The State of Ohio s Long-term Direct Care Workforce Project Request for Applications

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The State of Ohio’s

Long-term Direct Care Workforce Project

Request for Applications

Summary: The State of Ohio’s Long-term Direct Care Workforce Executive Committee is

requesting applications from qualified investigators to perform research projects and write briefing papers and comprehensive reports on a variety of subjects covered by the project. Up to $672,000 has been budgeted to fund approximately seven research projects.1

Background: Ohio’s Long-term Direct Care Workforce Project was established to coordinate the efforts of multiple state agencies (Job and Family Services, Aging, Education, Health, Mental Health, Developmental Disabilities, Alcohol and Drug Addiction Services) to develop a unified health and human services strategy to improve the long-term direct service workforce in Ohio. As part of this project, faculty from five universities with expertise in curriculum development and health and human services research will collaborate with stakeholders to develop curriculum for a latticed certification program. This project will identify specific workforce needs across disciplines and service sectors, as well as collaborative solutions to minimize costs and create efficiency. Some examples of workforce needs that may be addressed by the project include recruitment, retention, worker literacy, overlapping skill sets for emerging models of care, and a development of a consumer services database.

Research Topics: Research proposals may address the research priorities listed below. A complete discussion of the various research priorities included in Appendix I of this document. Research proposals that combine multiple datasets are encouraged.

Selection Criteria: The following criteria will be considered when making awards: :

● Qualifications of investigators

● Experience of investigators in the topic area selected for study

● Institutional infrastructure and support (e.g., computing equipment, software, etc.) ● Strength of the proposed research plan and methodology, including:

a) Clear and well articulated objectives

b) Justification of the importance of those objectives

c) Appropriateness of the proposed research design to investigate the topic d) Identification of study and comparison populations

e) Use of data sources

f) Analytical methods, including analysis of complex survey design g) Analysis of statewide and regional trends in area selected for study

● Projected policy implications and recommendations, especially those related to long-term direct care workforce issues

● Suitability of the proposed budget and budget justification ● Overall distribution of funded projects across topics

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March 25, 2011 Release of RFA

March 25-April 20, 2011 Question and answer period

April 20, 2011 Letters of intent indicating the area(s) the researcher intends to address May 15, 2011 Final applications due

June 20, 2011 Research project awards announced July 1, 2011 Research project start date

July 2011- May 2012 Principal Investigators meet monthly with policy review teams April 30, 2012 First draft of research reports due

May 30, 2012 Final research reports due

June 2012 Conference presentation of final reports/Project end date

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Eligible applicants include public and private colleges and universities located in Ohio (Special rules apply for private universities, contact program manager for details). Each proposed project must have a designated Principal Investigator. A person may serve as a Principal Investigator for only one project.

Each application must include a program budget using the form provided on the Long-Term Care Direct Care Workforce website: http://grc.osu.edu/projects/long-termcareworkforceinitiative/index.cfm. Award funding may be used for personnel expenses, software, travel and other direct costs. Funds may not be used for computer hardware. Awards are limited to no more than $50,000 in federal funding and require up to $50,000 in university matching funds. In-kind or cash

contributions comprising 50% of total project expenses is required. The university may use

unrecovered facilities and administrative costs (F&A) to meet this in-kind requirement. The federal award may include indirect funding up to a 10 percent limit. (Please refer to budget example in Appendix I which demonstrates how the university’s in-kind contribution is used to fulfill project funding.)

Each award recipient will be assigned to one or more individuals appointed by the Long Term Direct Care Workforce Executive Committee who will consult with the Principal Investigator during the lifecycle of the project about methods and project progress. The awardees will be required to submit periodic progress reports to the Long Term Direct Care Workforce Executive Committee. Awardees must also submit a policy brief of research (approximately four pages in length) and a comprehensive report that will be published by the Ohio Colleges of Medicine Government

Resource Center and its sponsors. Comprehensive reports are typically about 20 pages in length (not including tables, appendices and bibliography). The comprehensive report should include:

• A discussion of the methodology, summary of results, implications, recommendations and conclusions

• A complete list of tables and statistical results

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The report will be in the public domain and will not be copyrighted. Publishing rights of the report shall be maintained by the Ohio Colleges of Medicine Government Resource Center and its sponsors. Principal Investigators will be responsible for determining report authorship and providing acknowledgments. A standard set of acknowledgements designated by the project will be provided for inclusion in all published reports. Individual Investigators are free to adapt the results of research projects for use in separate scholarly publications.

