Professionalizing Youthcare Work in Residential Treatment
One State Association’s Efforts to Effect Change
For years the Rhode Island Council of Resource Providers for Children, Youth, and Families (RICORP), a state association comprised of children’s residential programs, has been engaged in efforts to professionalize youthcare work in residential treatment. As is the case in other states, administrators of programs in Rhode Island have long believed that staff members in children’s facilities, due to their daily contact with children and youth, have the greatest opportunity to impart change in a youth’s lives. Since 1998 RICORP has planned, organized, and sustained numerous initiatives to professionalize the work. And, as has been the case in other states, the Association has found that the task is monumental.
First Steps: Parameters of the Direct Care Position
Since the words profession, professionalism, etc. hold different meanings to individuals, one of the first things to be established was how the Association was going to define the term. The one definition that seemed to apply to RICORP’s efforts was labeling profession as “a vocation that requires specialized knowledge.” This was backed by Greenwood (1957) who discerned a profession as requiring “a systematic body of knowledge, possessing a culture of values and norms, and adhering to a code of ethics.” The membership of RICORP, which had previously endorsed the ACYCP’s Ethics of Child and Youth Care Professionals (1995) felt these statements captured the definition.
The second issue the Association had to resolve (as it just kept coming up) was whether the profession was really suffering because of low pay, a lack of esteem for the position or anything else. RICORP tried to answer the following questions: 1) Would increased pay and benefits attract better workers?; 2) Would incentives (i.e., education) help agencies retain direct care workers?; 3) Were there other intangibles causing high staff turnover rates and lack of applicants for open positions, and what were they?
To investigate the second issue (education), beginning in 1999 RICORP began the task of compiling data detailing youthcare work in Rhode Island programs. To collect the information, surveys were developed to ascertain the number of direct care workers in each agency, their salary and benefits, their employment status (full or part time), and their educational level. The Association felt that this information would provide a starting point in developing initiatives for the profession.
The following table not only reflects the results of the 1999 survey, but also those from 2001 and 2003:
RICORP Direct Care Staff Salary and Benefits Survey
Avg. Starting Salary(full-time) /
Benefits
/Education
/Turnover Rate *
/Agencies
Responding1999 / 17,721 / Varied: Many agencies offered minimal health benefits. / 74% held or were pursuing associates or bachelors degrees. / 38% / 76%
2001 / 20,033 / Varied: Most agencies offered health/ pension plans. / 72% held or were pursuing associates or bachelors degrees. / 31% / 69%
2003 / 20,247 / All but one agency offered health/ pension plans. / 79% held or were pursuing associates or bachelors degrees. / 37% / 68%
* Only full-time direct care workers included. When adding part-time, case managers and
supervisors the turnover rate was 46% in 1999, 39% in 2001, and 45% in 2003.
Second Step: Advocating for Legislative Increases
Though the rate of responding agencies was just above two-thirds, it was obvious, especially in the 1999 survey, that the salary for direct care workers was low. To make matters worse, the benefits offered to these workers were minimal at best. This was understandable as prior to 1999 Rhode Island state-contracted residential providers had been level-funded for 7 of 9 years. Armed with the data from the first survey RICORP approached the 2000 legislative session in the hopes of securing multi-year increases.
During the 2000 legislative session, the Association was a fixture at the State House. RICORP’s leadership had numerous meetings with the House of Representative’s Finance Committee. This time was well spent as committee members understood that low pay and high staff turnover lead to instability of programs and likely related harm to kids. For the first time in years, a bill calling for increases for children’s residential program funding was not tabled or killed in committee.
The original legislation drafted by RICORP’s Director called for 8% provider agency budget increases over the next three years. However, the legislature made the following amendments to the bill: 1) 5% increases over two years, 2) the funds had to be utilized for direct care positions, 3) “purchase of service” providers (those agencies which did not contract for a given number of beds with the State, but rather accepted placements on a child-by-child basis) were excluded, the rationale being that these agencies develop their own rates and that these agencies had received regular increases. This final version of the bill was approved in the House of Representatives by a vote of 87-0 and 45-0 in the Senate. (The governor had opposed the legislation but took no action when it was added into the State’s budget.)
Thus, state-contracted providers received 5% budget increases in 2001 and 2002. This meant that if an agency’s budget was $1 million, they received a $50,000 increase in 2001 and a $52,500 increase in 2002, for a total of $102,500 over the two years. In addition, the legislature gave these agencies an additional COLA (cost of living adjustment) in 2002, or an estimated $10,000 – $35,000 in additional funding. In 2003 providers received a 2.7% increase. What all of this amounted to was that if an agency entered 2001 with a $1 million budget, by the end of 2003 that agency’s total operating budget was in the vicinity of $1.2 million.
