Professional Workforce Key to Implementing Consent Decree in Rhode Island

By Gina Macris

Rhode Island faces a crisis in its inability to recruit and retain a high quality front-line workforce to support people with developmental disabilities. 

The problem - substandard working conditions and low pay in a poorly trained workforce plagued by high turnover - must be resolved if the state is to implement a landmark 2014 consent decree with the U.S. Department of Justice that requires dramatic changes in the way services are configured.  

That was the consensus Feb. 23 during the start of a two-day conference at Rhode Island College, where some 75 employers, researchers, state officials and family members brainstormed about how to jumpstart a new way of doing things – and getting the funding necessary to make it happen. 

Maria Montanaro, director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH)  wondered aloud if her agency could shift funding in the short term to roll out a high-quality pilot program demonstrating the need for better funding of the entire system.                                                               

With perhaps a quarter of the state’s 20 private developmental disability providers participating, she said, the pilot program would offer better salaries and training to motivate staff to show ways that services can be changed to support individual needs rather fit people with developmental disabilities into existing programs.  

That change is a pivotal element in requirements of the Consent Decree that mandate individualized supports in community-based settings.    

Montanaro said a successful pilot program would yield research data that could be leveraged into advocacy for increased funding system-wide during the2017 General Assembly session.  Such a pilot program would not require legislation, she said.  

Montanaro responded to a presentation at Rhode Island College (RIC) by Amy Hewitt, a Minneapolis researcher with a national reputation in identifying effective practices for helping people with intellectual and developmental disabilities live and work in their communities. 

Hewitt, director of the Research and Training Center on Community Living at the Institute of Community Integration at the University of Minnesota, set the tone for discussing advocacy strategies that are based on research statistics gleaned in the implementation of new policies.  

She was hosted by her counterpart in Rhode Island, A. Anthony Antosh, director of RIC’s Sherlock Center on Disabilities, which is charged through the consent decree with showing the way toward greater community integration.  

Montanaro said, “We have to get the advocacy voice mobilized in Rhode Island” so that the message of the disability community gets to the legislature “in a cogent and compelling way.”  

She said she is in a position to speak to Governor Gina Raimondo, but in the executive branch, “they’re responding to the legislative temperament.”  

Governor Raimondo’s latest budget proposal, now before the legislature, asks for some additional funding for developmental disabilities. To a greater degree, however, it would shift residential supports from expensive group home care to less costly shared living arrangements in private homes and use the savings to support employment and other community-based activities.  

The state also could leverage additional Medicaid money in creative ways to provide community-based services, Montanaro said.  

Mary Madden, the state’s new interim Consent Decree Coordinator, noted that expanding the use of Medicaid money still would mean convincing the state to pay for half the new funding.  According to Medicaid rules, the federal government pays for about 50 percent of allowable services, as long as states pick up the other half.  

Hewitt, meanwhile, said legislation and litigation drive public policy, with lawmakers responding only when the the data backs up the argument for change.  

 “The happy stories are not going to get money,” she said. Policy makers don’t make decisions based on the “feel-good stuff. That’s the realist in me talking. They make decisions based on unmet need” that is supported by statistics.  

“We expect the direct service professional to be a little bit of everything,” Hewitt said, referring to the formal title of front-line worker.

The job encompasses the role of teacher, nurse, psychologist, occupational and physical therapist, counselor, nutritionist, chauffeur and personal trainer all at once, she said. 

Yet direct service professionals are paid an average of a little less than $11 an hour in Rhode Island, she said. 

“You have to figure out a way” of changing perceptions so that “these people are not thought of as workers but professionals,” she said.  

The workforce problem in the field of developmental disabilities runs nationwide, Hewitt said.  

“No state has solved this problem, but there are few states further along the path,” she said.  

Hewitt offered a myriad of statistics that link training, supportive supervision, and decent pay to a stable, high-quality workforce that makes a difference in the lives of people with developmental disabilities.  

She is to return Feb. 24 to serve as a resource as the group of about 75 works on specific strategies for stabilizing and improving the system in Rhode Island.  

The conference participants are mostly senior officials of the private agencies that provide services to almost all the 3600 people with developmental disabilities in Rhode Island.  No front-line staff attended.  

Pam Goes, the mother of an adult with developmental disabilities, said families need to be included in policy-making and advocacy statewide.  

“Right now families feel isolated and apart,” said Goes, who is also a former family support director at the Trudeau Center in Warwick.