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Steps In The Development of Intentional Care Performance Standards
For nine years the staff at Advocates Inc. and their consultant, Patricia E. Deegan Ph.D., worked to develop Intentional Care Performance Standards. We developed a methodology for developing the Standards that is given below.
Beginning
- The consultant and the Advocates Inc. supervisory team develop a list of domains for which Performance Standards would be helpful.
- The consultant develops questions in regard to the domain to be worked on. Questions are distributed to program supervisors.
Staff Discussion
- Supervisors have a meeting with staff to discuss the questions developed by the consultant. The answers given by staff are recorded.
Client Discussion
- When applicable supervisors have a meeting with clients in the programs. Their responses are recorded.
- Client and staff responses are returned to the consultant.
The Supervisors Rating Scale
- The consultant lists all responses from the programs and then adds a space for responses such as "agree", "disagree" or "unsure".
- This list is now a supervisors' rating scale that is distributed to the supervisors' group.
- Each supervisor rates the items on the list.
- These ratings are returned to the consultant who studies the response pattern and writes a report on the findings.
- The report highlights areas where there is strong consensus between individuals on the supervisors' team and areas in need of discussion and clarification.
- The supervisors' team is presented with the report and meets, prepared to discuss it.
Discussions that Lead to a Draft the Performance Standard
- The consultant takes notes during the discussions. The consultant also pushes the supervisors to think through the more difficult parts of the issue. Sometimes the consultant acts as provocateur, pressing the group to (for instance) distinguish between providing incentives for clients and bribery.
- After each meeting it is the consultant's job to organize and write the consensus of the group.
- After the report on the supervisors' rating scale has been reviewed, it usually takes three, 3hour meetings (held once a month) for the group to come up with a first draft of a Performance Standard. Supervisors often comment that these discussions are of great value in clarifying their thoughts about the work they do.
- Further drafts can be done until the group is satisfied with the Performance Standard.
Client Critique of the Performance Standard Draft
- The draft then goes to the consumer/survivor Advisory Board for revision/comment/critique.
- Representatives from the two groups meet to discuss and negotiate changes to the draft Performance Standard.
- Final revisions are made and a Performance Standard is "finished".
Implementation
- The consultant develops a training for supervisors on the Performance Standard. The training is simply an opportunity for supervisors to role-play using the standard during individual staff supervision.
- New supervisors and staff study the Performance Standards as part of their orientation and must pass written competency tests for each standard by the end of the three months of employment.
- The Performance Standards are used regularly during individual and/or group supervision.
- The Performance Standards are used regularly during staff meeting to help guide decision-making in day-to-day work. The role-plays are also used and discussed during these meetings.
- The annual evaluation of staff is based on how well they implement the Performance Standards and special evaluation forms have been developed for this purpose.
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