By mandate these increases had to be utilized to advance the direct care positions. This included increased salary, health benefits, and enhanced training. The survey results demonstrate that agencies followed the guidelines of the legislature as salaries went up and health insurance and employee retirement plans became commonplace in RICORP-member agencies. However, the 2001 and 2003 surveys both revealed that scarcely 2/3rds of direct care workers held degrees or were matriculating.
Third Step: Providing Training Programs and College Education
While three years of increases has helped raise the starting salaries of direct care workers and has provided them with added benefits, staff turnover rates have not decreased. We will return to that observation later in this paper. (In addition, the 2001 and 2003 surveys revealed that scarcely 2/3rds of direct care workers either held degrees or were matriculating in college programs). In order to help agencies retain staff (by offering another benefit for workers) as well as to help ensure quality care, RICORP began offering training programs in the late 1990’s. The Association also collaborated with the Community College of Rhode Island (CCRI) in 2001 to develop a college curriculum in “children’s residential programming” .
Since that year, RICORP’s Training Program has developed and maintained certification-training sessions for direct care workers and supervisors. These tracks meet standards of certification mandated by the State’s Residential Child Care Regulations. On two occasions, in 2000 and 2002, RICORP received grants from the Human Resource Investment Association (RI Department of Labor and Training) to develop and offer training programs to staff of member agencies – free of charge. Through the fall of 2004, the Association has certified 425 direct care workers and 175 supervisors.
Further elaborating on what was done before, beginning with the Fall 2002 Semester, staff from RICORP-member programs could earn a Certificate in Children’s Residential Programming granted by a reputable state institution of higher learning . The program is the result of a continuing collaboration between RICORP and the Community College of Rhode Island (CCRI). The ten classes that comprise the certificate program also serve as the halfway mark towards an Associates Degree in Human Services. The classes are offered at both RICORP’s administrative office and on the CCRI campuses. And, as a result of a source of state funds identified by the Association and DCYF, workers can enroll in each 3-credit class for just $80 (the difference between that and the actual cost are the identified state funds).
Starting in the winter of 2005 a group of workers who have completed the certificate will begin matriculating in the Associates Degree program. It is hoped that by the time this group earns this degree a Bachelors Degree program will be in place.
Fourth Step: Provider Index Coalition
Though not part of its original plan to professionalize the field, in 2003 RICORP joined forces with the state’s ARCs, Community Mental Health Centers, Home Health Care Aides and Drug and Alcohol Treatment Association to form a coalition to promote the creation of an annual index for providers, similar to the National Nursing Home Index. The group has since become the Provider Index Coalition (PIC).
Pursuant to PIC’s endeavors, and with the support and leadership of the late Representative Paul Sherlock, Article 27 was included in the State’s 2004 budget. The aim of the Article was to create a commission to look at this issue and develop a plan to create an index. In March 2004 such a Legislative Commission was formed. Comprised of three members from the RI House of Representatives, three members of the RI Senate, and three appointees of the Governor, the commission voted for the state to adopt the Home Health Care Market Basket Index for all of the state-contracted programs from the aforementioned groups. Legislation will be introduced in 2005 in an effort to include the index starting in the 2006 state budget. Such an index would provide annual funding stability for contracted provider agencies.
Evaluating RICORP’s Efforts
While the State Legislature has been receptive to the Association’s efforts to bolster agency budgets, there is still a long way to go to bring direct care salaries in line with those of other professions. This is demonstrated by staff turnover rates continuing to be relatively high. In addition, it is still inconceivable that adults with families to support will want to stay in a highly demanding job that continues offer an average gross salary of just under $500 a week. This is why the RICORP is an active member of the Provider Index Coalition. If an annual index is implemented in Rhode Island , direct care workers will receive increases on a regular basis and hold positions that afford health insurance and retirement plans.
In addition to salaries and benefits, direct care workers have greatly benefited from RICORP’s Training Program. Not only has this helped provide them with specialized knowledge but it has also bolstered the direct care workers’ confidence and respect that they feel within their agencies. RICORP hopes to evaluate whether this initiative (training program), more than the salary increases, has helped long-time direct care workers feel valued by the field.
RICORP believes that professionlizing the direct care position is something it must continue to promote. Paying workers for their specialized knowledge is important, and there is a lot of “backfill” to do in bringing wages in line with other professions. As RICORP moves forward in its efforts to combine funding with knowledge it is hoped that the Association is moving in a direction that makes children’s residential work a viable profession.
Bibliography
Association of Child and Youth Care Practice (1995). Ethics of Child and Youth Care
Professionals. (On-line) Available: (2004, July 30).
Greenwood, E. (1957). Attributes of a Profession. Social Work, 3 (2), 44-45.
Harris, J. (2003). Respecting Residential Work with Children. Holyoke, MA: NEARI
Press.
State of Rhode Island (2004). Final Report of the Joint Legislative Commission to Study
the Impact of a Funding Index for Community Based Providers. (On-line) Available:
(2004, October 2).
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