Specialty Training Improvement and Expansion Project

The State of Washington Department of Social and Health Services (DSHS), within one of its functions, licenses and monitors the state's Assisted Living Facilities and Adult Family Homes. Within that network of care, three care specialties exist which require caregivers to complete training in dementia, mental health, and developmental disabilities, called Specialty Training. The specialty training topics, learning objectives, and competencies and training requirements are detailed in the Washington Administrative Code (WAC), Chapter 388-112—Residential Long-Term Care Services.

In January of 2014, DSHS retained the services of an independent consulting group (Coraggio Group) to assist in implementing sections of SSB 5630 that enact recommendations of the Adult Family Home Quality Assurance Panel and related to improving and expanding specialty training for Adult Family Homes and Assisted Living Facilities.

Below are a detailed series of steps DSHS took with regard to improving and expanding the specialty training content. Steps 1 and 2 are completed, and Steps 3 and 4 are currently being implemented.

Step 1: Stakeholder Outreach
Step 2: Research and Recommendations
Step 3: Updates to Specialty
Step 4: Key Dates and Class Schedule
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After You Take the Class
Resources
Questions

Step 1: Stakeholder Outreach

As a first step, DSHS and Coraggio Group undertook a statewide Stakeholder Outreach tour to:

Solicit feedback on the current specialty trainings and requirements,
Identify opportunities to improve the trainings,
Identify needs for additional specialty trainings, and
Identify opportunities for the revision of relevant portions of the WAC.

Planning for the Stakeholder Outreach effort began with identification of target stakeholder groups, assessment of geographic distribution of homes, and development of discussion guides to ensure that the conversations generated consistent categories of feedback. Forty meetings were held, including individual interviews, focus groups, public meetings, telephone interviews, and telephone focus groups. An online survey was also employed to gather feedback. The Stakeholder Outreach effort concluded in mid-June, 2014 and ultimately included nearly 400 individuals sharing their perspectives about the specialty trainings. Generally speaking, stakeholders felt that the current specialty trainings have served DSHS well, but that updates are necessary. The most common opinions involved improving access to training, updating training curricula to reflect current thinking and methods, making training and examinations more consistent around the state, and bolstering training around behavior management and effective communication on multiple levels.

The Stakeholder Outreach report details outreach methodology and statistics, key findings by specialty, and an appendix which compiles all of the meeting notes and survey responses.

Step 2: Research and Recommendations

The second step involved a research effort where the content, instructional quality, and program design of the specialty training was reviewed against current research in care and adult education, as well as trends among other states and international care programs. This research effort also included visits to Adult Family Home facilities and interviews with caregivers and providers. Based on this combination of stakeholder input and research, Coraggio Group formulated an independent report of their final recommendations which are contained in the reports below.

The recommendations were posted on the website, emailed to all stakeholders, presented in public forums as well as in local stakeholder organization meetings - providing an opportunity for input and feedback across the state.

A summary has been compiled that provides a high-level overview of the recommended changes for the three existing specialty trainings plus recommendations for additional specialty trainings that should be developed and prioritized based on stakeholder input, complexity of care and the frequency of comorbidity with other conditions.

Overview of Recommendations; Recommendations for Additional Specialty Training

DSHS assessed the recommendations included in the reports proposed by Coraggio Group and worked with stakeholders to evaluate and determine which recommendations to implement that provide the best care outcomes for the clients we serve. Furthermore, it was essential to address the training needs of the care providers, with consideration of fiscal impact.

Step 3: Updates to Specialty

A new DSHS curriculum has been developed along with an implementation plan to offer classes to instructors, and to update rules on class content and instructor qualifications.

Key updates to the specialty training are:

Curriculum

The new DSHS curriculum that replaces both the Manager Dementia Specialty Training and Long Term Worker Dementia Specialty Training is entitled Dementia Level 1: Dementia Capable Caregiving (Dementia, Level 1). In order to teach the new 8-hour curriculum, the instructors must complete the class. Classes will be available for instructors beginning February 15, 2017.
Alternative curricula that have been approved by DSHS as Long-Term Care Worker Dementia Specialty Training curriculum may be offered through June 30, 2018. All alternative curricula must be resubmitted to DSHS for approval based on the updated topics, learning objectives and competencies in order to be offered after June 30, 2018.
The DSHS developed curriculum entitled Manager Dementia Specialty Training and Long Term Worker Dementia Specialty Training will be retired considering if you are a community instructor or a facility instructor. See details below.

