The Importance of Pairing Time

I think one of the biggest mistakes that can happen in behavioral intervention and community support services is a lack of building rapport or “pairing” with a new client. While I appreciate a provider who wants to start driving change right away, pairing is an important success factor in service provision. Many studies (Behavioral Analysis in Practice 2017, Journal of Early Intensive Behavioral Intervention 2007, Behavioral Interventions 2015, etc.) have recognized the importance of building rapport prior to starting intervention. Several have also found an importance in client pairing at the beginning of each session.

The term “pairing” comes from the act of connecting ourselves with reinforcing items or activities. According to HowToABA.com, “Pairing is the first step when you begin working with a new client… Your goal should be that the client wants to see you - your presence is not just tolerated, but actually enjoyed!”

AppliedABC.com explains “if an unfamiliar adult walks into your session without taking the time to pair with the child and then begins making demands, it’s likely that the child may engage in problem behaviors or avoid the adult entirely to show their discomfort.”

I witnessed this issue firsthand with my youngest child. He was starting behavioral intervention with a provider he had never met before. The provider had a lot of experience and strengths in plan development, setting boundaries and even engagement, however, we both were of the mindset that she should jump right into intervention. This backfired and my son became very defiant and disrespectful toward her.

The second time that we hired a provider, we decided that the first week or so should be exclusively dedicated to pairing. My son bonded with the provider before expectations were introduced and new skills were being taught. This built a foundational relationship based on trust and formed an impression within him that intervention was “fun”.

I asked a few intervention providers to share their experiences and perspectives about pairing. Here’s what they had to say:

“Pairing is the foundation of behavioral intervention - It is a continuous form of building trust and advocacy for our learners.”

— Jamie (Local BI Provider)

“Pairing is about building and maintaining a rapport between two people. It helps (future) boundary setting and demand requests.””

— Michelle (Local BI Provider)

Additionally, pairing provides opportunities to cultivate and explore curiosity, which facilitates relationship and learning.

“Everyone has experienced less-than-fulfilling interactions where someone just talks at you versus with you... It is the opposite that supports our feelings of kinship with others...

When someone is curious about you and you are curious about them, you gain that back-and-forth feedback system that has a synchrony, feels good, and is energizing...”

— Barb Avila, "Seeing Autism"

If you’re struggling to come up with ideas for building client rapport, here are a few suggestions:

• Observe them and see what they enjoy

• Participate in a preferred activity with them

• Repeat back what they said, so they know that you heard and understood them

• Talk about a subject they enjoy

• Have fun (play a game, be silly, use humor)

• Show empathy and compassion

I would love to hear how pairing has helped in YOUR intervention sessions or work with clients. Please share your best practices in the comments below.

Lessons Learned From Managing 10+ CSWs

While the Family Directed Services and Self-Directed Services programs in Idaho have been tremendously helpful to participants and families seeking high quality services, they have thrown many individuals into a managerial role without much training or previous experience.

I was fortunate to have multiple certifications in Human Resource Management, a decade of corporate recruiting experience and a few years of supervisory experience prior to my son starting in the FDS program. Even with this background, I had to learn some lessons the hard way. I’m sharing some of these lessons here, with the hope it will help you avoid potential pitfalls in this unique employment arrangement.

Be Selective

Your CSW will be responsible for keeping you or your loved one safe in certain situations. They will potentially have access to your home, vehicles, pets, other family members and private information. Their attention to detail, diligence or behavior in an emergency situation could make a difference in you or your loved one’s health and safety. In addition, there are predators who target vulnerable individuals. For all of these reasons and more, it’s essential that you are selective about who you hire as a CSW.

1. It’s a good idea to require a resume as part of your application process. A resume is documentation of the experience and skills the person is claiming to have. If the information they share in the interview doesn’t match up with their resume, this is an good indicator of deception.

2. It’s a good idea to interview the person more than once. If the information provided across the resume and multiple interviews aligns, it is more likely the person is being honest. This also gives you the opportunity to evaluate their candidacy in different scenarios.

