Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services

General Notice
UIpdated DSP and Supervisor Competencies Checklist (DMAS Form P241a)
Date Posted: 5/19/2021
Expiration Date: 10/19/2021
Submitted to Registrar for publication: YES
30 Day Comment Forum closed. Began on 5/19/2021 and ended 6/18/2021   [14 comments]

Developmental Disabilities DSP and Supervisor Competencies Checklist

 (for DD Waiver providers of Agency-Directed Personal Assistance, Agency-Directed Companion, Agency-Directed Respite, Center-based Crisis Services, Community-based Crisis Services, Crisis Support Services, Community Engagement, Community Coaching, Group Day Services, Group Home Residential, Group Supported Employment, Independent Living Supports, Individual Supported Employment, In-Home Support Services, Sponsored Residential, Supported Living Residential,  and Workplace Assistance)

The Direct Support Professional (DSP) Competencies Checklist is designed to ensure a more consistent level of expertise among DSPs and Supervisors who provide supports in Virginia’s developmental disabilities (DD) services system. “DSP” refers to staff members identified by the provider as having the primary role of assisting an individual on a day-to-day basis with routine personal care needs, social support, and physical assistance in a wide range of daily living activities so that the person can lead a self- directed life in his own community. The Competencies Checklist was developed by professionals with knowledge in best practices and in accordance with established orientation requirements for Virginia’s DD waivers per 12VAC30-122-180. The three competency areas are: 1. Demonstrates person-centered skills, values, and attitudes; 2. Understands and follows service requirements; and 3. Demonstrates abilities that improve or maintain the health and wellness of those whom they support.

To ensure the health and wellness of people receiving services, Competency 3 and all related skills must be confirmed as competent prior to providing support in the absence of paid staff who have demonstrated proficiency with this competency. Competent refers to the minimum required for acceptability where proficiency establishes an ongoing level of ability.

This checklist serves as a tool to document that proficiency was confirmed in the required competency areas. The focus is on basic DSP and supervisor ability to meet the requirements of the DD waivers and to support individuals to have a life that includes what is important to each person based on his or her own desires and what is important for each person in terms of health, safety, and value in the community. The initial and ongoing completion of this checklist is the responsibility of direct supervisors who oversee the work of DSPs providing support under any of Virginia’s DD waivers. A supervisor’s ability to meet the three required competencies is determined by the provider’s director (or designee), as well as through site visits conducted during DMAS, and as applicable DBHDS, program reviews. The elements of this checklist can be incorporated into established agency practices providing they are incorporated fully to include the type of training received, the three competencies and all related skills, as well as any observations that support the determination and confirmation of proficiency.

The columns in the checklist serve as a location to document the type of training received and the level of ability with each competency and related skills. The Training Received checkboxes are for recording the type of formal and informal training efforts related to the competency. Training can be obtained in a 1:1 setting, through group training, or through formal education such as a professional degree, online learning courses, or college courses that relate to the item. Evidence of training or education must be maintained for each individual and can cover one or more competencies as long as course content includes related information. The Observation (indicators) column serves as a guide to provide examples of what is observed to establish that the skill is present. An indication of one or more observations in this column substantiates the level of proficiency observed. This list is not meant to be all inclusive and may be supplemented by dates and comments provided in the last column. The Implemented Skills (tracking) column provides space to indicate staff ability based on direct observations during the 180 day period while identifying strengths and needs. DSPs or supervisors may demonstrate one of four levels of ability, which progresses from a basic understanding to proficiency:

  • Basic understanding: The individual is able to communicate a fundamental education of the skill or action; high level of supervision needed
  • Developing: The individual is in the process of establishing the ability or is showing some, but not all, aspects of the skill or action in practice; moderate level of supervision needed
  • Competent: The individual demonstrates all of the skills or actions in column two, but not on a routine basis as appropriate to the skill or action; low level of supervision needed. Competency refers to the minimum required for acceptability
  • Proficiency Confirmation: The individual demonstrates all aspects of the skill or action on a routine basis in practice as appropriate to the skill or action; minimal supervision needed. Proficiency establishes an ongoing level of ability.

