This series of poems documents the speaker’s experience working as a wilderness field guide for a substance abuse program in North Carolina. The poems explore what it looks like to work direct care and to hold responsibility for a group of women’s physical and emotional wellbeing. There is a secondary narrative that interrogates the speaker’s relationship to substances as well as the speaker’s father’s identity as a recovering alcoholic.

Turnover among direct-care workers in long-term care (LTC) facilities is high, and has a significant impact on residents, leaders, and owners of LTC facilities. The overall turnover costs are also substantial and constitute a significant financial burden in LTC facilities. This systematic review of the literature examined, retention strategies for direct-care workers in the LTC workforce. The information may be used to develop and provide practice recommendations that will help improve retention rates among direct-care workers in LTC facilities. The project design involved a systematic examination of English-only studies from 2001-2004, retrieved from 3 major databases: CINAHL with Medline simultaneous, ProQuest, and Ovid resources. The review led to the identification of 858 publications out of which 17 articles met the inclusion criteria. The manifested variables were critically analyzed and grouped into 8 categories: job training, management style, acknowledgement of accomplishments, career advancements, benefits, peer mentoring, competitive wages and work load. The findings from this systematic review of the literature suggest that several factors affect turnover rates in the LTC setting, including job training, management style, acknowledgement of accomplishments, career advancements, benefits, peer mentoring, competitive wages and work load. This project aims to provide insight to project developers, administrators, researchers, and policy makers concerning factors that affect retention. The information can be used as a catalyst for positive social change and reduce the turnover crisis among direct-care workers in the long-term care setting.

Yes / This study assessed the effects of a psycho-educational intervention on direct care workers' person-centredness during morning care to residents with dementia. A controlled pretest–posttest study was conducted in four aged-care facilities with 56 direct care workers (female, mean age 44.72 ± 9.02). Two experimental facilities received a psycho-educational intervention comprising person-centred care competences and stress management skills; control facilities received an education-only intervention, without stress support. In total, 112 video-recorded morning care sessions were coded using the Global Behaviour Scale. Both groups reported significantly higher scores on eight of 11 items of the Global Behaviour Scale and on the Global Behaviour Scale total score at posttest (F=10.59; p=0.02). Global Behaviour Scale total score improvements were higher for the experimental group, with values close to significance (F=3.90; p=0.054). The findings suggest that a psycho-educational intervention may increase care workers' person-centredness. Further research is needed to explore the long-term sustainability and extent of its benefits on workers and residents. / Foundation for Science and Technology

Previous studies have demonstrated the use of momentary time-sampling methods for the objective measurement of naturally occurring events (Zarcone, Iwata, Rodgers & Vollmer, 1993; Shore, Lerman, Smith, Iwata & DeLeon, 1995). These studies have provided information about observed levels and characteristics of direct care services, supervision, resident activity and facility conditions. The present study evaluated the utility of these assessment procedures in a residential facility for developmentally delayed adults. The procedure was further evaluated for sensitivity to changes relative to an intervention designed to increase staff and client interaction. A multiple baseline design was used to assess a data collection procedure in the context of intervention in four residences on a state facility campus. Intervention included the use of scheduling, modeling and performance feedback. Results indicate an overall increase of staff and client interaction and demonstrate the utility of the assessment procedure for the evaluation of multiple, on-going activities as well as intervention effects.

