Utilization

The utilization step took place on Friday afternoon from 2-5pm. The following schedule was explained to the participants when they returned from lunch.

TimeActivity Facilitator
2-3Review 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
3-4Small group sessions
4-4:50Presentation of results of small groups
Summary of map revisions BT
Summary of operationalizing of the five clusters Group Leaders
4:50-5Discussion of next steps and wrap-up Anita Pernell-Arnold

Review and Feedback on the Map's Clusters and Regions

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 "Supportive Behaviors."

Discussion of Other Competency Documents

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.

Small Group Sessions

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.

Small Group Operationalizations of Five Clusters

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 group generated.

1. ability to listen to consumers

not interrupt the consumer

able to repeat back what was said with the consumer affirming the correctness

not imposing your agenda on them

10. ability to motivate clients to change behavior

to be able to identify reasons for changing the behavior

to be able to help them identify consequences

willingness to serve as role model for desired change

willingness to reinforce behavior that has been changed

36. ability to use the helping relationship to facilitate change

use one's own experiences to encourage and guide the consumer

ability to demonstrate approval and pride in their accomplishments

87. ability to interact and provide support in a non-judgmental fashion

do not demean or patronize consumers

give feedback on behavior and not the person (Friday and McPheeters, 1985)

use language and behavior which reflects and perpetuates the dignity of the individual (Curtis, 1993)

5. ability to offer hope to others

truly believe that there is hope and verbalize it to the consumer

share examples of change that was possible in a seemingly hopeless situation

have a healthy sense of humor and minimize the adversity (Friday and McPheeters, 1985)

focus on consumer successes and help consumer see their own personal growth

6. belief in the recovery process

the worker has to demonstrate that he/she believes in the recovery process

to express the belief to the consumers that it's possible for them to live productive satisfying lives in the community (Jonikas, 1993)

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

point out and celebrate their successes

help them to see their failure as a learning experience

supporting risk-taking behaviors to move one step beyond

ability to have the consumer feel good and acknowledge own success no matter how small (adapted from Friday and McPheeters, 1985)

31. connecting (interpersonal) skills

demonstrate behaviors that accept the consumer where he/she is at

ability to establish a caring but not a consuming or possessive relationship

demonstrate behaviors that show interest in the consumer and his/her interpretation of needs

78. ability to work with consumer colleagues

to show sensitivity to the difficulties that they may encounter in their dual role

avoid labeling persons (either consumers or consumer colleagues) with stereotypes or derogatory terms (Friday and McPheeters, 1985)

be straight with consumer colleagues

have the same expectations as you do for all other colleagues

89. ability to normalize interactions and program practices

ability to generalize program experiences to activities in the broader community

have expectations within the program that are consistent with community expectations (with leeway in terms of enforcement)

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.

ability to maintain ongoing productive relationship based on client satisfaction

demonstrate high level of interaction (i.e., amount of time, interests, excitement, energy level)

communicates belief in growth potential

communicates understanding of thoughts/feelings of others in a non-judgmental manner

demonstrates holistic understanding of the individual

able to focus on the consumer's here and now needs/desires (there was some disagreement on the wording of this one)

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

All of 4A--some areas to "negotiate"

1. especially A and B (language, behavior and holistic understanding)

from Friday and McPheeters (1985):

III. Interpersonal - especially 2, 4, 6, 7, 8

Their group also listed some ways to measure competencies in this area:

amount of time spent with client

client satisfaction with the relationship (amount of support perceived)

peer feedback/input

share and use own life experience

reciprocity of relationship

genuineness

Cluster 3: Professional Role

For each statement in Cluster 3, the group generated one or two potential competency statements.

14. ability to negotiate

to demonstrate communication skills between stakeholders for the purpose of goal attainment which is satisfactory to all parties

58. ability to set limits

to identify personal skills and resources, and expectations held by stakeholders in order to achieve realistic/attainable goals

17. willingness to have fun

to actively participate in "activities"

82. ability to use self as a role model

to mutually share experiences and ideas

to achieve goals through partnership

47. ability to ask for help and receive constructive feedback from colleagues and consumers

51. ability to let go

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

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

be able to describe and explain one's own actions

56. good personal stability but not ego-centric

respond consistently and congruently to social and environmental demands

50. ability to handle personal stress

separate personal needs and behaviors from job performance needs and behaviors

18. flexibility

be able to change behaviors when situations, expectations and requirements are different

25. patience

to calmly wait until the objective is reached

28. sense of humor

to laugh at what is funny, to laugh at oneself, and to laugh with others

93. ability to know own limits

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 settings

29. ability to partialize tasks

41. ability to handle multiple tasks

69. ability to prioritize and manage time

recognition of total number of tasks inherent in responsibilities

identify critical tasks by applying an agreed-upon standard for what is most important

ability to gauge the level of effort and amount of time necessary to complete discrete tasks

ability to use organizational tools (calendars, to-do lists, tickler file) to keep track of tasks

ability to engage consumers in assisting with provider's task and time management

ability to recognize and deal effectively with personal stress resulting from multiple tasks

33. tolerance for ambiguity and enjoying diversity

Tolerating Ambiguity

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.

Enjoying Diversity

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 and interventions

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.

Small Group Map Revision

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:

Large Group Suggestions
Small Group Actions
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:

Statement
Original Cluster Location
Cluster Moved To
43. knowledge of a wide variety of approaches to mental health services Family RelationshipsMental Health Knowledge Base Competencies
40. ability to establish alliances with providers, professionals, families, consumers (partnership model) Family RelationshipsCommunity Resources Competencies
12. skills in advocacyAssessment Community Resources Competencies
15. strong crisis intervention skillsAssessment Intervention Skills Competencies
85. early identification and intervention skills to deal with relapse AssessmentIntervention Skills Competencies
94. never-ending willingness to develop oneself Personality CharacteristicsProfessional Development Competencies
53. ability to assess behavior in specific environments Intervention SkillsAssessment Competencies
55. functional assessmentIntervention Skills Assessment Competencies
64. ability to assess active addiction and co-dependency Intervention SkillsAssessment 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.

Next Steps

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.


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Copyright 1996, William M.K. Trochim