A Step-By-Step Guide to Training and Managing Personal Attendants
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A Step-by-Step Guide to Training and Managing Personal Attendants: Agency Guide By Gary R. Ulicny, Amy B. Adler, Sara E. Kennedy, & Michael L. Jones
The Research and Training Center on Independent Living, University of Kansas Copyright 1987 by Research and Training Center of Independent Living (RTC/II.). University of Kansas, Lawrence, KS 66045
An increasing number of persons with disabilities are using attendant services. From the independent living perspective, consumers are encouraged to take responsibility for training and supervising their own attendants. However, for many consumers, assuming the role of employer will require some degree of training or assistance. This manual is for agencies interested in developing programs to train consumers to he better attendant service managers.
This manual is designed to be used in conjunction with a “Step-by-Step Guide to Training and Managing Attendants: Consumer Guide.” The Consumer Manual provides consumers with a systematic model for managing attendants. This manual describes: 1) where in the model your assistance may be most helpful to consumers and the type of assistance that may he needed, 2) how to train consumers to use the model, and 3) how to set up the model as a permanent service in your agency.
The first step is to familiarize yourself with the model by reading the manual written for consumers. If you are to be training consumers in its use, you must know the model inside out. So, please refer to the consumer guide, and read the entire manual thoroughly. We’ll he waiting for you here when you get back.
Welcome back. We hope you took the opportunity to read the whole consumer manual. If so, you should have a pretty good idea how consumers use the model. Now let’s spend some time discussing your role in assisting consumers. Let’s start by describing how you might start an attendant management program based on our model. There are three things you will need to implement the model at your agency:
- Consumers who need attendant management training.
- A copy of this manual.
- A staff person or persons who will be responsible for assisting consumers.
The first step is to ensure that the responsible staff person(s) understands and are familiar with how the model works. If you have staff members who are attendant service users, an excellent way to familiarize staff with the model is to begin your program with them.
The model is designed so that small groups or individual consumers may be trained.
While we would hope that consumers could simply use the manual to set up their own program, there are several areas where the ILS’s assistance can be helpful. The next section describes the role of an ILS as the consumer moves through each step of the manual.
The first step is to provide the consumer with a general description of the model. This can be done by giving him/her a copy of the consumer section of the manual to read. The ILS can then schedule a time to meet with the consumer to discuss any questions or problems. Meetings or training sessions can be conducted in the consumer’s home or at your agency.
Once you are sure that consumers have a basic understanding of the model, you are ready to begin. It may seem funny that there are several sections in the manual before the section on hiring PCAs. The reason for this is that consumers should he familiar with their own routines before describing them to prospective attendants. Plus, the checklists that are developed in the early sections serve as a specific job description when interviewing applicants.
Rather than repeating information already in the consumer manual, the following is a brief list of the steps involved and the assistance the ILS may provide. Remember, the consumer decides what, when, and how much attendant services he or she receives.
- Fill out needs assessment. Schedule a meeting with the consumer or consumers to fill out the needs assessment. At this meeting, the ILS should refer consumers to the generic checklists and discuss how checklist items are written. Ask consumer(s) to prepare the first draft of their checklists for the next meeting.
- Refine checklists. At the next meeting, go over the checklist, and make suggestions about their format. This is a time when it is really helpful to have more than one consumer involved in training. It allows consumers the opportunity to discuss their checklists with each other.
- Prepare working version. Once the checklists are in draft form, have them typed. We recommend entering them on a computer using any available word processing software. This makes it easier to make any changes. We have included a diskette that includes every form listed in the consumer and agency manual. This information can be copied to a diskette and modified to each consumer’s specific needs. If you don’t have access to a word processor, make a legible hand-written copy now, and type up the final version later.
- Verify the checklists. Because consumers are developing the checklists from memory, it is a good idea to have someone (you, family member, etc.) observe the consumer’s routine and make changes, additions, or deletions on the draft copy of the checklists.
Once the consumer has developed the finalized checklists, he/she is either ready to begin training an attendant, if they already have one, or ready to hire an attendant. Let’s talk about hiring first.
