The utilization step took place on Friday afternoon from 2-5pm.
The following schedule was explained to the participants when
they returned from lunch.
|2-3||Review progress and where we stand||BT|
|Review and Feedback on the map's clusters and regions||BT|
|Discuss the competency documents||JC|
|Present the two small group tasks and have participants select their group/task||JC|
|3-4||Small group sessions|
|4-4:50||Presentation of results of small groups|
|Summary of map revisions||BT|
|Summary of operationalizing of the five clusters||Group Leaders|
|4:50-5||Discussion of next steps and wrap-up||Anita Pernell-Arnold|
The first part of the utilization discussion involved suggestions
from participants regarding changes that could be made to the
final map in order to make it more interpretable, cohesive and
usable. The discussion which took place raised the following points.
Reactions to the Five Regions
1 Doesn't matter which five labels we use.
2 Change the name "Techniques."
3 What is the meaning of "consumer" (consumer involvement issues).
4 "Practitioner" is very broad.
5 Change titles by adding "competencies" to the labels.
6 Some consumer competencies are knowledge-based, others are techniques, others are system issues.
7 View (regions) as "key ingredients."
Reactions to Clusters
1 People did some categories according to the specific words in titles (e.g., "ability to...", or "knowledge of..."). Was this wise?
2 Family relationships is lacking key intervention skills--want to add more?
3 Reconsider the two consumer clusters -- are labels OK?
4 Take another look at Friday and McPheeters broad classification -- better than ours? (Some said they lose the values; do they exclude the consumers?).
5 Rename cluster 9 (Assessment) or think of dividing it up.
6 Revisit the cluster name "Personality Characteristics."
7 Consider combining "Interpersonal Social Skills" and
The group then discussed the four competency statement documents
(Curtis, 1993; Friday and McPheeters, 1985; Jonikas, 1993; IAPSRS
Ontario Chapter, 1992) that they skimmed over lunch and compared
these to the map. The following comments were made:
1. Current group has defined a set of competencies that is impressive. Need to be clear that we shouldn't come up with competencies that are unrealistic, over-skilled, characterize a broad range of competencies.
2. Curtis (1993) was not intended to specify competencies limited to PSR.
3. Curtis (1993) is good in its specificity.
4. Jonikas (1993) document has a totality that will be useful in deciding what to put where.
5. Eighty percent of all documents (including the concept map) were similar.
6. Friday and McPheeters (1985) shows earlier development of the field.
7. There is more in the literature of competencies than we thought.
8. Competencies related to knowledge of principles may not capture the centrality of safety, spirituality, work, decent place to live, social life, education, and physical health in PSR. Don't want to lose the essentials. Also want to emphasize high quality outcomes in these areas.
9. IAPSRS Ontario Chapter (1992) is impressive in its succinctness and specificity. Could help guide us in our document. Action verbs were good in this document.
10.Curtis (1993) document emphasizes the importance of creation
of environments, social situations. Not just changing the individual,
but creating contexts. Good use of respect as a concept/process.
In the middle of the afternoon utilization step, the participants
were divided into small groups in order to accomplish some more
detailed work. Five groups of 2-3 participants each took one of
the first five clusters and attempted to operationalize the statements
in the cluster into ones that better approximated competency statements.
One small group of six participants discussed and made slight
revisions to the final concept map. The results of these two types
of small group exercises are described in separate sections below.
Based on the interpretation discussion in the morning session,
it was clear that the participants thought that many of the statements
in the first five clusters were better described as "values"
than as operationalized competency statements. The group thought
that these value statements could be operationalized and that
this would be a central task for IAPSRS to accomplish as it developed
competencies. The central utilization task of the afternoon therefore
was to have small groups of participants, each assigned one of
the first five clusters, take the statements in the clusters and
develop draft operational competency statements. The summaries
of these discussions (taken from the newsprint sheets used at
the presentation of the results) are reproduced below.