Community Instructors

Current specialty training instructors will be grandfathered with regard to the instructor qualifications. Instructors will not need to reapply but will be required to attend and submit certificates of completion for the classes described below.
Community instructors will no longer be able to request to teach the DSHS developed curriculum entitled Manager Dementia Specialty Training and Long Term Worker Dementia Specialty Training.
All instructors will be required to complete the Dementia, Level 1 class and either the DSHS Adult Education class or a class that meets requirements of WAC 388-112-400.
DSHS has provided a schedule for Dementia, Level 1 and Adult Education classes. A schedule is available here.
Once community instructors have met the requirements and receive approved curriculum materials, they must begin teaching Dementia, Level 1 to caregivers and facility instructors. The instructor must not offer curriculum for Manager Dementia Specialty Training and Long-Term Worker Dementia Specialty Training after this point.

Facility Instructors

Specialty instructors approved prior to Washington Administrative Code (WAC) finalization will be grandfathered with regard to the instructor qualifications. Instructors will not need to reapply but will be required to attend and submit certificates of completion for the classes described below.
Facility instructors must complete the adult education class and complete the Dementia, Level 1 class by December 30, 2017 unless teaching an approved alternate curriculum.
Upon effective date of WAC, new instructors will be required to apply and meet the WAC qualification requirements in WAC 388-71-0380 by completing an application and to attest to their qualifications.
Upon effective date of WAC, all new instructors will be required to complete the Dementia, Level 1 class and either the DSHS Adult Education class or a class that meets requirements of WAC 388-71-400.
DSHS has provided a schedule for Dementia, Level 1 and Adult Education classes. A schedule is available here.
Once facility instructors have met the requirements and receive approved curriculum materials, they must begin teaching Dementia, Level 1 to caregivers. The instructor must not offer curriculum for Long-Term Worker Dementia Specialty Training after this point..

Long-term Care Workers

Caregivers that were employed prior to January 1, 2018 that have already completed Long-Term Worker Dementia Specialty Training have met the specialty training requirements. If they choose to take Dementia, Level 1: Dementia Capable Caregiving Training, it may be completed for Continuing Education (CE) credit. Caregivers are not required to complete both classes.
Since the new Dementia, Level 1 Capable Caregiving training is rolling out in 2017, staff that complete this in 2017 can apply the hours either towards their basic training requirements or CE for this year and the training would meet the current requirements for completing the dementia specialty training requirement.
New caregivers as of January 1, 2018 must complete Dementia, Level 1: Dementia Capable Caregiving (or a DSHS approved alternative course) if they did not already complete the dementia specialty training. The 8-hour class may be applied to a caregiver’s basic training hours or to continuing education if exempt from basic training.

Managers

Current managers that have already completed Manager Dementia Specialty Training have met their specialty training requirement. If they choose to take the Dementia, Level 1 training, it may be completed for CE credit.
New managers upon effective date of the WAC must take the Dementia, Level 1 training.
Manager Dementia Specialty Training is discontinued as a curriculum offered by community instructors as of June 30, 2017.
Dementia, Level 1 meets all requirements of the current Manager Dementia Specialty Training for manager training.
In the future a class will be developed on the topic of management and not specific to a population. This course will be optional and will apply toward CE.

Step 4: Key Dates and Class Schedule

Key dates:

February 15, 2017: Classes are available for the Dementia, Level 1 and Adult Education. (Class schedule link below).
June 30, 2017: Due date for all currently approved community instructors to have received training in Dementia, Level 1 and Adult Education.
June 30, 2017: Manager Dementia Specialty Training and the Long-Term Worker Dementia Specialty Training curricula may no longer be offered by community instructors
December 31, 2017: Due date for all currently approved facility instructors to have received training in Dementia, Level 1 and Adult Education.
June 30, 2018: Alternative courses previously approved by DSHS for dementia specialty training cannot be used after this date until approved based on the new learning objectives.

As an initial roll out, we have scheduled a number of Dementia, Level 1 and Adult Education classes across the state with approved instructors. Please use the registration links provided for each class. Class sizes are limited. Early registration is recommended to get your preferred dates.

Note that there is a fee to attend the Dementia, Level 1 classes; however, the Adult Education classes are being offered at no charge for the dates scheduled.