The last column, Proficiency Confirmation, is a location to confirm that proficiency is achieved. Staff must consistently demonstrate each related skill and action to verify that proficiency is present. All skills and actions must be confirmed as “proficient” to establish an understanding and demonstration of the competencies necessary to support individuals with developmental disabilities under the DD waivers. By the end of the 180-day evaluation period from the date of hire, individuals must consistently demonstrate all skills and actions under each competency, with checkmarks of confirmation in the last column. The competency is then considered to be met and can be dated and initialed by the approving supervisor, director, or director’s designee.

DSPs and supervisors are deemed competent once all related skills and behaviors have been confirmed and indicated on the checklist, including noting as not applicable (NA) if an action related to any skill does not apply in the current role. Proficiency is established when the skills are observed over time and each area must be confirmed as proficient within 180 days. Each competency must be dated and initialed by the supervisor for DSPs or the agency director (or designee) for supervisors.

This checklist must be reconfirmed (and updated as appropriate) at least annually to ensure that DSPs and their supervisors are proficient in the competencies as described. Competencies may be documented on this tool, or adapted into an alternative format as long as the competencies and areas of reporting remain consistent with this document. The initial completion of the checklist and annual updates must be maintained in the staff personnel file and available for review by the Department of Behavioral Health and Developmental Services, the Department of Medical Assistance Services, and other reviewers as required.

If at any time a DSP or DSP Supervisor is found to be deficient in any competency area, the provider must document actions taken and the date that restoration of ability is confirmed pursuant to 12VAC30-122-180. Agencies with DSPs or DSP supervisors who have failed to pass the orientation test or demonstrate competencies as required will be referred to DMAS Program Integrity for consideration of additional actions.

Competencies, Skills & Abilities

Observation (indicators)

DSP

Supervisor

Implemented Skills (tracking)

Proficiency Confirmation

Competency 1

Demonstrates person-centered skills, values and attitudes

Training Received:

1:1,        Group,        Formal education

Enter supervisor initials and date when proficiency determined or reconfirmed for all elements of

Competency 1 →

 

1.1 Facilitates interactions with others in natural settings with persons without disabilities (other than those paid to support the individual)

Demonstrates including individuals in conversations (e.g. with cashiers, neighbors, salespeople, hairdressers)

Assists in communication with parents and family (e.g., phone calls, visits, letters)

Assists in getting to know

neighbors

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.2 Supports individuals to participate in naturally occurring community activities that reflect the individuals’ preferences

Names at least 3 possible community activities that address what is important to the people they support

Assists with developing community interests (e.g., strengthening friendships, going places liked, using local

businesses)

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.3 Communicates understanding of what is important TO

Articulates what’s needed for people they support to be happy, content, and fulfilled

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.4 Communicates understanding of what is important FOR

Articulates what’s needed for health, safety and value in community for the individuals they support

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.5 Communicates effectively with individuals about support being provided

Asks permission before touching

States steps about to occur when providing supports

Uses respectful language/

tone

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.6 Demonstrates person-first language

Refers to people by name rather than disability

Speaks directly to the person supported

Demonstrates active

listening

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.7 Recognizes behavior as a form of communicating

Gives 3 examples of how actions convey messages (e.g. damaging property can mean a person feels pain or boredom)

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

1.8 Involves individuals in choice throughout their days

Provides choice of clothing Provides choice of foods Provides choices about

where to go

 

 

basic understanding developing competent

proficiency confirmed

Competencies, Skills & Abilities

Observation (indicators)

DSP

Supervisor

Implemented Skills (tracking)

Proficiency Confirmation

 

Provides choices about who to go with

Provides choices about when to go

Provides choices about free

time

 

 

Comments:

Comments:

1.9 Serves as a model for Direct Support Professionals by demonstrating respectful communication

Models respectful communication by using a polite tone with clear instructions

Models including people supported in conversations

Models active listening

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

Competency 2

Understands and follows service requirements

Training Received:

1:1,       Group,      Formal education

Enter supervisor initials and date when proficiency determined or reconfirmed for all elements of

Competency 2 →

 

2.1 Describes the service being provided

Conveys the purpose of the service provided in accord with the service definition

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

2.2 Describes outcomes, support activities, and instructions on Plans for Supports for individuals supported

Locates individual support plans and instructions;

Describes the plans for the person(s) they support

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

2.3 Maintains required documentation that is timely and factual

Completes documentation correctly

Completes documentation within required timeframes; Writes a signed, dated note that meets Medicaid requirements by including

the support provided, person’s response to the

support, and

any additional actions

needed

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

2.4 Works cooperatively with individuals, families, co- workers, professionals and others

Consistently demonstrates punctuality for planned meetings;

