CDS: Introduction to Mental Health and Mental Illnesses
CDS: Introduction to Mental Health and Mental Illnesses
College of Direct Support (CDS)
The College of Direct Support (CDS) is a competency based training and development tool. These competency sets are nationally validated and/or come from expert consensus. The foundation of competencies makes lessons and courses easier to use in a coordinated way. They can be selected to develop a person’s overall competence. They can be used to create a meaningful development plan. These lists provide you with the competency sets that reinforce the CDS content. They indicate the specific competencies covered by this lesson or course.
NADSP Competency Areas
The following competency areas and skill statements are used by the National Alliance on Direct Support Professionals (NADSP). The NADSP set is based on the Community Support Skills Standards (HSRI, 1996). The CSSS are a nationally validated set of competencies for DSPs. The ones listed below are only part of the whole set. They are the knowledge and skills a learner must be able to demonstrate at a basic level of competence having completed the content. See the full set of NADSP competencies and to learn more about the NADSP.
Area 1: Participant Empowerment
The Direct Support Professional enhances the ability of the participant to lead a self-determining life by providing the support and information necessary to build self-esteem, and assertiveness; and to make decisions.
- The competent DSP assists and supports the participant to develop strategies, make informed choices, follow through on responsibilities, and take risks.
- The competent DSP promotes participant partnership in the design of support services, consulting the person and involving him or her in the support process.
- The competent DSP provides opportunities for the participant to be a self-advocate by increasing awareness of self-advocacy methods and techniques, encouraging and assisting the participant to speak on his or her own behalf, and providing information on peer support and self-advocacy groups.
- The competent DSP provides information about human, legal, civil rights and other resources, facilitates access to such information and assists the participant to use information for self-advocacy and decision making about living, work, and social relationships.
Area 2: Communication
The Direct Support Professional should be knowledgeable about the range of effective communication strategies and skills necessary to establish a collaborative relationship with the participant.
- The competent DSP uses effective, sensitive communication skills to build rapport and channels of communication by recognizing and adapting to the range of participant communication styles.
- The competent DSP has knowledge of and uses modes of communication that are appropriate to the communication needs of participants.
Area 3: Assessment
The Direct Support Professional should be knowledgeable about formal and informal assessment practices in order to respond to the needs, desires and interests of the participants.
- The competent DSP initiates or assists in the initiation of an assessment process by gathering information (e.g., participant’s self-assessment and history, prior records, test results, additional evaluation) and informing the participant about what to expect throughout the assessment process.
- The competent DSP conducts or arranges for assessments to determine the needs, preferences, and capabilities of the participants using appropriate assessment tools and strategies, reviewing the process for inconsistencies, and making corrections as necessary.
- The competent DSP discusses findings and recommendations with the participant in a clear and understandable manner, following up on results and reevaluating the findings as necessary.
Area 4: Community and Service Networking
The Direct Support Professional should be knowledgeable about the formal and informal supports available in his or her community and skilled in assisting the participant to identify and gain access to such supports.
- The competent DSP helps to identify the needs of the participant for community supports, working with the participant’s informal support system, and assisting with, or initiating identified community connections.
- The competent DSP ensures participant access to needed and available community resources coordinating supports across agencies.
Area 5: Facilitation of Services
The Direct Support Professional is knowledgeable about a range of participatory planning techniques and is skilled in implementing plans in a collaborative and expeditious manner.
- The competent DSP maintains collaborative professional relationships with the participant and all support team members (including family/friends), follows ethical standards of practice (e.g., confidentiality, informed consent, etc.), and recognizes his or her own personal limitations.
- The competent DSP assists and/or facilitates the development of an individualized plan based on participant preferences, needs, and interests.
- The competent DSP assists and/or facilitates the implementation of an individualized plan to achieve specific outcomes derived from participants’ preferences, needs and interests.
Area 6: Community Living Skills & Supports
The Direct Support Professional has the ability to match specific supports and interventions to the unique needs of individual participants and recognizes the importance of friends, family and community relationships.
- The competent DSP assists the participant to meet his or her physical (e.g., health, grooming, toileting, eating) and personal management needs (e.g., human development, human sexuality), by teaching skills, providing supports, and building on individual strengths and capabilities.
- The competent DSP assists with identifying, securing and using needed equipment (e.g., adaptive equipment) and therapies (e.g., physical, occupational and communication).
- The competent DSP supports the participant in the development of friendships and other relationships. needed.