Award recipients are required to attend the Long Term Direct Care Workforce Presentation Conference in Columbus in June 2012. Awardees will have the unique opportunity to present research findings before an audience of legislators, state agency personnel, researchers and the media. Travel expenses related to this conference shall be included in an applicant’s proposal budget.

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Letter of Intent. All potential applicants must submit a letter of intent that identifies the priority

area(s) that will be addressed in the proposal. This letter is due by April 20, 2011 and may be submitted via emailed to, Dushka Crane-Ross, Project Director, at

[email protected]. There is no required format for this letter.

Final Application. Final applications are due on May 15, 2011. Applications are limited to 12

pages, not including budget, bibliographic references, biosketches, and sample articles. The entire application shall be written using 12 point font (Arial or Helvetica), double-spaced, with 1 inch margins. The application shall include the following sections:

1. Project Proposal (no more than 12 pages) a. Abstract (no more than 500 words) b. Specific Aims (no more than two pages)

c Background and Significance (no more than four pages)

d. Research Design, including treatment of data sources, study and comparison groups, analytical methods, and limitations (no more than eight pages)

e. If applicable, protection of human subjects and confidentiality considerations 2. Itemized budget (use prescribed budget form available on the website)

3. Bibliographic references (no more than one page)

4. A one-page description of the roles and responsibilities of project personnel and biosketches, using the four page NIH format for all key personnel

5. Up to two examples of relevant previously-published articles or reports produced by

members of the research team (inclusion of a policy brief as one of the examples is strongly preferred - no unpublished material will be accepted)

Application materials must be received by 5 PM on May 15, 2011. Only electronic versions of the application in searchable PDF format will be accepted. Applications must be emailed to, Dushka Crane-Ross, Project Director, at [email protected]. Failure to conform to any of the above-specified requirements may result in disqualification of a proposal. Questions regarding the RFA process must be submitted in writing to

[email protected]. Answers to all questions received will be posted on the Long-Term Direct Care Workforce website at http://grc.osu.edu/projects/long-termcareworkiniative/index.htm). Applicants should periodically check the site for updates. Questions received after April 20 will not receive responses.

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Long-Term Direct Care Workforce Budget Worksheet Example

University and Other Contributions

University

Contribution

Budget Item Total Grant

Project Expense

Cash In-Kind University

Total Federal Medicaid Personnel -Faculty $ 30,000 -GA expenses $ 15,000 Total Personnel $ 45,000 Consultant Costs $ 10,000 Software/Supplies $ 5,000 Travel $ 2,000

Other Direct Expenses $ 3,789 Total Direct $ 65,789 $ 20,335 $ 20,335 $ 45,455 INDIRECT COSTS @ 52 % F&A $ 34,211 Indirect at 10% Limit $ 4,545 Indirect Applied as In Kind Match $ 29,665 $ 29,665

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Ohio’s Long-Term Direct Service Workforce Project Research Priorities

March 9, 2011

Direct Service Workforce Capacity. Healthcare reform, combined with efforts to re-orient service delivery systems toward home and community-based settings rather than institutional care, will require more workers in different sectors of the health and human services workforce, including but not limited to direct service workers. Information is needed to inform recruitment efforts and meet future workforce demand. Examples of the types of information needed include:

a. A demographic and socioeconomic depiction of Ohio’s current direct service workforce and a comparison of these factors across settings;

b. A description of the demographic characteristics and needs of individuals currently receiving services in Ohio;

c. Ohio-specific estimates of the number of current direct service workers and the number of direct services workers needed across settings in 10-20 years;

d. A list of states with similar direct service workforce composition to provide a benchmark for future impact studies aimed at assessing policy effectiveness; and

e. A study to assess the feasibility, costs, and benefits of developing a statewide minimum dataset that includes variables such as those identified in the February 2009 CMS and National Direct Service Workforce Center report, The Need for Monitoring the Long-Term Care Direct Service

Workforce Recommendations for Data Collection.

Skill Sets and Competencies of Long-term Direct Service Workers. To meet the demands of long-term direct service in various care settings, and adapt to emerging healthcare delivery models and technologies, direct service workers need a range of basic skills (e.g., computer skills, basic knowledge about the common medical and neuropsychiatric conditions, interpersonal communication skills, familiarity with American culture). Research is needed to assess the extent to which the current workforce possesses these basic skills and knowledge. Potential areas of focus may include:

a. Identifying skill sets and competencies required of direct service workers who may work in a patient-centered medical home (PCMH);

b. Identifying specific skills and competencies needed to work effectively with individuals with behavioral health conditions receiving long-term care (e.g., individuals with Alzheimer’s disease frequently have co-occurring depression);

c. Identifying and evaluating specific evidence-based interventions that would be most effective for individuals with serious mental illness who are receiving long term care. These may include interventions delivered by workforce at various levels of the career lattice; and

d. Assessing the level of correspondence between the cultural and demographic characteristics of the workforce and those of the population served. What is the impact of cultural differences on the quality of service in different service sectors? To what extent can the lattice model contribute to the goal of increasing cultural diversity in some professional sectors?