Demonstrates respectful communication with

individuals, families, and

other professionals

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

2.5 Communicates the expectations and

Describes DSP role effectively;

 

 

basic understanding developing

competent

proficiency confirmed

Competencies, Skills & Abilities

Observation (indicators)

DSP

Supervisor

Implemented Skills (tracking)

Proficiency Confirmation

responsibilities to the DSPs they supervise

Provides clear instructions to those they supervise

 

 

 

Comments:

 

Comments:

2.6 Provides DSPs with guidance or takes remedial action to the extent necessary to ensure: a) provision of services and b) necessary documentation

Responds professionally to concerns with performance by

following agency procedures around performance management

maintains documentation per policies

minimizes or eliminates related risks to those

supported

 

 

basic understanding developing competent

 

Comments:

proficiency confirmed

 

 

Comments:

Competency 3 and all related skills must be confirmed as competent prior to providing support in the absence of paid staff who has demonstrated proficiency with this competency.

Competency 3

Demonstrates abilities that improve or maintain the health and wellness of those they support

Training Received:

1:1,       Group,      Formal education

 

 

NOTE: Two confirmations are required for this section. All DSP and DSP Supervisors must be confirmed as “competent” in all of the skills in Competency Area 3 prior to working in the absence of staff who have been determined proficient in this area. Competence is established when all observation indicators in column two have been observed. Proficiency must be confirmed within 180 days of hire or original contract date for contracted staff.

Enter supervisor initials and date when competence* is determined for all elements of Competency 3 ↓

Enter supervisor initials and date when proficiency determined for all elements of Competency 3 ↓

 

 

3.1 Conveys a basic understanding of the health information for the people they support

Describes the identified health and behavioral support needs for each individual and their role in providing support to each person

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.2 Conveys an understanding of the steps needed to ensure medications are provided as prescribed to include providing medications or contacting qualified staff who can provide medications

Successfully locates medication and side effect information according to agency standards;

Demonstrates ability to administer medication by the right dose, method and person;

Describes process for reporting unusual health events according to agency

procedures

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.3 Correctly follows nutrition plans and meal preparation guidelines (including the use of thickeners, special textured food preparation such as pureed and chopped consistencies and uses the correct utensils)

for all individuals supported

Demonstrates steps needed to prepare foods according to individual needs

Provides supports correctly according to individual plans

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

Competencies, Skills & Abilities

Observation (indicators)

DSP

Supervisor

Implemented Skills (tracking)

Proficiency Confirmation

3.4 Operates and maintains adaptive, orthopedic, and communicative equipment correctly

As appropriate, correctly uses communication devices, locking wheels on

wheelchairs,

making walkers available, using mechanical lifts

correctly,

cleaning wheelchairs and checking them for safety,

applying splints/socks

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.5 Demonstrates providing proper oral hygiene for the individuals they support

Provides support with oral care consistently and correctly based on individual needs

Describes the importance of and ways to maintain good

oral health

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.6  Explains the process for observing and reporting changes in behavioral or health status to include:

 

a.  How to monitor and document changes

b.  When to call a supervisor

c.  When to call REACH/Emergency Services

d.  When to call 911 (medical or police)

Describes role in monitoring and documentation up to and including the appropriate notification of the health or behavioral event

Describes role in notifying a supervisor when non- emergent changes in health and/or behavioral status occur

Provides two examples (one medical and one behavioral) of circumstances that require a 911 call

Describes role in contacting 911 immediately when serious health events occur

Describes role in contacting REACH/Emergency Services immediately when serious behavioral events occur

Explains process of scheduling, keeping, and following through on all health

appointments

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.7 Demonstrates an understanding of the requirements of adhering to privacy requirements

Describes standards of confidentiality and ethical practice (i.e. adheres to polices for release of information, shares information on as needed basis, etc.)

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.8 Accurately records health data/information (e.g. seizures, falls bowel movements, intake/output, etc.)

Records data per agency requirements

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

3.9 Implements health and behavioral plans as written

Assists with completing personal care (e.g., hygiene and grooming) activities.

 

 

basic understanding developing competent*

proficiency confirmed

Competencies, Skills & Abilities

Observation (indicators)

DSP

Supervisor

Implemented Skills (tracking)

Proficiency Confirmation

 

Assists individuals in implementing health and medical supports

 

 

Comments:

Comments:

3.10 Maintains a safe environment

Assists person with household management (e.g., meal prep, laundry, cleaning, etc.)