Area 8: Advocacy
The Direct Support Professional should be knowledgeable about the diverse challenges facing participants (e.g., human rights, legal, administrative and financial) and should be able to identify and use effective advocacy strategies to overcome such challenges.
- The competent DSP and the participant identify advocacy issues by gathering information, reviewing and analyzing all aspects of the issue.
- The competent DSP facilitates, assists, and/or represents the participant when there are barriers to his or her service needs and lobbies decision-makers when appropriate to overcome barriers to services.
- The competent DSP interacts with and educates community members and organizations (e.g., employer, landlord, civic organization) when relevant to participant’s needs or services.
Area 10: Crisis Prevention and Intervention
The Direct Support Professional should be knowledgeable about crisis prevention, intervention and resolution techniques and should match such techniques to particular circumstances and individuals.
- The competent DSP identifies the crisis, defuses the situation, evaluates and determines an intervention strategy and contacts necessary supports.
- The competent DSP continues to monitor crisis situations, discussing the incident with authorized staff and participant(s), adjusting supports and the environment, and complying with regulations for reporting.
Area 11: Organizational Participation
The Direct Support Professional is familiar with the mission and practices of the support organization and participates in the life of the organization.
- The competent DSP incorporates sensitivity to cultural, religious, racial, disability, and gender issues into daily practices and interactions.
Area 13: Building and Maintaining Friendships and Relationships
Support the participant in the development of friendships and other relationships.
- The competent DSP encourages and assists the individual as needed in facilitating friendships and peer interactions.
- The competent DSP encourages and assists the individual as needed in communication with parents/family (e.g., phone calls, visits, letters).
- The competent DSP implements individual supports regarding community activities.
- The competent DSP provides incentive or motivation for consumer involvement in community outings.
- The competent DSP assists the individual as needed in getting to know and interacting with his/her neighbors.
- The competent DSP encourages and assists the individual as needed in dating.
- The competent DSP encourages and assists the individual as needed in communicating with social workers and financial workers.
Area 14: Provide Person Centered Supports
- The competent DSP provides support to people using a person centered approach.
- The competent DSP modifies support programs and interventions to ensure they are person centered.
- The competent DSP challenges co-workers and supervisors to use person centered practices.
Area 15: Supporting Health and Wellness
Promotes the health and wellness of all consumers.
- Administers medications accurately and in accordance with agency policy and procedures.
- Observes and implements appropriate actions to promote healthy living and to prevent illness and accidents.
- Uses appropriate first aid/safety procedures when responding to emergencies.
- Assists individuals in scheduling, keeping, and following through on all health appointments.
- Assists individuals in completing personal care (e.g., hygiene and grooming) activities.
- Assists individuals in implementing health and medical treatments.
- Assists individuals to take an active role in their health care decisions.
The Centers for Medicare and Medicaid Services (CMS)- Direct Support Workforce Core Competencies.
The CMS core competencies for the Direct Service Workforce (DSW) were part of an initiative to improve access to high quality LTSS for all populations. The competencies are designed to improve worker quality. These competencies are designed to inform direct support service delivery and promote best practices in community-based LTSS. They are also a core foundation to career development. Only some of the competencies are listed here. These are the ones a learner should be able to demonstrate basic competence in once completing the content. Read the full set of CMS-DSW competencies.
Area 1: Communication
The DSW builds trust and productive relationships with people s/he supports, co-workers and others through respectful and clear verbal and written communication.
The Direct Service Worker:
- Explains services and service terms to the individual being supported and his or her family members.
- Communicates with the individual and his or her family in a respectful and culturally appropriate way.
Area 2: Person-Centered Practices
The DSW uses person-centered practices, assisting individuals to make choices and plan goals, and provides services to help individuals achieve their goals.
The Direct Service Worker:
- Provides supports and services that help the individual achieve his or her goals.
- Works in partnership with the individual to track progress toward goals and adjust services as needed and desired by individual.
Area 4: Crisis Prevention and Intervention
The DSW identifies risk and behaviors that that can lead to a crisis, and uses effective strategies to prevent or intervene in the crisis in collaboration with others.
The Direct Service Worker:
- Recognizes risk and works to prevent an individual’s crisis in a way that meets the individual’s need.
- Uses positive behavior supports to prevent crisis and promote health and safety.
- Sees own potential role within a conflict or crisis and changes behavior to minimize conflict.
- Uses appropriate and approved intervention approaches to resolve a crisis.
- Seeks help from other staff or services when needed during a crisis.