Training Hiring Skills
The manual describes a step-by-step method of hiring an attendant. The consumer should write up an ad for advertising and adapt the application and employment contract to meet his or her needs. You can assist in this by providing support and suggestions along the way.When the consumer(s) is ready to begin interviewing prospective attendants, you can assist by practicing with the consumer or coordinating practice sessions between consumers. The best way to practice is by role playing.
The initial practice sessions can be conducted in your agency office. However, for a touch of realism, it is a good idea to schedule at least one dress rehearsal. This involves actually calling the consumer on the phone (phone interview) and visiting the consumer’s home to practice the personal interview. A visit allows the consumer to practice showing the layout of the house or apartment and describing modifications or adaptive equipment. Sample role-playing situations for phone and personal interviews are provided in the consumer section.
To provide consumers with feedback on how well they are interviewing, we have provided interviewing checklists. When the role-playing session is finished, YOU or a consumer can go over the checklists, pointing out items that were forgotten or could he improved. Scoring these checklists allows consumers to concentrate on specific areas that need improvement and practice giving feedback on interviewing performance to other consumers.
We recommend that you set some kind of minimum criteria that consumers must reach before moving on to the hiring process. For example, you might decide that a consumer must succeed in asking 80 percent of the interviewing questions correctly during three consecutive role-plays before interviewing someone in “real life”. Percent correct is the number of items correct divided by the total number of items.
Did the consumer:
- Answer the phone in a friendly manner?
- Give a brief description of the duties, hours, and pay?
- If applicable, mention the job involved nudity and/or bowel and bladder care?
- Ask for:
Name Address Phone number
Prior job experience
If the applicant has transportation
- Schedule a personal interview or tell them they would call back?
- Thank them for calling?
Did the consumer:
- Greet the applicant in a friendly manner?
- Spend some time getting acquainted?
- Give the checklists to the applicant to look over?
- Inform the applicant of the hours and pay?
- Explain the procedures for absenteeism, tardiness, and termination?
- Get the applicant to fill out the application?
- Review the application to make sure it was filled out correctly?
- Tell the applicant that he or she will be called as soon as a decision has been made?
- Thank them for their time?
One of the most important management skills is the ability to give performance feedback. Assisting consumers in developing this skill will require that you (the ILS) are familiar with the components of performance feedback. While this is explained in the consumer section of the manual, let’s have a short review.
There are three types of performance feedback--positive, corrective, and negative. Typically, very little feedback is given until something goes wrong, resulting in negative feedback. Our model focuses on two types of performance feedback during training--positive and corrective.
Positive feedback is defined as feedback given to an individual about correct performance. In order for feedback to be positive, it must:
- Praise correct performance.
- Specify exactly what was performed correctly.
My hair feels so clean. You really did a great job of washing it today.’ ‘That lunch tasted SO good. The beans were cooked just right.’
“You did a good job.’ ‘Thank you.’
Corrective feedback is feedback given to improve performance. In order for feedback to he corrective, it must:
- Specify exactly what was done incorrectly.
- Give specific instructions for correcting the problem in the future.
- Be nonpunitive.
“We need to work on combing my hair. I really prefer my part a little more to the left.” “The beans at lunch today were a little overcooked. I’ve found if you cook them on medium for 30 minutes, they come out just right.”
“You really screwed up my hair today.” “You just didn’t do it right.”
While we hope that positive and corrective feedback can be used to handle most situations, there may he times when the attendant needs to he corrected more firmly. For example, when the attendant continually performs tasks incorrectly that he/she knows how to do, or when the attendant tests the consumer to see what he/she can get away with. In these cases, negative feedback will be required.
We recommend some strategies for dealing with problems that get out of hand. Have the consumers talk to the attendants about what’s been troubling them. Explain what it is that upsets you. It won’t help for the attendant to feel defensive: that won’t change the situation and is likely to make the attendant ignore the consumer. One way to prevent the attendant from becoming defensive is to use statements that begin with “I feel.” The attendant can’t argue with you, if these are your feelings. Also, try getting the consumer to brainstorm ways that the problem could be handled. While we recommend that consumers only use negative feedback as a last resort, remind them to be firm in dealing with the attendant. Make sure he/she understands what’s important to them and why, as well as the possible consequences of the behavior should it continue.