Cluster 1: Interpersonal Skills
This group took each statement in the cluster and generated several
more operationalized statements. Where appropriate, they chose
statements from several of the other competency documents and
these are cited. This listing shows each brainstormed statement
in Cluster 1 and the draft competency statements that the small
1. ability to listen to consumers
ï not interrupt the consumer
ï able to repeat back what was said with the consumer affirming the correctness
ï not imposing your agenda on them
10. ability to motivate clients to change behavior
ï to be able to identify reasons for changing the behavior
ï to be able to help them identify consequences
ï willingness to serve as role model for desired change
ï willingness to reinforce behavior that has been changed
36. ability to use the helping relationship to facilitate change
ï use one's own experiences to encourage and guide the consumer
ï ability to demonstrate approval and pride in their accomplishments
87. ability to interact and provide support in a non-judgmental fashion
ï do not demean or patronize consumers
ï give feedback on behavior and not the person (Friday and McPheeters, 1985)
ï use language and behavior which reflects and perpetuates
the dignity of the individual (Curtis, 1993)
5. ability to offer hope to others
ï truly believe that there is hope and verbalize it to the consumer
ï share examples of change that was possible in a seemingly hopeless situation
ï have a healthy sense of humor and minimize the adversity (Friday and McPheeters, 1985)
ï focus on consumer successes and help consumer see their
own personal growth
6. belief in the recovery process
ï the worker has to demonstrate that he/she believes in the recovery process
ï to express the belief to the consumers that it's possible for them to live productive satisfying lives in the community (Jonikas, 1993)
ï help the consumer believe in his/her inherent capacity
to improve or grow, given the opportunity and resources, as it's
true for all persons (adapted from Jonikas, 1993)
39. ability to build on successes and minimize failures
ï point out and celebrate their successes
ï help them to see their failure as a learning experience
ï supporting risk-taking behaviors to move one step beyond
ï ability to have the consumer feel good and acknowledge
own success no matter how small (adapted from Friday and McPheeters,
31. connecting (interpersonal) skills
ï demonstrate behaviors that accept the consumer where he/she is at
ï ability to establish a caring but not a consuming or possessive relationship
ï demonstrate behaviors that show interest in the consumer
and his/her interpretation of needs
78. ability to work with consumer colleagues
ï to show sensitivity to the difficulties that they may encounter in their dual role
ï avoid labeling persons (either consumers or consumer colleagues) with stereotypes or derogatory terms (Friday and McPheeters, 1985)
ï be straight with consumer colleagues
ï have the same expectations as you do for all other colleagues
89. ability to normalize interactions and program practices
ï ability to generalize program experiences to activities in the broader community
ï have expectations within the program that are consistent with community expectations (with leeway in terms of enforcement)
ï set reasonable limits on bizarre behavior with explanations
as to why you are doing it
Cluster 2: Supportive Behaviors
This group generated the following draft competency statements
to cover the material listed in Cluster 2.
ï ability to maintain ongoing productive relationship based on client satisfaction
ï demonstrate high level of interaction (i.e., amount of time, interests, excitement, energy level)
ï communicates belief in growth potential
ï communicates understanding of thoughts/feelings of others in a non-judgmental manner
ï demonstrates holistic understanding of the individual
ï able to focus on the consumer's here and now needs/desires (there was some disagreement on the wording of this one)
ï ability to respond in a normalizing manner to the individual's
diverse needs and strengths
The following were suggestions from the group about what statements
might be "borrowed" from existing lists:
from Curtis (1993):
4. Demonstrates basic communication and support skills
A1. Exhibits supportive interpersonal skills (i.e., ...)
A2.Establishes and maintains productive relationships with service recipients
ï All of 4A--some areas to "negotiate"
1. especially A and B (language, behavior and holistic understanding)
from Friday and McPheeters (1985):
ï III. Interpersonal - especially 2, 4, 6, 7, 8
Their group also listed some ways to measure competencies
in this area:
ï amount of time spent with client
ï client satisfaction with the relationship (amount of support perceived)
ï peer feedback/input
ï share and use own life experience
ï reciprocity of relationship
Cluster 3: Professional Role
For each statement in Cluster 3, the group generated one or two
potential competency statements.
14. ability to negotiate
ï to demonstrate communication skills between stakeholders
for the purpose of goal attainment which is satisfactory to all
58. ability to set limits
ï to identify personal skills and resources, and expectations
held by stakeholders in order to achieve realistic/attainable
17. willingness to have fun
ï to actively participate in "activities"
82. ability to use self as a role model
ï to mutually share experiences and ideas
ï to achieve goals through partnership
47. ability to ask for help and receive constructive feedback
from colleagues and consumers
51. ability to let go
ï to assist consumers to identify their skills/resources
and promote a belief in efficacy of their skills in order for
consumers to take charge
88. ability to overcome personal prejudices when providing services
ï to identify personal values/beliefs and evaluate their
potential impact on all interactions
Cluster 4: Personality Characteristics
For each statement in Cluster 4, the group generated one or two
potential competency statements.
