The Iowa Department of Public Health received a Health Resources Services Administration (HRSA) grant to develop and implement the Iowa Personal and Home Care Aide State Training (PHCAST) project. The NRC was contracted to provided evaluation expertise to measure direct care worker knowledge, retention and job satisfaction and provided recommendations for ongoing program improvement.

Turnover is a concern in the direct care field as high turnover rates may lead to worker shortages, reduced quality of care, and stress for direct care professionals. Existing literature demonstrates that training and learning opportunities can decrease turnover and increase overall job satisfaction. The Iowa Personal and Home Care Aide State Training (PHCAST) project provided training and developed direct care professional credentialing in the state of Iowa through 6 training modules developed as part of the grant, with a goal of increasing employee satisfaction and retention.

The evaluation, directed and implemented by the NRC, examined the effects of the training modules on direct care worker knowledge, retention and job satisfaction and the extent to which the training could be associated with the development of a stable, well-qualified, and flexible direct care workforce.  Pre- and post-test knowledge scores among treatment and control groups were assessed along with ongoing employment information, interviews with families/caregivers, and interviews with those who have terminated employment.  Test results show that changes in mean knowledge scores were significant for all modules in the treatment group.

This evaluation also gathered demographic information about the direct care workforce. The treatment group was 84.6% female, 78.1% white; 40.9% had “some college”.  79.6% have been in their current position for less than one year, while 62.5% have worked in the direct care field for two years or more.

Results and recommendations from this evaluation will provide ongoing process and program improvement information to the Iowa Department of Public Health.

For more information about the PHCAST evaluation, please contact Kellee McCrory, MPH, MSW at