Organizational Best Practices within the Provider Community. Research is needed to identify organizational best practices that support worker retention and job satisfaction, and to identify what the most successful organizations are doing differently than the rest. In particular, information is needed about the use of effective recruitment, selection and retention practices, including the following:

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a. Preparing a job description, providing a realistic job preview to candidates, and using structured behavioral interviews;

b. Providing effective induction, orientation and socialization strategies with new hires; c. Providing supervisors with training on effective supervision practices;

d. Using competency-based training and criteria-based job performance and advancement criteria; e. Empowering staff to participate in a range of decisions regarding work space and process, and as

a member of a planning team supporting an individual;

f. Adopting models that foster integration of direct care workers as members of the ‘care team;’ g. Allowing consumers to decide which direct support staff will provide personal care for them; h. Providing effective recognition programs;

i. Using strategies such as practice transformation and quality improvement science; j. Developing organizational pathways for workforce development, growth, and reward; k. Providing opportunities to advance beyond an entry level position (i.e., a career ladder); and l. Identifying resources available to foster professional and personal growth.

Training Resources. Information is needed regarding current training requirements and resources in Ohio to educate and sustain a long term direct service workforce. For example,

a. What are the similarities and differences amongst the various sectors and setting types regarding training requirements, including pre-service, in-service, and continuing education policies and requirements?

b. To what extent are qualified trainers available to provide training across all required competencies to direct support staff in various sectors and settings? To supervisors of direct support staff? To administrators and human resources professionals?

c. State agency support. How do the state agencies responsible for paying for and monitoring the quality of direct services support organizations and individuals obtain needed training, resources and other supports to perform effectively?

d. Differential Access to Training. Are there any groups of direct support staff members (e.g., personal care attendants who work in family homes, independent providers, direct support staff employed directly by individuals with disabilities, staff who work in remote parts of the state or who work evening, overnight or weekend hours) who do not have adequate access to training, career development or other opportunities to enhance their skills, expand their capacity to support different populations, or know about and move across the career lattice?

e. Support for Self-Directed/Consumer-Directed Service. Are there training resources available for individuals with disabilities and family members who direct their own services? What resources are available to help these families manage staffing challenges, including recruitment, retention and training?

Trends in Workforce Turnover. The rate of turnover in the long-term direct service workforce is very high, resulting in increased cost to providers and funders and reduced access and quality of care. In order to inform future recruitment and retention efforts, research is needed to:

a. Identify trends in the rate of turnover in different sectors of Ohio’s long-term direct service workforce;

b. Assess the impact of turnover on access, cost, and quality; c. Identify factors associated with turnover; and

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Entry into the Long-term Direct Service Workforce. Recruitment efforts may be informed by research that identifies factors that motivate people to seek direct service employment including:

a. Points of entry into the long-term care workforce; b. Pathways to assuming direct service positions; and

c. Barriers/facilitators to assuming a direct service positions.

Prepare a "Business Case" for Direct Service Workforce Development. An assessment is needed to understand the impact of implementing the proposed health and human services lattice and state

credentialing system on quality and cost of care. This assessment should include an appraisal of the costs of continued high turnover and lack of training, if the proposed changes are not implemented. In

addition, information is needed to identify the administrative and regulatory constraints that may impede building a health and human service workforce lattice.

Reimbursement and Regulatory Constraints. Information is needed about the relationships (including strengths and limitations) between existing reimbursement models and efficient care within public and private sector long-term service and support provider organizations.

Innovative Direct Service Workforce Initiatives. Information is needed about innovative workforce initiatives currently underway in Ohio and other states, including their impact, feasibility, costs and benefits of expanding their use in Ohio. Examples of innovative practices that have shown promise include use of therapy animals, the use of technology such as video monitors and robots, and the Virginia “Grand-Aids” model.

Use of Technology. Given the anticipated shortage of workers, information is needed to explore opportunities for Ohio’s manufacturing industry and post-secondary institutions to develop innovative products and services that will help meet the long-term service and support needs of Ohio’s older population in the next decade.

Participation by People with Disabilities. What structures currently exist across populations and setting types for people with disabilities and their family members to comment on, inform, or direct changes in how the direct support staff they encounter will be recruited, trained, compensated and retained?