Dr. Charmayne Dubé Dr. Beverley Temple Best Practices for Training Direct Support Professionals who work with Adult with Intellectual or Developmental Disabilities: A Rapid Scoping Review Dr. Charmayne Dubé Dr. Beverley Temple

Acknowledgment Amanda Humphries and Nichole Nayak, Research Interns, for their work on this project Diane Cepanec, Senior Research Manager, who provided methodological guidance and supervision to the research interns Manitoba Center for Nursing and Health Research, Summer Research Internship Program

Background Direct care staff represents the largest proportion of the workforce providing support for adults with Intellectual/developmental disabilities (ID/DD). While direct care staff tend to spend more time than any other providers in direct contact with adults with ID/DD, they tend to have the least amount of education and training. Abilities Manitoba is interested in the exploring the possibility of establishing of a mandated training program (best practices and competencies) for direct support professionals. A rapid scoping review was conducted to help guide decision-making for this potential initiative.

Objective Review questions The Objectives of this review was to map the existing published literature related to best practices for training direct care staff who work with adults with ID/DD. Review questions What kinds of training for direct care staff working with adults with IDD have been implemented and evaluated? Is the training provided part of orientation/basic/mandated training or is the training provided part of professional development/ongoing continuing education?

Methodology A rapid review format was used rather than a full systematic review. The main difference between the rapid scoping review and full review is that rapid reviews provide a streamlined approach to synthesizing evidence. Rapid reviews are increasingly undertaken in health to meet the demands of decision-makers and clinicians who ultimately need timely evidence to inform decisions. For this rapid scoping review, the team had a twelve-week timeframe to complete the review.

INCLUSION CRITERIA Type of Population Concept Context Adults with an intellectual or developmental disability. Concept Best practices for training direct care staff, as well as the types of training that have been implemented, evaluated, and reported in the published literature. Context Training/education provided to direct care staff working in institutional or community settings (i.e. in group homes).

THREE MAIN CONCEPTS WERE USED IN THE SEARCH : SEARCH STRATEGY Comprehensive literature searches were conducted in Medline, PsycINFO, Scopus, and ERIC from January 1st, 2005 to June 30th, 2016. THREE MAIN CONCEPTS WERE USED IN THE SEARCH : Intellectual Disabilities/Developmental Disabilities Direct Care Staff Education/Training

DATA SCREENING Two reviewers reviewed the 1905 potentially relevant papers according to the inclusion criteria by title and abstract screening. A total of 105 potentially relevant primary studies were retrieved for full text review and assessed for relevancy according to the inclusion criteria. Following assessment of the full text paper, 99 papers were included and 6 were excluded based on the inclusion criteria.

Prisma 2009 Flow Diagram Identification Eligibility Screening Included Records identified through database searching (n = 2306) Records after duplicates removed (n = 1905) Eligibility Records screened (n = 1905) Records excluded (n = 1800) Screening Full-text articles assessed for eligibility (n = 105) Full-text articles excluded, with reasons (n =6 ) Studies included in scoping review (n =99 ) Included

DATA EXTRACTION The data was extracted from the 99 articles from the comprehensive search using a data extraction tool that included information on the study purpose aim and type of training/education.

FINDINGS Of the 99 papers that were included in this review, 2 papers identified training that was provided as part of orientation or basic training. The remaining 97 papers focused on innovative training approaches or specific topics that were delivered as part of continuing or professional development for direct care staff.

THEMATIC ANALYSIS Behaviour Management: (e.g.: ABA, SIB reduction, CBT, behavior analysis, staff attribution, cognitive therapy, person focused training) and Physical Health Supports: (e.g.: oral health, medication management, nutrition, vison, dementia, sleep, pain, epilepsy, palliative care). The vast majority of professional development sessions targeted Staff Directed Self Care: (e.g.: mindfulness, emotional intelligence, stress management, resiliency, enhancing ESL skills) and Specific Competency and Value Based Sessions: (e.g.: relationship building, social interactions, value ‘act’ training, Active Support, enhancing communication, clinical reasoning). Other common topics included: Skill Building Strategies for People with IDD: (e.g.: communication, sexual abuse awareness, anger management, literacy, social inclusion) and Modes of Staff Training: (e.g.: train the trainer/ pyramidal, direct/onsite, online). Less frequent published training sessions focused on:

OTHER FINDINGS None of the papers in the comprehensive search discussed mandated training; however, one article found as part of the additional confirmation and sensitivity search did discuss the development of a mandated training program and core competencies for direct care workers that included workers in the field of ID/DD as well as workers the fields of mental health and addictions. In our screening of title/abstracts we did find two review papers that addressed training direct care staff. One review focused on mindfulness and the second review examined aspects determining effectiveness of training. As part of the initial screening, we also found 14 primary studies that examined direct care staff perceptions of training/education, training and support needs.

CONCLUSION Based on the results of this review, there appears to be very limited research evidence related to “best practices” for training direct care providers working with adults with ID/DD. The research evidence that does exist focuses on innovative training strategies or specific training topics that have been evaluated.

SUGGESTIONS/RECOMMENDATIONS FOR NEXT STEPS Conduct a grey literature search to see if evidence on best practices exists but is not part of the published research literature. Conduct an environmental scan locally, nationally, internationally to identify best practices for training being used in organizations. Consider using a consultative approach (such as a Delphi Method see Appendix G) that could include following up with organizations that employee Direct Support Professionals to identify and reach consensus on core competencies required for direct support staff.