- Monitors situations and communicates with the individual and his or her family and support team to reduce risk.
- Sees own potential role within a conflict or crisis and changes behavior to minimize conflict.
Area 6: Professionalism and Ethics
The DSW works in a professional and ethical manner, maintaining confidentiality and respecting individual and family rights.
The Direct Service Worker:
- Supports individual in a collaborative manner and maintains professional boundaries.
- Seeks to reduce personal stress and increase wellness.
- Respects the individual and his or her families right to privacy, respect, and dignity.
Area 7: Empowerment & Advocacy
The DSW provides advocacy, and empowers and assists individuals to advocate for what they need.
The Direct Service Worker:
- Supports the individual to get needed services, support and resources.
- Assists the individual get past barriers to get needed services.
- Tells the individual and his or her family their rights and how they are protected.
Area 8: Health and Wellness
The DSW plays a vital role in helping individuals’ to achieve and maintain good physical and emotional health essential to their well-being.
The Direct Service Worker:
- Supports the spiritual, emotional, and social wellbeing of the individual.
- Gives medications or assists the individual to take medication while following all laws and safety rules.
- Assists the individual to learn disease prevention and maintain good health.
Area 9: Community Living Skills and Supports
The DSW helps individuals to manage the personal, financial and household tasks that are necessary on a day-to-day basis to pursue an independent, community-based lifestyle.
The Direct Service Worker:
- Assists the individual meet his or her physical and personal care needs (i.e. toileting, bathing, grooming) and provides training in these areas when needed.
- Provides person centered support and helps the individual to build on his or her strengths in life activities.
Area 10: Community Inclusion and Networking
The DSW helps individuals to be a part of the community through valued roles and relationships, and assists individuals with major transitions that occur in community life.
The Direct Service Worker:
- Supports the individual to connect with friends and to live and be included in the community of his or her choice.
Area 11: Cultural Competency
The DSW respects cultural differences, and provides services and supports that fit with an individual’s preferences.
The Direct Service Worker:
- Provides or accesses services that fit with the individuals’ culture or preferences.
- Seeks to learn about different cultures to provide better support and services.
- Recognizes own biases and doesn’t let them interfere in work relationships.
- Respects the cultural needs and preferences of each individual.
- Assists the individual to find social, learning and recreational opportunities valued in his or her culture.
NADD An Association for Persons with Developmental Disabilities and Mental Health Needs DSP Competency Standards
Supporting people with co-occurring intellectual disabilities and mental illnesses well takes special skill, knowledge, and effort. The NADD competency standards were to define critical areas of skill that people need to do this well. There are several levels of competencies developed by national experts in this area. The ones listed below are only part of the set for direct support professionals. They are the ones that a learner should be able to demonstrate at a basic level of competence having completed the course. Read the full set of NADD competencies and related certification and accreditation efforts.
Competency Standard 2: Behavior Support
The qualified direct support professional (DSP) is competent in the area of “behavior support” as it relates to individuals with Intellectual or Developmental Disabilities and Mental Illness (IDD/MI).
Benchmark 2B: Maintaining a Supportive Physical and Social Environment
The qualified DSP is aware of patterns and triggers to challenging behavior and plans accordingly. He/she is skilled at adapting demands and supporting new skill development. The DSP recognizes and build on a person’s strengths and interests. He/she encourages maximum choice and control in each environment. The DSP is validating and reinforcing of the person’s use of positive behavior choices.
Benchmark 2B Performance Indicators
In the area of “supportive physical and social environment,” the qualified DSP:
- Provides a positive physical and social environment consistent with the preferences and expectations of individuals supported.
- Uses effective methods to ensure that expectations are clear to individuals and presented in ways that make sense to them.
- Maximizes each person’s choices and ability to control his or her environment at all times.
- Keeps people informed about changes in plans, expectations, or other issues that affect them. Supports them to participate to the maximum extent possible in decisions regarding these situations.
- Uses effective and respectful communication strategies. Is patient and appropriate when communicating with individuals.
- Recognizes early signs of frustration or confusing and helps individual’s identify and self-manage frustration levels and communicate needs effectively.
- Recognizes unique environmental triggers for challenging behavior for each individual and plans accordingly to avoid triggers or support the person in an appropriate response to triggers.
- Is validating of individual’s feelings and experiences and supports people in recognizing and labeling feelings.
- Is encouraging of positive behavior and recognizes, rewards, and celebrates the use of new skills and appropriate responses on a daily basis with individuals.
- Modifies his/her interaction style and expectations in response to each individual’s mood and behavior in the moment.
