Informed Decision Making Direct Support Professional Roles & Responsibilities Raleigh, N. Carolina 6.10.2019 Presented by National Alliance for Direct Support Professionals John Raffaele, MSW Director of Education
Introduction John Raffaele MSW, Director of Educational Services NADSP
Introductions NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
What is The NADSP? THE NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS
Understanding Our Past & How Far We’ve Come “We have a situation that borders on a snake pit, children live in filth, our fellow citizens are suffering tremendously because of a lack of attention, lack of imagination , lack of adequate manpower”. Senator Robert M. Kennedy, 1968
Changing Long-Term Supports and Services Landscape HCBS Settings Rule Olmstead Act Department of Justice Litigation and Settlement Agreements Transitions to Managed Care Budget Implications Growth in demand and and Shift to Individualized Supports Focus on Recovery and Community Inclusion Supported Decision Making
Where is Quality Defined? “ It is defined at the point of interaction between the staff member and the individual with a developmental disability. ” John F. Kennedy, Jr. (1995) Chair, President ’ s Committee for People with Intellectual Disabilities THE NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS
Also at the Point of Interaction: Abuse & Neglect THE NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS
What is Informed Decision Making? NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
What is Informed Decision Making? (A comprehensive definition for Direct Support Professionals) ◦ Informed decision making is a process where a person supported has obtained information and knowledge about a situation or problem ◦ With the assistance of a direct support professional or other person, the person supported understands the choices available to them and the outcomes possible ◦ When they make a final choice it reflects their personal values, not those of the people assisting or supporting them ◦ Finally, it is the acceptance of the associated responsibility and risk of the decision. This decision is their decision alone and non-coerced by the professional . NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP) NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Some Context… • We all use informed decision-making! So why do we need a training on it?! Because people with disabilities have historically and systematically been denied the right to make decisions, take risks, and experience life in the way that those without the label of disability have.
Changing Context… • The way Centers for Medicare and Medicaid Services defines home and community-based settings changed in 2014. – Defined by personal autonomy and choice! • Scheduling • Food • Visitors • Daily activities • Physical environment • Who he/she interacts with
NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Supported and Informed Decision Making When people are supported to make decisions for themselves, they are seen as more capable by others. When we are not allowed to make our own decisions or when someone else makes our decisions for us, we are seen as less capable and as having less value in community . 2014 INDEPENDENT BUT NOT ALONE : A GLOBAL REPORT ON THE RIGHT TO DECIDE Page 65 NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
New Federal Requirements Actions To Complete For Compliance 441.301(c) (4) – Optimizes, but does not regiment, individual initiative , autonomy , and independence in making life choices , including but not NATIONAL ALLIANCE FOR PROFESSIONALS (NADSP) DIRECT SUPPORT limited to: daily activities, physical environment, and with whom to interact. Proposed State Transition Plan Deliverables : “ Identify, develop, and distribute training tools and policy updates that are needed for compliance ” NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
New Federal Requirements Providers must ensure that services are furnished : (i)Under a written person-centered service plan (also called plan of care) that is based on a person-centered approach: • Reflect risk factors and measures in place to minimize them, including individualized back-up NATIONAL ALLIANCE FOR PROFESSIONALS (NADSP) DIRECT SUPPORT plans and strategies when needed. • The individual will lead the person-centered planning process where possible • Includes people chosen by the individual. • Individual directs the process to the maximum extent possible • Reflects cultural considerations of the individual NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Informed Decision-Making The NADSP 5 Step Process 1. Understand the decision/issue/situation 2. Gather information 3. Explore options & consider outcomes 4. Decide, act & empower 5. Evaluate the decision NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Home and Community Based Settings Community Settings Rule Direct Support Professionals Must Understand: People will have the freedom and support to control their own NATIONAL ALLIANCE FOR PROFESSIONALS (NADSP) schedules and activities, and have access to food at any time. DIRECT SUPPORT People will be able to have visitors of their choosing at any time. People will have the freedom to furnish and decorate their sleeping or living units Are Direct Support Professionals Prepared? NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Step 1 1 Understanding the; Decision/Issue/Situation NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Step 2 2 Gathering Information NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Step 3 Explore Options and 3 Consider Outcomes NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Step 4 4 Decide, Act and Empower NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Step 5 Evaluate the Decision 5 NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Informed Decision-Making The NADSP 5 Step Process 1. Understand the decision/issue/situation 2. Gather information 3. Explore options & consider outcomes 4. Decide, act & empower 5. Evaluate the decision NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS (NADSP)
Vital Questions to ask … .. What kind of decision is being made? Has the person made a decision like this before? Has the person been assisted to understand the risks and benefits? How big is the impact of this decision in the person's life? How long would the person live with the decision? How hard would it be to undo? Most important: What is the least restrictive level of support that might work. NATIONAL ALLIANCE FOR DIRECT SUPPORT PROFESSIONALS
EXPERIENCE Something we get just after we needed it… SUPPORT PROFESSIONALS (NADSP) We all learn by experience-usually, NATIONAL ALLIANCE FOR DIRECT its bad experience… People we support need opportunities to EXPERIENCE different options in order to establish a preference. Those options may and will include some degree of risk!
PROVIDE CHOICE & ENSURE SAFETY? SUPPORT PROFESSIONALS (NADSP) NATIONAL ALLIANCE FOR DIRECT States & Providers must find the balance between choice and risk
PROVIDE CHOICE & ENSURE SAFETY? SUPPORT PROFESSIONALS (NADSP) NATIONAL ALLIANCE FOR DIRECT States & Providers must find the balance between choice and risk
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