Frontline Initiative Dual Diagnosis

Providing excellent support to people with dual diagnosis:
A Major League approach


Erin Paul, BS, OBHP, NADD-DSP is a Team Leader at Meridian Health Services

Does a major league pitcher win by throwing the same pitch to every batter every time? Does a singer advance his or her career by singing the same song every time he or she sings? Does a leader become great by reciting the same speech over and over? The answer, of course, is no. Just as doing the same thing as always doesn’t work for athletes, art­ists, and leaders, nor does it work when working with folks who have a dual diagnosis. A Direct Support Professional (DSP) can’t use the same methods with each person supported and expect posi­tive results. Every person is unique and requires a unique, individual­ized approach to intervention. Let’s discuss a couple of ways this can be done.

Work with a Team

You’ve heard the saying — two heads are better than one. Several minds and levels of experience can be very valuable when supporting individuals with particularly chal­lenging behaviors. Other people’s ideas might help uncover what the person’s core therapeutic issues really are and how you might best support him or her. Let’s go back to the baseball player. If a baseball player wants to win games and lead his team to victory, then he needs the help of his teammates. Teammates can help him increase his abilities, practice new and bet­ter plays, and become stronger at what he does. It is the same with supporting people with dual diag­noses. As a DSP, I rely on the help of my team.

I began my career working with adults and transitioned to work­ing with youth. The first youth I worked with was challenging for me. He had Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). He also had a number of other diagnoses. I worked very intensely with him as he had behaviors that put his participa­tion in school at risk. After weeks of trying the same way to work with him and realizing that wasn’t working, I sat down with several of my team members and dis­cussed other possible strategies. We talked about why he might have the behaviors he was hav­ing and what he may be getting out of it. We also discussed how to help him get the same result without having the inappropri­ate behaviors that put him at risk of classroom removal. Based on those conversations, I changed the environment in which I worked with him and added another person to the support team. I also addressed his behaviors in a different way that was more concrete for him. After some time, he was able to stop his own inappropriate behaviors with only a few reminders. Then he went on to successfully graduate. This was not thought to be a possibility when I started working with him. I believe the support and collabo­ration of my team were critical in allowing me to provide effective supports during the short amount of time I worked with him.

Seek Training

Search out and request training in areas that you may be less knowledgeable about. Trainings can be very beneficial in opening up your mind to new possibilities and other methods. I have at­tended some trainings that I found very useful and insightful. One of the most beneficial lectures I attended was given by someone living with the diagnosis that I was there to learn about. She talked about how she worked through her difficulties and what support strategies were most helpful. Not only was it inspiring, but it was the most informative lecture I had ever heard. I learned how some­one with a disability can succeed when she develops self-advocacy skills and participates in the com­munity.

There are lots of things a DSP can do to increase his or her knowledge and skills for support­ing people with dual diagnoses. The recommendations I have pro­vided are a couple of important key actions that DSPs can take to promote effective supports. Work­ing within a team and seeking out specific trainings have both shown to be positive strategies when supporting people with dual diagnoses. How might you utilize a team approach? What trainings or professional development op­portunities might be available?

*Adapted with permission from the DSP Interests and Concerns column in the NADD Bulletin (No­vember/December 2012, Vol. 15, No. 6.).