Benchmark 2C: Responds to Challenging Behavior
The qualified DSP can successfully interrupt or prevent use of challenging behavior. He/she responds to challenging behavior in a skillful, respectful, and professional manner. The qualified DSP uses information from the whole team to develop and assess strategies.
Benchmark 2C Performance Indicators
In the area of “responding to challenging behavior,” the qualified DSP:
- Deescalates challenging behavior by acting quickly to modify conditions (environmental, social, or others conditions) that may contribute to the behavior.
- Recognizes the communicative intent of behavior and suggests or demonstrates alternative behavior that will help the individual meet needs in an appropriate ways.
- Stays calm, focused, and supportive of the individual and his or her needs when engaging around challenging behavior.
- Responds to challenging behavior in such a way that minimized reinforcement of the unwanted behavior and reinforces the use of desirable behavior related to the individual’s motivation, as identified by formal or informal functional behavior assessment.
- Follows treatment and behavior support plans as written and gives appropriate and timely feedback to plan writers regarding barriers and effectiveness.
- Documents any incidents of challenging behavior in accordance with existing plans and policies. Follows documentation protocol for special incident reporting and contacts appropriate team member(s) or supervisor(s).
- Is familiar with and engages crisis intervention and response plans when behavior is dangerous or has extreme consequences for the individual or others.
- Ensures the safety of the individual and others when crisis behavior occurs.
- Advocates for an effective crisis plan to be in place when a person has dangerous or serious behaviors.
- Avoids physical management of people in behavioral crisis. Uses personal control techniques only when properly trained, when risk to safety is immediate and unavoidable and in accordance with employer policy and guidelines and all applicable laws and regulations.
- Explains legal, ethical, and practical reasons why aversive procedures should not be used and reports any unauthorized or aversive procedures to appropriate persons.
- Avoids the use of aversive techniques. Uses these only with explicit permission in a treatment plan that has been developed by a treatment team, been given informed consent, reviewed by all required committees and found compliant with all existing policies, regulations, and laws, and when there is clear evidence that there is no other effective response or prevention options that affect the behavior.
Benchmark 2D: Teaching New Behaviors and Skills
The qualified DSP demonstrates skill in teaching and support methods related to behavior support. The DSP understands that the individual with intellectual disabilities may have cognitive challenges that affect learning. However, he/she does not make assumptions on individual learning potential. The DSP recognizes that behavior is complex. He/she teaches skills related to behavior management. However, he/she also recognizes that quality of life affects behavior. He /she take the time to teach life skills that promote independence, integration, and opportunity.
Benchmark 2D Performance Indicators
In the area of “teaching new behaviors and skills,” the qualified DSP:
- Uses basic principles of effective communication and teaching including clearly communicating expectations, checking for understanding, and adjusting styles to meet unique needs.
- Identify incremental steps to behavior change and teaches and supports the next positive step for the person in behavior management.
- Encourages people to define their own reasons and strategies for self-management of behavior rather than relying only on external consequences and guidance to maintain control.
- Supports people in developing ability to identifying and use the likely natural consequences that follow behavior as a method of making behavioral decisions.
- Uses formal or informal functional behavior assessment and person-centered planning to guide choices and methods skill development and reinforcement.
- Takes steps to protect people appropriately from severe consequences of behavior, even if these are “natural consequences.”
- Identifies and uses appropriate replacement behaviors for challenging behaviors.
- Models appropriate behavior and interactions.
- Uses reinforcement frequently, appropriately and positively.
- Assists individuals in identifying new skills as an alternative to meet behavior function.
- Uses techniques identified in a behavior support plan to develop new skills.
- Tailors instruction and intervention strategies to address individual differences, preferences, goals, learning styles, and culture.
- Uses the least restrictive effective approach to change behavior.
Competency Standard 3: Crisis Prevention and Intervention
The qualified direct support professional (DSP) is competent in the area of “crisis prevention and intervention” as it relates to individuals with Intellectual or Developmental Disabilities and Mental Illness (IDD/MI).
Benchmark 3A: Knowledge and Use of Crisis Prevention Strategies
The qualified DSP recognizes great toll that crisis takes on individuals supported. He/she works to help each person reduce the risk of repeated crisis. The DSP implements daily strategies that reduce the likelihood of crisis. This includes supporting a health and safe environment. This includes helping the person learn new skills and abilities that prevent crisis. It is includes being aware of early signs of building crisis or triggers for each person and taking early steps to avert crisis.