Direct-care workers can provide an array of service types to children, adolescents, and their families in behavioral health treatment. They may also work in a variety of settings (e.g., group homes, inpatient units/hospitals, residential treatment, treatment foster care, day treatment, in-home treatment, etc.). Direct-care workers typically are involved in the supervision of youth and in the implementation of a treatment plan developed by the youth’s treatment team. For youth who are lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) and are receiving behavioral health services, such workers form a critical part of their therapeutic experience. However, little is known about these workers’ competencies related to working with LGBTQ youth. This study begins to fill that gap by developing and testing a measure that assessed LGBTQ cultural competencies related to behavioral health practice with youth and a measure that was relevant to the roles and responsibilities of direct-care (e.g., paraprofessional, front-line) workers. In order for direct-care workers to use LGBTQ cultural competency in their practice, more understanding is needed about their current level of LGBTQ-related cultural competency. The LGBTQ Youth Cultural Competency scale (abbreviated as LGBTQY-CC) provides a means to measure those competencies. An exploratory factor analysis found that the new scale consists of one primary factor which represents knowledge, attitudes, skill, and awareness of LGBTQ cultural competency. Cronbach’s alpha, correlations with other measures for concurrent validity, and correlation with a measure of social desirability all resulted in evidence that the LGBTQY-CC has good validity. Analyses examined how the new measure was related to constructs associated with training and competency in direct-care workers. Multiple regression analyses showed that higher levels of LGBTQ cultural competency (as measured by the LGBTQY-CC) were significantly related to age (younger), political ideology (more liberal), more social contact with LGBTQ individuals, and degree of religious belief about LGBTQ being a sin. A model including these factors explained 60% of the variance in LGBTQY-CC scores. The LGBTQY-CC was created with the long-term goal of creating training interventions for direct-care workers to improve their practice with LGBTQ youth. The measure could be used to assess training participants’ knowledge, attitudes, skills, and awareness and to evaluate the effectiveness of varying types and styles of training programs. Federal and state regulatory bodies have begun to require service providers to identify how they will address disparities faced by LGBTQ individuals, so service providers need to demonstrate how they are improving access to and quality of care for LGBTQ individuals. Therefore, the LGBTQY-CC may provide a means to gather data on efforts made by service providers to improve their behavioral health workforce’s capacity to serve LGBTQ youth.

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking.<p> Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina QuAppelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest.<p> Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005.<p> Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed.<p> Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR.<p> Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.

Use of restraint during crisis intervention is of great concern as these situations evoke stress responses in the direct care staff that respond to them. This stress response often leads to non- neutral reactions. Acceptance and Commitment Therapy (ACT) has been used to effectively de- literalize task-related stimuli in individuals that share similar physiological symptoms of stress to those that direct care staff might experience during crisis. The purpose of this study was to evaluate how an ACT intervention would improve direct care staff performance during crisis interventions and increase accuracy of incident report writing. Results indicated that four out of the six participants improved their performance following ACT training, while the most improvement was observed in accuracy in incident report writing. This study expands upon the limited research available on the utility of ACT in the workplace. Implications of this study suggest that ACT may be a beneficial intervention to increase staff performance during crisis.

This study examined the relationship between subordinates perception of the quality of leader-member exchange (LMX) relationship, dyadic demographic factors and turnover intent in rehabilitation agencies. The sample consisted of 152 direct care employees that work with individuals with disabilities at rehabilitation organizations in the state of Illinois. In particular, the focus was on determining the best fit model that predicts turnover intent among quality of LMX, dyadic age, gender, educational level, ethnicity and duration and their two-way interactions with LMX. Participants were asked to complete the team Leader-Member Exchange scale (LMX-SLX), Turnover Intent Scale (TIS) and a demographic questionnaire. Results of the regression analysis showed that LMX significantly predicted turnover intent, β = -.272, t=-3.298, Sig. F Change = .001. None (dyadic educational level, β = -.146; dyadic ethnicity, β = .068; dyadic gender, β = .100; dyadic duration, β = -.076) of the demographic factors except dyadic age, significantly predicted turnover intent (Sig. F Change = .112). Dyadic age, β = .258, t= 2.502, p= .014 was a significant predictor, although the overall model was not significant. All (dyadic educational level_LMX, β = -.60; dyadic ethnicity_LMX, β = .037; dyadic gender_LMX, β = -.130; dyadic age_LMX, β = .071; dyadic duration_LMX, β = .071), of the interactions significantly predicted turnover intent, although the overall model was not significant. In addition, implications, limitations and delimitation, and recommendations for future research are discussed.

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