Using Collective Impact to Examine Direct Service Worker Training and Credentialing in North Carolina: Recommendations for Change

Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 113,000 often under-resourced and inadequately supported direct service workers (e.g., personal care aides, direct support professionals, nurse aides) in North Carolina. The demand in NC is projected to be ∼ 23,000 new direct service jobs from 2020 to 2030. We conducted a Medicaid-funded landscape analysis of direct service training/credentialing requirements and practices across service delivery models using the Collective Impact (CI) framework. With input from HCBS, licensing entities, advocates, and those with lived experience, we characterized NC's HCBS training/credentialing landscape and generated a first-of-its-kind comprehensive crosswalk resource. This project revealed the complexity and limitations of the multiple and varied training and credentialing requirements for direct service workers in NC. Robust community engagement efforts drove the development of preliminary findings and recommendations for improving the training and credentialing requirements for direct service workers in NC.