Benchmark 3A Performance Indicators
In the area of “crisis prevention,” the qualified DSP:
- Obtains and reviews information about specific risk of crisis and methods of preventing and responding to crisis on the part of each person he or she supports prior to providing support. Asks questions as needed to ensure understanding.
- Recognizes signs of increased agitation, risks of suicide, or indications of potential criminal or crisis behavior on the part of a person supported and takes steps to deescalate the situation effectively.
- Engages with the person and full team in obtaining further assessment and planning if a crisis has occurred in order to identify the best prevention and response strategies.
- Reviews each crisis (formally or informally) after the fact to consider their own behavior and environmental triggers, in order to improve future capacity to manage and prevent crisis.
- Assists individuals in identifying and responding to potential catalysts to crisis, helping them identify signs and trends in their behaviors and strategies that stop or reduce crisis. Help them identify what others can do to support them in prevention and response.
- Supports people in lifestyle choices that reduce vulnerabilities (exercise, sleep, food, therapy, support group, family time, relaxation, etc.).
- Supports the person in identifying and learning alternative coping skills and for how to avoid or reduce triggers to crisis.
- Maintains a positive environment that minimizes or eliminates triggers to crisis and prevents dangerous options per ethical and legal guidelines. (i.e., remove or lock up pills, knives, alcohol, etc.)
- Uses treatment and crisis plans to guide responses when individuals experience loss, crisis, and challenging behavior.
- Adjust daily support and expectations in order to prevent crisis when there are signs of increased needs of individuals at risk for crisis.
- Assists and support coworkers and others in understanding crisis, behavior management, coping skills, and treatment planning.
- Accepts and implements suggestions for improved ability to prevent and respond to crisis.
- Seeks additional information and skills related to causes of crisis and crisis prevention on a regular basis and as needed.
Benchmark 3B: Knowledge and Use of Crisis Intervention Strategies
The qualified DSP uses safe and effective crisis intervention strategies when necessary. He/she is aware of the specific needs and triggers of individuals supported and works with each person individually. He/she also is able to handle unexpected crises by using established response techniques. In a crisis, the qualified DSP is able to stay calm and work well with the person and others. He/she is able to work effectively with emergency response personnel. He/she is able to consider immediate as well as long-term outcomes for the person in choosing responses. The DSP is organized with necessary information and supports the comfortable transition of the person supported to crisis services. The DSP correctly identifies who to inform and when post-crisis.
Benchmark 3B Performance Indicators
In the area of “crisis interventions,” the qualified DSP:
- Recognizes when a situation has become unsafe or the person needs more assistance and takes steps to respond in a way that protects people.
- Activates procedures identified in the crisis plan as described.
- Describes how crisis may engage past trauma experiences and the person’s ability to process and respond to information and describes methods that may be effective in this situation.
- Uses methods likely to reduce trauma and agitation including a calm gentle voice, a relaxed but attentive demeanor at a safe distance, allowing for maximum freedom of movement of the individual, validation of individual’s concerns or needs, and offers of help. Paces interventions so that the person has time to process.
- Avoids methods that may increase trauma or agitation such as crowding the person, threatening the person with aversive consequences, yelling, panicking, demanding, dismissing the person’s concerns, touching or unnecessarily blocking the person from movement.
- Uses non-physical interventions to control and/or protect individuals and others in a crisis situation whenever possible.
- Identifies and utilizes appropriate contact information in crisis situations (i.e. community mental health services, 911 and hotline resources, etc.).
- Provides crisis prevention/intervention education to first responders and emergency personnel regarding the individual’s dual diagnosis.
- Is prepared for contact with emergency personnel including complete medical and personal information, complete details of the incident, and preferences for treatment and intervention.
- Works effectively with police officers and recognizes when and how to advocate for the individual when criminal justice systems are engaged.
- Recognizes cultural and social factors may influence a person’s trust and ability to comply with police and crisis intervention services and works with individuals to provide maximum safety of all involved if these interventions are necessary.
- Identifies the function and importance of debriefing and actively encourages individuals to participate in debriefing sessions following a crisis.
- Accompanies individuals to emergency room, psychiatric health facilities or other temporary placements as possible for comfort and to assist with determining appropriate course of action plans.
- Promptly reports crisis to correct members of the support and treatment team.
- Facilitates follow-up services while individuals are in other temporary placements as requested.
