the group to which the consumer is attached.
Listen to Consumers
It is their program. They know what they want, they know what happens to them, they are often good self-advocates. Understanding who they are and what they need is important, so communication should remain open between consumers, staff, and management.
Understand Staff and Consumers
Finally, it is important to understand the people who are working for you and the consumers you serve. Each individual has a different way about them, some are more sensitive, some more outgoing. Some would rather be in more quiet settings, others need more bustle. Some are academic, some are athletic. Some are health-conscious, some are entertaining. The list goes on. Understanding what staff need, what consumers need and even making more harmonious matches between staff and consumers could do wonders for the smooth operation of the day program and a happy environment.
Do you think issues of wages, rest breaks, communication, safety and work load are important in Day Programs?
In conclusion, I think it is important that staff are cared for, because without them being healthy, with energy to handle the job, the program goes nowhere and no one is cared for. I think consumers should be heard, should be considered and it should be remembered that without them, also, there would be no program.
All of these considerations could create and support a healthy and harmonious, smoothly operating community-integration day program for people with developmental disabilities.