To summarize, teach consumers to:
- Express their concerns immediately, right after the problem.
- Speak in a calm tone of voice.
- Tell the attendant specifically what he or she did wrong.
- Let them know the consequences of their action and how upset you are.
- End by telling the attendant they know he or she will try to do better in the future.
“Tim, this is the second day in a row that you have been late without an excuse. I know that when you are late it makes me late also. I’m pretty upset about this, Tim, and if it happens again, I will have to let you go. I don’t want to do that, because you are a good attendant. Let’s not let it happen again, okay?’
“You really are a lousy attendant.” “How can you be so dumb?” “You make me SO angry I wish I could hit you.”
Training Consumers to Provide Effective Feedback
The primary method for training consumers to provide feedback is role-playing. Using the consumer’s checklists, situations can be developed that require the consumer to provide a specific type of feedback. Below are some situation examples and, in parentheses, the type and an example of feedback that should be given:
Situation: It is your attendant’s second day, and you had to remind her twice to use creme rinse after shampooing.
(corrective feedback) “It’s really important that we use creme rinse; if we don’t, you’ll never be able to get a comb through my hair.”
Situation: Your attendant has been doing an outstanding job making your lunch for the last week. (Positive feedback) ‘Tim, this week’s lunches have been especially good. I really appreciate the extra care you take in preparing them.”
Situation: Your attendant is continually leaving food on your dishes after washing them. You have told him numerous times using corrective feedback that you do not like this.
(Corrective feedback) “Tim, last night I found egg on the dish that you washed yesterday morning. I really don’t like having to eat off of dirty, unsanitary dishes. I know you know how to do them correctly. Take your time, and please make sure you get them clean.”
When consumers conduct feedback sessions, they should use an adapted form of their checklist with a column of spaces alongside the various checklist items. After the initial structured feedback session, the consumer can begin referring to entire subroutines when providing feedback. As mentioned in an earlier section of this manual, the checklist items fall under subheadings (e.g. breakfast, wheelchair maintenance, bathing). The consumer can take advantage of these logical subdivisions by referring to a particular subroutine when giving feedback on several items. The consumer can give positive feedback on the subroutine.
For example, “You did a really good job preparing breakfast today.” When corrective feedback is called for, the consumer should, of course, continue to refer to each of the particular items that need improvement. When the consumer gives feedback by subroutines, all the items within a subroutine should be marked with a “+“ or a “NI.” Those items that are not applicable for that day should be marked “N/A.”
You can conduct the majority of feedback practice sessions in your agency. However, it is extremely helpful if you visit while the consumer is training an attendant and observe him/her giving feedback. Once the attendant has left, you can sit down with the consumer and discuss the feedback session. Things you should note while observing include:
- Did the consumer provide enough feedback?
- Was the feedback correct according to our previously described criteria
- Did the consumer allow the attendant to ask questions and offer suggestions at the end of the feedback session?
Optional Training Aids
Many agencies and independent living programs have access to videotape equipment.
This equipment can be useful when consumers are practicing interviewing and how to give feedback.
Videotaping practice sessions allows the consumer to review his/her interview or feedback exactly as it was performed. In addition, research has shown that video models that are similar to the viewer are more effective in presenting information. In this case, the model and the viewer are the same person, further enhancing the videotape’s effect.
One thing to remember when providing feedback to consumers on videotape performance: Point out positive aspects as well as areas that need improvement. It is a good idea to film your first practice session using a script. This ensures that there are lots of opportunities for positive feedback, and the consumer can model appropriate behavior right from the start.
One of the basic tenets of the independent living philosophy is consumer control. We wholeheartedly support the premise that people with disabilities are in the best position to advocate for other disabled persons. One excellent way to incorporate this philosophy into attendant care training is through the use of peer trainers.
Peer trainers are attendant care users who assist other consumers in learning the model.
They should be skilled in the use of the model and have the ability to convey those skills to others.
The use of peer trainers has several benefits: 1) it increases the number of persons who can assist consumers; 2) it enables peer trainers to share “tricks of the trade’ with new attendant care users; and 3) it provides the new user with an appropriate role model during training.
