Description

The 4Ps curriculum is used to teach problem solving and communication skills to direct-care workers.

Sponsoring Organization

Home Care Associates (HCA) of Philadelphia

Setting

Home Care Associates (HCA) of Philadelphia, a home care agency founded in 1993. In July 2002, the agency employed approximately 125 home health aides and personal care assistants, many of whom were former welfare recipients. HCA is a member of the Cooperative Healthcare Network, a group of paraprofessional staffing agencies and training programs affiliated with the Paraprofessional Healthcare Institute.

Target Group

Home health aides and personal care assistants

Start Date

1997

Objectives

• To increase problem-solving capabilities, especially for home care workers assisting clients in the field, where supervision is not immediately available
  
• To help workers develop self-awareness
  
• To create a framework and language for providing feedback to direct-care workers.

Key Components

HCA's in-house, 4-week entry-level training program lasts approximately 130 hours. More than 15 of those hours are devoted to the 4Ps curriculum. The 4Ps is also taught as part of orientation to any home health aides and certified nursing assistants who have received training prior to their employment at HCA.

Defining the 4Ps. The 4Ps curriculum breaks down the problem-solving process into these four steps:

• Paraphrase: Listening actively and asking questions to ensure full understanding of a problem
  
• Pull back: Gaining emotional control in a stressful situation
  
• Present options: Identifying critical facts, brainstorming solutions, considering consequences, and presenting options to a client or supervisor
  
• Pass it on: Passing on important information to a supervisor or to others involved in a situation, either verbally or in writing

• Adult-learning techniques. These techniques are built on the assumption that trainees learn in different ways (visual, audio, experiential) and that most have had limited or negative experiences with formal schooling. In lieu of a textbook, training incorporates role-plays, case studies, small group discussions, hands-on training, and interactive lectures. To teach the 'Pull Back' step, for example, the instructor introduces a role-play with a surprise element that forces trainees to practice pulling back and assessing a situation. During the first 30 minutes of the 'Pass It On' session, participants discuss agency policies, examining what does and does not need to be passed on. In addition, trainees practice documentation skills by using time sheets and other agency forms.
  
• Seasoned instructors. Instructors are selected because they are skilled at adult learner-centered teaching techniques and have demonstrated natural teaching ability. They are also fluent and comfortable with all sections of the 4Ps curriculum. For example, one of the current 4P instructors is a former senior aide and peer mentor with eight years of experience at HCA. Others were recruited without health care experience because of their experience in adult learner-centered methods and began teaching the 4Ps after teaching other components of the curriculum.
  
• Peer mentors in the classroom. Senior direct-care workers help teach the curriculum and offer examples from their experiences for role-plays.
  
• Constant reinforcement of the language and concepts. This reinforcement continues throughout the training, not just in the section devoted to teaching the 4Ps curriculum. Also, the language and concepts are reinforced by other staff throughout the agency. If an employee runs into difficulties with a client, for example, her supervisor might ask, 'Did you pull back? What options did you present?'
  

Results, Outcomes, Evaluation

This practice has not been formally evaluated. However, staff who were at the agency before 1997 have noted fewer phone calls from the field regarding problems and a decrease in the number of call-outs and no-shows since the problem-solving curriculum was introduced. The culture of the agency has also changed, they say. Staff are more apt to help each other solve problems, and they use language and behaviors learned in the 4Ps curriculum. Workers are also more inclined to take responsibility for their actions, rather than blaming others or attributing problems to external causes (for example, blaming public transportation for an inability to get to cases on time).

Lessons Learned

In order to be fully effective, HCA staff emphasize that the 4Ps must be integrated not just into training but also into everyday interactions between agency staff. HCA staff also believe it is vital that home health aides provide the 'real-life' situations for role-plays and act as models and mentors for trainees.

HCA found that the curriculum is most effective when taught by someone familiar with the overall training program and the trainees rather than a guest instructor. It was also important to find trainers who could work through each step with conviction, although some steps might initially feel contrived.

Initially, after each training session, instructors talked over the curriculum with trainees. That feedback, they say, helped them amend the curriculum to improve future training sessions. Because accurate self-assessment is an important part of learning the 4Ps, trainers find it important to set ground rules such as respecting confidentiality and other people's opinions at an early stage of the training (generally on the first day). This makes it easier for trainees to share their thoughts and feelings.

Costs and Funding

The curriculum is included in Home Care Associates' training. The annual budget for training is $871,000 a year, or about $4,300 per trainee. Foundation support and Temporary Assistance to Needy Families (TANF) reauthorization funds cover some training costs.

Contact Information

Sara Joffe
Director of Educational Programs
Paraprofessional Healthcare Institute, c/o Home Care Associates
1315 Walnut Street, Suite 832
Philadelphia, PA 19107

t: (215) 248-2248
e: sara@paraprofessional.org

Other Resources

Paraprofessional Healthcare Institute. 2002. Relational Skills Curriculum: Teaching problem solving and communication skills. Bronx, NY: Paraprofessional Healthcare Institute. This curriculum is made available with PHI consulting services. Please contact the number above for more information.