16. self awareness
ï be able to describe and explain one's own actions
56. good personal stability but not ego-centric
ï respond consistently and congruently to social and environmental
50. ability to handle personal stress
ï separate personal needs and behaviors from job performance
needs and behaviors
ï be able to change behaviors when situations, expectations
and requirements are different
ï to calmly wait until the objective is reached
28. sense of humor
ï to laugh at what is funny, to laugh at oneself, and to
laugh with others
93. ability to know own limits
ï to be able to stop when necessary; to be able to ask for
help; to be able to ask for information
Cluster 5: Self Management
24. ability to read and write
1. person must meet high school equivalency level of reading and writing
2. must include accommodations for disabilities like blindness
3. ability to write in behavioral language
4. ability to write with clarity
5. reading comprehension skills must include ability to look up
words in the dictionary, comprehend language(s) used in service
29. ability to partialize tasks
41. ability to handle multiple tasks
69. ability to prioritize and manage time
ï recognition of total number of tasks inherent in responsibilities
ï identify critical tasks by applying an agreed-upon standard for what is most important
ï ability to gauge the level of effort and amount of time necessary to complete discrete tasks
ï ability to use organizational tools (calendars, to-do lists, tickler file) to keep track of tasks
ï ability to engage consumers in assisting with provider's task and time management
ï ability to recognize and deal effectively with personal
stress resulting from multiple tasks
33. tolerance for ambiguity and enjoying diversity
1. Ability to problem-solve ambiguous situations through involvement of others in identification of problem, generation of a number of potential solutions, evaluating candidate solutions, seeking staff/consumer/family/network feedback re: viability of solutions, selection of solutions, implementation and evaluation of solutions.
2. Ability to recognize and accept unresolvable ambiguities through letting-go, acceptance, humor and other strategies.
3. Ability to distinguish between truly ambiguous situations and
situations based on lack of: info, training, feedback from others.
Also, ability to address lacking areas by obtaining info, furthering
education/training, seeking feedback.
1. Ability to identify the opportunities presented by diversity
and to incorporate them positively into the rehabilitation process
through providing alternatives for behavior, problem solution,
identification of opportunities.
91. willingness to take risks
1. demonstration of creative approaches
2. allowing/assisting consumers to exercise options not endorsed by practitioner, after applying standards of reasonable judgment (safety, etc.)
3. demonstration of willingness to try new or untested approaches
45. ability to be pragmatic and do hands-on sorts of work
1. Recognition that PSR rehabilitation involves the doing of hands-on tasks for role modeling, relationship building, etc.
2. Willingness to accept and perform well on hands-on, practical tasks.
3. Ability to develop and implement rehabilitation situations
in which behavior or doing leads to insight rather than vice versa.
94. never-ending willingness to develop oneself
1. NOTE: The group suggested that this item be moved to the Professional Development cluster. This suggestion was adopted.
2. Development of one's personal growth through hobbies, therapy, education, and to share that growth with consumers/peers for role modeling and motivation.
3. Willingness to seek help appropriately with one's own problems.
The small group that considered the revisions to the map began
by working with the suggestions generated earlier by the entire
participant group. The following shows these suggestions along
with the actions taken, if any, by the small group:
|Reactions to the Five Regions|
|1. Doesn't matter which five labels we use.||Two changes were made to the original five labels. The label "Techniques" was changed to "Rehabilitation Methodology Competencies" and the original label "Consumer" was changed to "Consumer-Centered Competencies". In addition, all five labels had the term "Competencies" appended to the end.|
|2. Change the name "Techniques."||The label "Techniques" was changed to "Rehabilitation Methodology Competencies".|
|3. What is the meaning of "consumer" (consumer involvement issues).||The original label "Consumer" was changed to "Consumer-Centered Competencies".|
|4. "Practitioner" is very broad.||The group decided that the term "Practitioner" would be left as is because it was an appropriately broad label for a region name.|
|5. Change titles by adding "competencies" to the labels.||This was done for all region and cluster labels.|
|6. Some consumer competencies are knowledge-based, others are techniques, others are system issues.||The small group agreed but made no changes to the map in response to this.|
|7. View (regions) as "key ingredients."||The small group agreed but made no changes to the map in response to this.|
|Reactions to Clusters|
|1. People did some categories according to the specific words in titles (e.g., "ability to...", or "knowledge of..."). Was this wise?||The small group agreed but made no changes to the map in response to this.|
|2. Family relationships is lacking key intervention skills--want to add more?||The cluster label "Family Relationships" was changed to "Family-Focused." No intervention items were added.|
