Frontline Initiative: Health and Wellness

Supporting Routines to Encourage Health and Wellness


Erkia Brandon is a direct support professional at Penn-Mar Human Services in Glen Rock, Pennsylvania. Erkia can be reached at

Erkia Brandon is standing outside in the woods. She is smiling, with long brown extensions, and a long plaid shirt that is colored rust, black, and white. She is wearing a black knit hat. Her long fingernails are painted pink and she is wearing a ring on her left hand. There are green, yellow, and rust leaves on the trees and brown leaves on the ground.

Erkia Brandon, DSP, author.

As direct support professionals (DSPs), we provide person-centered supports every day to the people we support. The people I support have disabilities, and my role is to support them to be as independent as possible. Penn-Mar's mission is to ‘’support people to live courageously in pursuit of their best life.” I strive to provide this type of support each day to the gentleman I’ve been supporting since I started at Penn-Mar four years ago.

The person I support communicates non-traditionally, using gestures, sounds, grunts, and even taking your hand to lead you to what he needs or wants. He’s diagnosed with severe obsessive-compulsive disorder, autism, and mild intellectual disability, but these diagnoses don't define him. He’s independent with most things, including his laundry, showering, taking his own medications, and eating by himself. Along with his other support staff, I provide support in cooking, cleaning, and medication administration.

I saw how delayed he was from getting dressed and going out. I knew I could help address some of his routine/ritual preferences that led to time management issues.

Due to his diagnosis, he’s routine-oriented and ritualistic. He doesn't take his medications at typical medication times; rather, he takes them when he finishes a ritual or routine. He goes through each ritual and routine to move on to the next step. This can delay him in taking a shower, taking his meds, or getting dressed. Sometimes this will cause him to go days without getting dressed or leaving his house to go out into the community. I saw how delayed he was from getting dressed and going out. I knew I could help address some of his routine/ritual preferences that led to time management issues.

A man sitting in a booth in a restaurant, with short gray and white hair, smiling and wearing a red Champion brand sweatshirt. His arms are resting on the table and his hands are on a food menu.

Dennis smiles as he looks over the menu at a restaurant.

First, due to his routines and being delayed on certain days, we now schedule his appointments on the days he can complete his routines and be ready for appointments. This is typically Tuesdays and Saturday mornings. Since most offices aren’t open on the weekends, we try to do all his appointments on Tuesdays. His other support staff and I ensure that he attends each of his follow-up appointments with his primary care provider, his psychiatrist, his dentist, and preventive appointments. By doing this, we are encouraging his healthy state of being, such as balancing his nutrition and mental well-being.

Since he doesn't communicate with words, we ‘’seek other ways to understand’’ him, as stated in the Code of Ethics. He would yell in certain areas of his house if he didn’t have what he needed to complete his routine. This was alarming for us DSPs. I know he feels misunderstood at times. Together with the team, we made a chart of things that relate to his everyday routines. Sometimes when he was ready to do a routine, the things he needed would be missing in certain areas of the house, and this caused problems. The chart listed what he needed in each area of the house. For example, in the bathroom, does he have oral care items? His shower things? Does the laundry room have detergent to wash his clothes? Does the kitchen have everything he needs, such as silverware or drinks that he likes? Making this chart helped communicate what he wanted in place, and it decreased his challenging behaviors. It also helped his time management by having everything he needed set out for him so it wouldn’t delay him any further.

What is Missing?

If Dennis wants to go into the office:

Does he have oral care in this bedroom

Does he have a med cup with body wash? (Shower Days)

Does he need more toilet paper?

Does he need laundry detergent?

Is he missing any pills?

Does he want to change the calendar to the next month?

Does he need bath towels / socks with initials?

Does he need a dishwasher detergent tab?

Does he have a pan he would like to put away on a shelf in the office?

If Dennis wants to go into the pantry?

Would he like a snack or drink?

Is he missing any of his silverware, plates, etc. from the dishwasher? (1 set of silverware, 1 dinner plate, 1 lunch plate, 1 bowl, and 1 small cup)

Does he need trash bags? He keeps them in the far right drawer next to the dishwasher.

Does he want toast and butter?

A chart of Dennis's needs.

Man with short blonde hair, smiling, and wearing a red pullover shirt with a 1/4 zipper down the front, with stitching of two cardinals. He is sitting in a booth in a restaurant.

Dennis smiles as he waits for his meal.

As DSPs, we also observe him diligently for any marks on his body. He is known to self-injure when he’s upset or doesn't have what he needs right away. Since he is prone to cellulitis, which causes swelling of his feet or ankles, we sweep and mop the floor every day because any small cut on his feet can cause infection. We encourage healthy meals for the person I support, including a high-fiber diet, as instructed by his doctors. His challenging behaviors can get intense, so he needs 2:1 staffing in his home. We communicate regularly with his behavioral supports coordinator to help with this and try to find other ways to decrease his challenging behaviors. He also meets with a behavioral consultant at the Center for Autism and Developmental Disabilities. We all work together, aiming to enhance his well-being.

As DSPs, we encourage the people we support to enhance their health and well-being. Health and wellness impact your life by improving your chances of living longer and healthier. It improves your overall mood and can prevent chronic diseases and long-term illness. It also makes you feel good about yourself. Taking care of your health is important for your self-esteem, as is maintaining a healthy lifestyle by doing what’s right for your body.

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