Benchmark 3D: Managing Stress and Burnout
The qualified DSP recognizes that supporting people who experience significant or frequent crisis is a challenging job. The DSP recognizes that these experiences affect their own mental health and well-being. The DSP knows that burnout and stress can reduce effectiveness. In order to maintain a positive and effective approach to support, the DSP must be skilled at recognizing and attending to his or her own needs. The DSP has methods of recognizing signs of toxic stress and burnout. The DSP regularly engages in prevention and response strategies relate to these needs.
Benchmark 3D Performance Indicators
In the area of “managing stress and burnout,” the qualified DSP:
- Observes healthy and positive boundaries with people supported, support teams and coworkers.
- Maintains a healthy lifestyle that allows for energy and focus when providing direct support.
- Describes risks of being overtired, stressed out, or frustrated when providing direct support and ways in which a DSP can manage these risks.
- Recognizes signs that he/she is becoming toxically stressed or burned out and engages effective strategies for getting back on track.
- Seeks professional help or assistance from employer as needed to prevent or manage toxic stress and burnout.
Competency Standard 4: Health and Wellness
The qualified direct support professional (DSP) is competent in the area of “health and wellness” as it relates to individuals with Intellectual or Developmental Disabilities and Mental Illness (IDD/MI).
Benchmark 4A: Knowledge of Health and Wellness
The qualified DSP has skills in basic health support. He/she uses proper infection control procedures. The DSP recognizes and responds to signs and symptoms of illness. He/she helps people obtain preventative and responsive medical services as needed. The qualified DSP recognizes health and wellness as holistic. He/she supports activities, choices and lifestyles that lead happiness and satisfaction on the part of the person. The DSP supports overall quality of life despite barriers. The DSP helps people develop and maintain positive relationships, valued social roles, and new opportunities.
Benchmark 4A Performance Indicators
In the area of “health and wellness,” the qualified DSP:
- Uses effective infection control procedures when performing intimate care, cleaning, or when helping with food preparation or storage.
- Recognizes signs and symptoms of infection or injury and responds appropriately.
- Recognizes signs of seizure disorders and engages effective responses in the event of a seizure.
- Recognizes signs of health crisis and obtains correct help in a timely way.
- Identifies individual’s risks and strengths in the area of health and wellness and recovery.
- Provides culturally appropriate support, consistent with the individual’s choices, perspectives, and expectations.
- Identifies how stress, spirituality, grief and loss, trauma, social roles, and relationships influence the individuals and considers these components in planning and intervention strategies.
- Incorporates the expectations of each individual’s identified support network in life planning.
- Supports positive lifestyle options for good health, illness management and recovery (i.e. sufficient sleep, proper nutrition, regular physical activity, and stress management, etc.).
- Encourages and assists individuals to be engaged in their own health maintenance in ways adapted to their abilities and understanding.
- Provides health and wellness information and education to individuals as needed and adapted to needs and preferences.
- Facilitates problem-solving and planning skills around life planning appropriate to the individual’s abilities.
- Assists individuals with scheduling medical and health-related appointments.
- Attends health related appointments as needed and requested.
- Prepares for health related appointments with objective information regarding behavior, responses, and related treatment issues.
- Expresses concerns regarding health trends and provides updates regarding treatment plans and outcomes to the appropriate treatment team.
- Obtains critical information from professionals by asking questions, being receptive to professional advice, and incorporating recommendations into treatment plans as needed.
- Serves as a liaison between the individuals and health professionals to support individuals in having an active in their health and recovery activities.
Benchmark 4B: Knowledge Intellectual and Developmental Disabilities, Mental Health Disorders and Co-Occurring Disorders
The qualified DSP demonstrates an understanding of the implications of common disorders. (I.e., intellectual, developmental, and mental health disorders.) He/she recognizes these disorders will have implications in many areas. These include behavior, health, physical capacity, communication, judgment, impulse control, and moods. It will also affect the person’s ability to self-manage. The DSP demonstrates knowledge about the specific impairments and needs among the individuals he or she supports. The DSP is knowledgeable regarding best practice in co-occurring disorders. He/she has an understanding of treatments, interventions and support for people supported as well as general knowledge.
Benchmark 4B Performance Indicators
In the area of “intellectual and developmental disabilities, mental health and co-occurring disorders,” the qualified DSP:
- Recognizes signs and symptoms of major mental health disorders (MI) including major depression, bipolar disorder, schizophrenia, anxiety disorders, and borderline personality disorder.