   Personally, I conduct a 30-minute phone interview with qualified candidates first, then invite the finalists to come to our home and to meet us in-person. It’s always interesting to see how behaviors and answers shift or remain the same across these steps.

3. After the interview, compare how the person’s answers matched up with their actions. For example, if they claimed to be in this field because they love working with individuals with unique needs but were more interested in learning about the pay/schedule than the participant, this is likely a case of someone telling you what they think you want to hear.

4. Always conduct a background check and consider checking professional references. Every year there are countless cases of crimes against vulnerable individuals. While financial exploitation is the most common crime against vulnerable individuals, there are also regular instances of emotional abuse, physical abuse, sexual abuse, kidnapping and more. It’s critical that you check each potential CSW’s criminal history BEFORE hiring them.

A few resources/links you may find helpful in this effort:

Potential CSW Interview Questions

Idaho DHW Criminal History Unit

Checkster Online Reference Checks

10 Signs of Deception

Be Clear About Expectations

You may have certain ways you like things done, expectations about how items in yours space are handled or a unique parenting approach that you practice. Your CSW won’t know any of this unless you tell them.

I suggest starting this process at the point of posting the job. Your job ad should share any important details about your environment, necessary qualifications and how the CSW role operates (FEA involvement, support goals, etc.) You can also convey these details in the first interview.

Once you’ve selected an individual, it’s important to have an orientation process. Some families write up a document that they share with new CSWs, others talk through important items and some even develop an entire training manual to share. Whatever your method, the point is to set your new CSW up for success. This is also when you will want to go through the SSP and backup plans with a new employee.

Be Empathetic

Many CSW roles involve stressful situations, high levels of responsibility, physical demands and more. I find it important as an employer to recognize that this job is tough. I not only allow, but encourage my CSWs to vent their frustrations (when the participant isn’t around). Often times, validation is all that is needed to move forward from a troubling moment. You want your employee in a good headspace while they are engaging with your child.

While some folks won’t be impacted by an act of aggression, others will be. I let my CSWs know that I won’t ever hold it against them if they need to take a moment to regulate themselves. I am quick to step in and help if I can see they are flustered or upset.

Nearly half of employees surveyed by Udemy said they quit their last job because of the boss (not the work, pay or benefits). While you may not be able to improve the pay, provide benefits or control how the participant behaves, you CAN control how you manage your CSWs.

Be Approachable

Your employees shouldn’t fear asking for time off, making a suggestion, requesting help or sharing a concern. If you create a toxic environment, you WILL lose good employees. Consider your facial expressions, tone of voice and how realistic your expectations may or may not be. While a request for time off may bring a host of challenges for you, it’s completely normal for an employee to need to take some time off from work for appointments, parenting duties and overall wellness. Meet your CSW’s requests and ideas with kindness and a solution-focused mindset.

Be an Advocate

Department pay rates and expectations have historically not aligned well with labor market trends. Correcting these issues requires advocacy and this primarily has had to come from participants (not CSWs). Be prepared to speak to your legislators, DHW leadership and program administrators about your concerns. Participate in Department meetings and surveys. It will take all of our voices to drive change.

Be Prepared to End the Relationship

The average tenure for CSWs is around 6 to 12 months. It’s easy to burnout in this field if you aren’t maintaining good self-care, taking breaks (time off) and growing your skills. While it may be difficult to accept, your CSWs likely won’t stay with you for more than a year or two.

You can choose to be supportive of their future departure or resentful of it. I choose the former because:

1) it enables a relationship of mutual trust and respect,

2) it’s fun to help folks achieve their dreams, and

3) your reputation with past employees impacts future hiring.

Nearly all the CSWs that I’ve hired have given me at least 2 months notice before leaving because they know that I will be supportive of their plans. (It’s also because they care about our family and are awesome humans.) When it’s safe to give notice, employees are more likely to do so.

