Competencies for person-centered practice in the home and community-based services workforce: a scoping review of gray literature.

Abstract

Home and community-based services (HCBS) in the United States are required to deliver person-centered practice (PCP) under the HCBS Settings Rule, yet peer-reviewed literature provides limited insight into how PCP workforce competencies are operationalized in HCBS practice. This scoping review synthesized gray literature, including policy briefs, training guides, government documents, and practice resources, to describe PCP competencies and explore barriers and facilitators to implementation in the HCBS workforce. Twenty-eight documents met the inclusion criteria. Most competencies aligned with the five competency domains of the National Center on Advancing Person-Centered Practices and Systems, while additional competencies related to trauma-informed practice, health and safety, staff attributes, and crisis intervention also emerged. Implementation barriers included variation in training requirements, workforce shortages, inconsistent documentation and monitoring, and administrative challenges. Facilitators included standardized training, organizational support, and competency development opportunities. Findings complement evidence from academic research, highlighting recommendations to improve PCP in the HCBS workforce.