- Identifies the effects of common intellectual and developmental disabilities (IDD) including: down syndrome, autism spectrum disorders, fragile X syndrome, spins bifida, cerebral palsy, traumatic brain injury, fetal alcohol spectrum disorders and unspecified or general intellectual disabilities.
- Gives examples and describes ways in which a co-occurring IDD with MI and implications for services and supports.
- Identifies for each individual he or she supports the effects of IDD/MI on their behavior, health, physical capacity, communication, judgment, impulse control, moods, and self-management.
- Acknowledges and explores the role of trauma in the development or manifestation of mental health challenges.
- Identifies a range of evidence-based treatment and support options for IDD or MI.
- Implements best practice in support of people with IDD/MI.
- Networks to locate practitioners who are knowledgeable and competent in the area of dual diagnosis and matches them with the individuals.
- Recognizes a sudden appearance or increase in frequency, intensity, or duration of challenging behavior is often a sign of underlying physical or mental health problems and takes adequate steps to obtain assessment and care.
Benchmark 4C: Use and Implications of Medication (psychotropic and others)
The qualified DSP demonstrates knowledge about the effects of medications. He/she recognizes the risks and benefits of medication use in general and specific to medications used by people supported. The qualified DSP takes an active role in ensuring medications are used as prescribed. He/she maintains important information and documentation regarding medications. The qualified DSP recognizes that the use of medications is one treatment option. It is not a substitute for a holistic treatment plan. The qualified DSP administers medications in accordance with agency policy and state guidelines.
Benchmark 4C Performance Indicators
In the area of “medications,” the qualified DSP:
- Identifies the basic purpose and use of psychotropic medications.
- Identifies critical issues concerning the use psychotropic medication (i.e. risks, benefits, appropriate use, side effects, adverse reactions, off-label use, polypharmacy, need for monitoring, etc.).
- Can list and describe common health and metabolic disorders that may be caused by medications including diabetes, high or low blood pressure, obesity, movement disorders, heart conditions and risk of infection.
- Is familiar with names of common psychiatric and seizure control medications, proper use and implications of misuse, signs of adverse reactions and side effects of these medications.
- Knows the names, doses, and proper use and need for monitoring for each medications that is used by individuals supported (when part of duties).
- Assists individuals in providing complete and accurate information to medical professionals regarding their medications as well as other potential substances that contribute to risk of medication interactions.
- Uses positive behavior support and holistic recovery options as part of a whole treatment and life plan for individuals using psychotropic medication.
- Educates people supported regarding their medications and issues related to the effects, side-effects, and adverse reactions of medications.
- Monitors side effects and adverse reactions to medications and communicates concerns to the treatment team.
- Supports individuals to advocate for an optimal balance with medications to maximize effects, reduce side effects and keep people from taking unhelpful medications.
- Assists individuals to comply with the recommended lifestyle and medical requirements related to their use of psychotropic medication (i.e. regular blood draws, avoidance of certain foods, avoidance of suddenly discontinuing medications, avoidance of alcohol, effects of smoking and nicotine, etc.);
- Assists individuals with learning medication management (i.e. name and dose, effects and side effects, and risks of misuse, etc.) and teaches according to their personal learning style, capacity, and needs.
- Supports effective problem-solving and decision-making when a individual refuses to take prescribed medications.
Benchmark 4D: Illness Management and Recovery
The qualified DSP supports holistic illness management and recovery efforts. The qualified DSP is knowledgeable about the health risks related having a dual diagnosis of IDD/MI (i.e. increased risk for substance abuse, smoking, self-injurious or challenging behavior, poor diet, lack of motivation, social isolations, fewer options). The qualified DSP works with the individual to create a life plan that allows for a full life, despite disabilities and disorders. He/she models, encourages, and teaches healthy lifestyle practices. The DSP helps individuals participate in active self-care regarding nutrition, sleep, exercise, activities, and relationships.
Benchmark 4D Performance Indicators
In the area of “illness management and recovery,” the qualified DSP:
- Assists individuals to develop a person-centered recovery and illness management plan (e.g., WRAP).
- Teach healthy coping skills such as boundary-setting, self-advocacy, stress management, emotional regulation, and frustration tolerance.
- Assist individuals to take an active role in their treatment and recovery and identify barriers to motivation.
- Supports the person in activities and relationships they find enriching, relaxing, and pleasurable on a regular basis.
- Respects boundaries set by person and works to overcome obstacles or differences collaboratively.