 

 

basic understanding developing competent*

proficiency confirmed

 

Comments:

3.11 Adheres to safety procedures

Follows evacuation procedures correctly

 

 

basic understanding developing competent*

proficiency confirmed

 

Comments:

3.12 Describes role in recognizing and reporting abuse, neglect, and/or exploitation (A,N,E)

States three possible signs of A,N, E (i.e. one for physical, sexual or verbal/psychological abuse; one for neglect ;and one for exploitation)

 

States three proactive things providers can do to prevent abuse, neglect and exploitation of individuals by their employees

 

States steps needed to report suspected A, N, E to DBHDS and the Department of Social Services within 24 hours and as required by agency

policies

 

 

basic understanding developing competent*

proficiency confirmed

 

Comments:

3.13 Provides guidance to Direct Support Professionals on identifying individual-specific changes that may indicate the need for an emergency response or team meeting

Explains DSP role effectively in identifying potential concerns and responding in agreement with agency standards

 

 

basic understanding developing competent*

 

Comments:

proficiency confirmed

 

 

Comments:

Billing under the DD waiver must cease when competency requirements are not met initially after 180 days (or annually upon review) and may resume once competencies are confirmed (or reconfirmed) as indicated by signatures and dates signed below.

Employee’s Printed Name

Employee’s Signature                                                                                                       Date

Supervisor’s Printed Name                                                                                                 Title

Supervisor’s Signature                                                                                                         Initials Date

 

These competencies must be updated annually by the supervisor for DSPs, or the agency’s director (or designee) for supervisors. Providing a signature and date of review below confirms that the DSP or supervisor continues to meet these competencies. The following updated form may be utilized for three consecutive years before a new checklist is needed for updates. A new competency checklist form must be completed in the fifth year.

Annual DSP and Supervisor Competencies Updates

Second year

Third Year

Fourth year

Complete the appropriate section below:

Complete the appropriate section below:

Complete the appropriate section below:

I have observed that the employee continues to meet DBHDS-standards by demonstrating the skills and behaviors in each of the three required areas:

I have observed that the employee continues to meet DBHDS-standards by demonstrating the skills and behaviors in each of the three required areas:

I have observed that the employee continues to meet DBHDS-standards by demonstrating the skills and behaviors in each of the three required areas:

1.  Person-centeredness,                                  Initials

2.  Following service requirements,               

Initials

3.     Supporting health and wellness.             

Initials

1.  Person-centeredness,                                     Initials

2.  Following service requirements,                 

Initials

3.     Supporting health and wellness.              

Initials

1.  Person-centeredness,                                    Initials

2.  Following service requirements,                

Initials

3.     Supporting health and wellness.             

Initials

 

 

Printed name                                Initials

 

 

Printed name                                Initials

 

 

Printed name                               Initials

 

Signature

 

Signature

 

Signature

 

Date

 

Date

 

Date

If at any time a DSP or DSP Supervisor is found to be deficient in any competency area, the provider must document actions taken and the date that restoration of ability is confirmed pursuant to 12VAC30-122-180.

Proficiency is confirmed (or reconfirmed) as indicated by signatures and dates signed below.

If at any time a DSP or DSP Supervisor is found to be deficient in any competency area, the provider must document actions taken and the date that restoration of ability is confirmed pursuant to 12VAC30-122-180.

Proficiency is confirmed (or reconfirmed) as indicated by signatures and dates signed below.

If at any time a DSP or DSP Supervisor is found to be deficient in any competency area, the provider must document actions taken and the date that restoration of ability is confirmed pursuant to 12VAC30-122-180.

Proficiency is confirmed (or reconfirmed) as indicated by signatures and dates signed below.

 

 

 

Printed name                              Initials

 

 

 

Printed name                               Initials

 

 

 

Printed name                              Initials

 

Signature

 

Signature

 

Signature

 

Date

 

Date

 

Date

Contact Information
Name / Title: Emily McClellan  / Regulatory Manager
Address: Division of Policy and Research
600 E. Broad St., Suite 1300
Richmond, 23219
Email Address: Emily.McClellan@dmas.virginia.gov
Telephone: (804)371-4300    FAX: (804)786-1680    TDD: (800)343-0634