Depending on the organization of your agency, peer trainers can be volunteers or paid staff members. Just as with any management model, there should be one person who meets periodically with peer trainers to discuss problems and suggestions and provide feedback of peer trainer performance.
Implementing the Model in Your Agency
- Establish an administrative structure. Clearly delineate who will be responsible for conducting training and/or supervising peer trainers. The supervisor will be responsible for training staff and evaluating the program on an ongoing basis.
- Train the staff or peer trainers. Each person who will be responsible for assisting consumers should be thoroughly trained in the use of the model. The most important skills are interviewing and providing effective feedback.
- Determine a training format. Several options are available for training consumers. If you serve rural areas, you may wish to conduct training in the consumer’s home. In urban areas, it may be easier to schedule regular classroom training sessions so several consumers can be trained at once. Finally, in some cases, it may be necessary to use a combination of home and classroom training.
- Advertise the availability of attendant management training. This can be done in your agency’s newsletter, the local newspaper, by contacting other agencies, or by word of mouth.
- Evaluate the effectiveness of training. It is extremely important that you evaluate the effectiveness of your training program periodically. The best indicator of effectiveness is the satisfaction of consumers who have been trained. To assist with this process, we have provided a training evaluation form on the following page. Please feel free to modify the form to your training situation.
- Analyze evaluation results and make any needed changes. The results of the training evaluation should provide valuable information on your program. If all responses are favorable, pat yourselves on the back and continue. However, if consumers respond unfavorably, especially on the same item, some changes may need to he made. These changes may he additional training for staff peer trainers or logistic changes, such as consumers who are unable to attend classroom sessions.
Training Evaluation Form
Number of sessions attended:
Name of trainer(s):
1= Not at all useful 5= Very useful
- How useful did you find this training? (circle one) 1 2 3 4 5
- How competent do you now feel as a manager of personal attendants? (circle one) 1 3 4 5
- What did you particularly like about the training sessions?
- How could the training session be improved?
Not all the consumers will be able to adapt to our management procedures easily. Some consumers may have developmental disabilities, and some may not read. It is important for your agency to make provisions for these consumers. One way to address the situation is to break down the skills training into even smaller steps or to focus on those parts of the training that might have the biggest chance for success.
For those consumers who find our manual difficult to read, you can have a trainer read through it with them and write down reminders with words that are easier to understand.
Further Consumer Education
Besides the management techniques outlined in this manual, some consumers might benefit from a training course on the requirements of their own health care and maintenance. If consumers are trained in wheelchair maintenance, how to check for pressure sores, how to clean and change ostomies, and other daily concerns, then they can be more clearly in charge of their own personal routines.
If there is a need in your agency for such training, we recommend that you provide lectures or individual training sessions with medical or other appropriate personnel.
It is beyond the scope of this manual to provide a complete guide to setting up an attendant referral network in your agency. It may be, however, that your agency already has one or plans to establish one. In that case, you may find yourself facing a consumer caught in the hire and fire cycle.
Not all consumers will be highly motivated to train attendants effectively. For example, one consumer seems to go through a tremendous number of attendants even after training. Your agency may start becoming annoyed at the amount of resources used in referring attendants to this consumer. The attendants may get fed up with attendant work, and the referral list for attendants may begin to shrink. How can your agency handle this situation?
We suggest a few basic steps. 1) Ask the consumer what’s going on; it is helpful to hear this side of the story to see if the problem areas can be quickly identified and dealt with. 2) Ask the attendants, past and present, what the problem is. 3) Determine if the problem is something that further attendant management training can address. Has the consumer forgotten, or never clearly understood, certain aspects of the training? Would it help to observe a typical interaction between consumer and attendant? Would it help the consumer to talk with an attendant user who has successfully faced the same problem?
If none of these steps leads to a successful resolution to the problem, you, as an agency, must decide what is in the best interest of your agency. Perhaps there needs to be some sort of consequence, such as a denial of service for a period of time, in order to maintain the reputation and integrity of your services. You might consider instituting some sort of limit setting (contract) for eligibility for your services. In this way, you can remain helpful to the many other consumers who use your agency.