Benchmark 4E: Documentation and Communication Related to Health and Wellness
The qualified DSP recognizes that for people with IDD/MI behavioral symptoms are often a key component to the diagnosis and treatment of health disorders. The DSP takes time to maintain accurate and complete documentation in accordance with agency/ organizational guidelines. He/she organizes and communicates this information in useful ways. The DSP teaches skills to assist individuals in monitoring their symptoms and maintaining personal records.
Benchmark 4E Performance Indicators
In the area of “documentation and communication,” the qualified DSP:
- Recognizes critical information to document and share with others.
- Communicates information regarding health and behavior effectively and in a timely way to appropriate team members.
- Follows the documentation requirements and guidelines of their state and agency/organization and records important information as it relates to individuals.
- Maintains complete, objective and accurate documentation regarding current needs of each individual.
- Monitors and records behavior patterns that are used to indicate signs of physical or mental health status.
- Supports individuals in self-identifying and self-monitoring critical information.
- Helps maintain a medical history that includes medications and treatments that have been ineffective or aversive.
- Works with individual and families to develop medical and mental health advanced directives.
Competency Standard 5: Community Collaboration and Teamwork
The qualified direct support professional (DSP) is competent in the area of “community collaboration and teamwork” as it relates to individuals with Intellectual or Developmental Disabilities and Mental Illness (IDD/MI).
Benchmark 5A: Knowledge of Service Systems
One objective of collaboration across systems is to improve the effectiveness of service delivery to individuals. The DSP supports effectiveness by working to harness the combined benefits of available support to meet the specific needs of individuals. The DSP has a basic awareness of options benefits available to people in their communities. This includes housing, transportation, employement support, case management, and education. It also includes other types of systems such as criminal justice diversion programs or community mental health clinic. The DSP is able to recognize when cultural issues may be barriers and reaches out to necessary communities in order to identify proper support for individuals. The DSP is able to effectively research additional options when needed.
Benchmark 5A Performance Indicators
In the area of “service systems,” the qualified DSP:
- Lists typical state and provincial systems and services available to individuals supported and how they must access them. (Including education, health care, DD/IDD services, mental health services, inpatient referral process, the justice system, foster care, youth services, community disability services, transportation and employment.)
- Supports people in obtaining information as needed regarding services, benefits or community based resources.
- Supports individuals in accessing state and provincial services.
- Supports individuals in understanding conflicts between systems and sorting through information in order to decide how to approach these issues.
- Describes and gives examples of common cultural barriers to service access and how he/she might overcome a barrier like this.
- Recognizes when cultural, linguistic or other diversity issues that are not being met by services and takes steps to improve the situation.
- Advocates for increased capacity for community to meet the needs of all citizens including citizens with IDD/MI.
Benchmark 5D: Promoting Person-Centered Support, Informed Consent and Advocacy
Person-Centered care places the individual at center of his or her support plan. The qualified DSP recognizes that by their nature services are not person-centered. He/she also recognizes that people with IDD/MI are at high risk for having their rights overlooked or denied. The DSP takes an active role in supporting individuals in participating in decisions about their own treatment. The DSP focuses on flexibility and choice. He/she recognizes that efforts must be made to ensure people with IDD/MI understand and are consenting appropriately. He/she helps individual reach out to their systems of natural support in decision-making. He/she helps individuals develop self-awareness about their treatment needs and preferences. The DSP promotes inclusion and independence in communities of the person’s choice. He/she supports self-advocacy and participates in advocacy when needed.
Benchmark 5D Performance Indicators
In the area of “person-centered support,” the qualified DSP:
- Assists individuals in developing skills to be proactive in their own supports/treatment program.
- Uses alternate methods of recognizing people’s preferences and choices in services and treatment when direct communication is not available. (For example, established method of PCP, observations, information from support network and social norms of peer group, etc.)
- Recognizes and encourages opportunities to promote self-directed supports on a daily basis.
- Describes the civil, legal, and service recipient rights people have.
- Vigorously protect people’s rights by reviewing their rights with them and helping them advocate when rights are violated.
- Assists individuals with understanding and evaluating treatment options and preferences so that it can be ensured they are making informed consent to services.
- Works collaboratively with guardians, families or others upon whom the person relieds to help protect their rights and organize services.
- Helps people obtain needed support when they lack a guardian or others who can help them with expression of rights (paid advocates, legal aid, protection and advocacy systems, guardian ad litem, etc.)
- Works across systems to build advances towards a more person-centered approach to service delivery.
- Works to protect an individual’s confidentiality to promote privacy and respect while simultaneously ensuring information gets to the correct people as desired by person supported.