Reducing Worker Turnover in IDD Services By Using Competency-Based Training: Results of a Group Randomized Controlled Study

Background: For years, the direct support workforce supporting adults with intellectual and developmental disabilities (IDD) has been marked by low compensation and high turnover (ANCOR, 2010; Larson et al., 2005; PHI, 2013). With expected demand for direct support workers expected to far outpace supply of people to fill positions in the next decade (Scan Foundation, 2012; Ward et al., 2009), there is increased need to understand methods for strengthening and stabilizing this segment of the health and human service workforce. This study offers one of the initial investigations about the effects of workforce training on direct support turnover in IDD services.

Methods: This was a group randomized controlled study, which included 16 multisite organizations providing residential or day services to adults with IDD. Sites from each organization were randomly assigned into an intervention or into a control group, which received the organization’s typical training. In addition to training as usual, direct support professionals (DSPs) in the intervention condition received a year-long intervention, which included standardized competency-based online training (3-5 hours/month), on-the-job mentorship, and facilitated discussions to apply online content to real work experiences.

At baseline and at completion of the intervention period, a battery of surveys were completed at both treatment sites and the control sites. These instruments gained information about site level workforce indicators, DSPs’ perceptions of their work, supervisors’ assessments of the competency of individual DSPs, and outcomes for people with IDD.

Results:  The results to be presented focus specifically on the site-level outcomes of this training intervention, with particular attention on turnover. Descriptively, 147 sites participated in this study, representing 1220 DSPs.  Mean site wages across all sites was $11.26 per hour (sd=1.38), with day services (M=12.50, sd=1.47) offering significantly higher mean DSP wages than residential services (M=11.06, sd=1.27; t(109)=4.01, p<.001). Across all sites, the annual turnover rate for DSPs was 25.76% (sd=19.88).

To further investigate the issues of DSP turnover, the investigators examined differences in turnover rate (from baseline to post-intervention) among treatment and control sites. ANCOVA results suggest there was a significant decline in turnover in the intervention sites, when setting (residential or day services), average level of ID in the site, average site wage, and average DSP educational attainment were all controlled (F(1, 146)=4.164, p<.05). Marginal means showed a 13.51% decrease in turnover in the intervention sites, while control sites saw a 2.85% increase year-over-year. This model explains 21% of variation in turnover rate differences.

Implications: The results of this study suggest that an intensive training intervention can have an effect of reducing turnover among DSPs working in community services for adults with IDD.  This is among the first pieces of empirical evidence to demonstrate the importance of training in promoting workforce stability in IDD services, and is therefore highly impactful.  Since turnover is costly both financially and in consumer outcomes, these results suggest that increasing training opportunities for DSPs may pay multiple dividends for service managers, and for policy makers who are considering ways to improve IDD service delivery with only modest investment.