Frontline Initiative Dual Diagnosis

Individuals with dual diagnoses and the critical role of competent DSPs


Robert Fletcher DSW is the Founder and CEO of NADD

What’s the first thing that we need to know about supporting individuals with a dual diagnosis? It’s what we don’t know. Then it’s important to learn how to find out more.

It’s also important for us to understand the significance of the role of a Direct Support Profes­sional (DSP) in a person’s life. A DSP can play a key role in assuring that a person with an intellectual or developmental disability and mental illness (IDD/MI) receives appropriate assessment and treat­ment. Individuals who have IDD/MI have complex needs. They may have difficulties with their behav­ior, communicating with others or maintaining relationships. They may be at risk of being over-medi­cated, having their rights restricted or being abused or neglected. Of all the professionals who enter the life of a person with IDD/MI, it is the DSP who spends the most time supporting the individual in his or her pursuit of a fulfilling life.

Therefore, in partnership with individuals and their support team members, it is important that DSPs develop competency in critical areas. These competency areas enhance DSP skills and abilities to provide individualized support for people with dual diagnosis —

Assessment and observation

A DSP often has opportunities to observe an individual in a variety of daily living situations and how the person functions. Often other professionals on the person’s support team don’t get to see this full picture. It’s important that DSPs appreciate the significance of signs and patterns they notice, and how to document and com­municate the observations. See the article, Partnering on Mental Health Needs: DSPs on the Front­line, on page 10-11 in this issue for questions to think through when gathering information for a health care provider.

Behavior support

DSPs are often the first to note be­haviors or changes that are chal­lenging. DSPs can understand the function that behavioral changes may play in a person’s life. They can discover the best ways to sup­port the person, rather than trying to control the behavior.

Crisis prevention and intervention

At times individuals with IDD/MI may experience a crisis when their behavior leads to risk of immedi­ate and serious harm. Therefore, it is important that DSPs know how to identify the potential for a crisis and how to act to prevent it.

Health and wellness

Good health is a state of overall physical, mental and social well-being. It’s not just the absence of disease or illness. Promoting good health and wellness is an active process that requires daily effort. People with IDD/MI are at risk for more health and wellness prob­lems than people without; there­fore DSPs are called to play a role in mitigating these risks.

Community collaboration and teamwork

People with IDD/MI require as­sistance from many systems and professionals. Supporting their quest for a fulfilling life requires a team effort; DSPs can’t do it alone. Highly competent DSPs know how to communicate across the various systems and foster positive relationships.