There may also be an instance where you need to terminate an employee for cause. Not everyone who enters this field should. I’ve heard stories of theft, dishonesty and even participant abuse. It’s a good idea to determine your deal breakers before hiring anyone. Once you have defined your boundaries, it’s a good idea to incorporate them into your CSW orientation process.

I hope this information is helpful as you begin or continue a CSW employment relationship. I would love to hear any tips you have to share as well.

How to become a CSW in Idaho

If you have a heart for individuals with developmental disabilities, a CSW position might be a good employment fit. But, how does one get started in this field? What does CSW stand for? Who would be your employer? This field can seem ambiguous from the outside looking in. Hopefully, I can shed some light on the matter today.

First, “CSW” stands for Community Support Worker. This title that was assigned by the State of Idaho when they established this unique role over a decade ago. It may be helpful to learn a little bit of history about this role and the program it supports.

The State of Idaho recognize a need for individuals and families to have more choice and flexibility in their developmental disability (DD) services. Previously, all services were delivered through a DDA, or developmental disability agency. The emerging need for more choice gave rise to the development of the Family Directed Services (FDS) and Self-Directed Services (SDS) programs in Idaho. The FDS program supports children up to 18 years old and the SDS program supports adults 18 years and older.

Within these programs, participants are able to hire and manage their own staff (CSWs), with the assistance of an approved Support Broker and Fiscal Employment Agency (FEA). Families and individuals can set their own qualifications, decide how much to pay their employees (within established ranges), supervise their employees, schedule their workers and manage their own budgets (in alignment with program requirements). Many program participants report improved DD service consistency and quality as a result of access to these programs.

CSWs come from a variety of backgrounds and their skills can be quite diverse. Since the position qualifications are determined by each participant or family, the ideal work experience is difficult to pin down. Some families are seeking an individual who can provide more personal care support while others may need a person who can provide more emotional or relationship support. Many CSWs come from a background in childcare, healthcare or education. Others may have very little direct experience in any of these fields but possess critical characteristics like dependability, adaptability, compassion and patience.

Program participants work with their Support Broker to prepare an annual Support & Spending Plan (SSP) that details specific goals that will be worked on during the CSW’s hours. These goals are unique for each participant and may change from year to year. As a CSW, you are required to be listed in and given a copy of this Plan.

The pay range for CSWs can currently range from $7.25 per hour (Idaho’s minimum wage) up to $16.99 per hour. There are a few exceptions where a participant’s need is great enough to warrant a higher rate of pay. If this is the case, the rate will not exceed $20 per hour. The Idaho legislature has been asked to approve funds to increase the maximum CSW rates, however, this process has not been finalized. Due to the local labor market and cost of living increases, we will hopefully see these rates increase in the near future.

It may also be helpful to know that there are similar roles that operate within the DDA and Residential Habilitation Agency environments. Titles can vary from one agency to the next, but typically are posted as Habilitative Support Specialist, Respite Provider or Direct Service Staff. Within an agency, the employee typically receives a lower hourly rate (than a CSW) but profits from training, interventionist or BCBA guidance (when needed), more scheduling opportunities and, in some cases, employee benefits.

If this CSW role sounds like a good fit for you, you can typically find available positions on the Idaho My Voice My Choice Facebook page. You can also find active opportunities here on our CSW & Caregiver Jobs page. If hired, you will be required to fill out a CSW Employee Enrollment Packet that will be provided by the participant’s FEA. Your participant will also likely require a State Criminal History Check. You can start this process ahead of finding a role by creating an account here and selecting a time to get fingerprinted. Getting this step done in-advance will allow you to start in the position sooner. DHW background checks are valid for 3 years.

What other questions do you have about becoming a CSW? Please post them in the comments and I will circle back to answer them.

Please note: All information provided is based on the author’s personal experience and perspective. For definitive information about CSW positions and processes, please visit DHW’s website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health/about-childrens-developmental-disabilities.

About the Author: Angela Watts is the founder of TheraJobs and the parent of a child with a developmental disability. She also serves as an advocate for FDS families and an Idaho Support Broker.