|3. Reconsider the two consumer clusters -- are labels OK?||Changed the original cluster label "Consumer Goal Attainment" to "Consumer Outcome Competencies."|
|4. Take another look at Friday and McPheeters broad classification -- better than ours? (Some said they lose the values; do they exclude the consumers?).||The small group felt that there was considerable cross-classifiability across the different competency documents and the map. No changes were made to the map in response to this.|
|5. Rename cluster 9 (Assessment) or think of dividing it up.||The group retained the name for the cluster, only changing it to "Assessment Competencies." See table below for specific statements moved into and out of this cluster.|
|6. Revisit the cluster name "Personality Characteristics."||The group changed the original cluster label "Personality Characteristics" to "Intrapersonal Competencies."|
|7. Consider combining "Interpersonal Social Skills" and "Supportive Behaviors."||These clusters (original clusters 1 and 2) were combined into one cluster labeled "Interpersonal Competencies."|
|The original cluster label "Cultural Competence" was changed to "Multicultural Competencies."|
|The positions of the original clusters "Family Relationships" and "Mental Health Knowledge Base" were switched on the map.|
In addition to the above changes, several specific statements
were shifted from one cluster to another. These changes are shown
in Figure 6 and listed in the table below:
|43. knowledge of a wide variety of approaches to mental health services||Family Relationships||Mental Health Knowledge Base Competencies|
|40. ability to establish alliances with providers, professionals, families, consumers (partnership model)||Family Relationships||Community Resources Competencies|
|12. skills in advocacy||Assessment||Community Resources Competencies|
|15. strong crisis intervention skills||Assessment||Intervention Skills Competencies|
|85. early identification and intervention skills to deal with relapse||Assessment||Intervention Skills Competencies|
|94. never-ending willingness to develop oneself||Personality Characteristics||Professional Development Competencies|
|53. ability to assess behavior in specific environments||Intervention Skills||Assessment Competencies|
|55. functional assessment||Intervention Skills||Assessment Competencies|
|64. ability to assess active addiction and co-dependency||Intervention Skills||Assessment Competencies|
In all of the nine statement shifts described above, the shift
was from one cluster into an adjacent one on the map. The revised
cluster listing showing the new cluster labels and the average
importance ratings is given in Table 5.
The small group also drew explicit lines dividing the five regions.
These are shown in Figure 7. They felt that several of the clusters
actually overlapped multiple regions and, consequently, the region
lines cut through a cluster shape rather than only going between
clusters. For instance, The felt that the cluster "Interpersonal
Competencies" should fall simultaneously and partially into
the three regions of "Consumer-Centered Competencies",
"Practitioner Competencies" and Rehabilitation Methodology
Competencies." Similarly, they felt that the cluster "Professional
Development Competencies" should fall into both the "practitioner
Competencies" and "Knowledge Base Competencies"
regions. The regional lines were drawn on the final map to show
these multi-regional clusters.
Figure 8 constitutes the final map for this project. It shows the clusters and regions and includes the average importance ratings for each cluster. There was considerable consensus across the participant group that it was a good and fair representation of their ideas regarding competencies for psychosocial rehabilitation workers.
The final discussion of the project involved consideration of
the next steps in the competency development process. The following
points were made:
1. Print up list of competencies and survey PSR workers.
2. Review and comment on Trochim concept mapping report.
3. Circulate regions, clusters and individual competencies to various constituencies: consumers, families, PSR workers, other stakeholders.
4. Further operationalize remaining competencies.
5. Distinguish between entry-level and second-level competencies.
6. Edit and make language consistent on materials sent out for review.
7. Clarify the intent of the present process re: the use to which the final product will be put.
8. Inform a wide range of stakeholders of IAPSRS's intentions in this area.
9. Bring in an expert in credentialing to clarify legal risks, probable results, etc.
10. Involve Training and Certification Committee in this process.
11. Don't send document for review prematurely. Use simple format that helps potential reviewers. Perhaps include a glossary to aid potential reviewers.
12. Be aware of other lists of competencies so review process doesn't become confused.
13. Include feedback from IAPSRS chapter presidents.
14. Certification conference.
15. Further literature review.
16. Hire someone to draft standards from competencies.
17. Develop an ethics statement based on already-held ethics forum.
18. Requirements of an "arms length" certification organization.
19. Need to consider the voluntary nature of CARF accreditation for organizations parallel to possible implementation of standards for practitioners.
20. Conduct a cost/benefit analysis of certification.