Impact Feature Issue on Supporting Wellness for Adults with Intellectual and Developmental Disabilities

Direct Support Professionals (DSPs) can, and do, play important roles in maintaining the health and wellness of persons with intellectual and developmental disabilities (IDD). How they fulfill that role is influenced by the commitment of service provider organizations to wellness for both those they support and those they employ. This article looks at specific ways that wellness for persons with IDD, and wellness for DSPs, are connected and can be supported.

How DSPs Can Support Others' Wellness

DSPs can assist individuals with IDD to stay on track in following established routines that support health and wellness. They can help prioritize healthy activities over less healthy activities, especially when stressors disrupt routines (e.g., if dinner is running late, the walk following dinner can still happen, but perhaps it’s a shorter walk). DSPs can assist individuals with IDD to monitor for, and recognize, important changes in their physical, behavioral, and psychological status. When there are concerns, DSPs can help individuals address those concerns. Experienced DSPs know that sudden changes in behavior (e.g., anger, aggression) are often signs of a health problem (e.g., pain, hunger, too little sleep, depression) and should be treated as such. Finally, when healthy routines get disrupted, DSPs can help individuals reestablish those routines.

Some of the specific ways that DSPs can partner with individuals with IDD to support health or wellness goals and objectives are the following:

• Routinely review expected outcomes of the individual’s service plan related to health and wellness, including basic information on short-term goal(s).
• Review possible activities to support short-term goal fulfillment, including who else should be included in the activities and where they’ll take place.
• Review options for scheduling or rescheduling activities.
• Assist the individual to plan for, and receive, meaningful rewards or acknowledgments as they achieve milestones in health and wellness goals.
• Assist with the ongoing recording and tracking of health and wellness activity and progress.

These kinds of initiatives could facilitate DSP fulfillment of wellness roles and responsibilities for others, as well as their own well-being.

Wellness and DSP Turnover

Some of our early research on DSPs and the health and wellness of persons with IDD showed that turnover of DSPs contributed to increased limitations due to secondary and other health conditions among persons with IDD affected by those staffing changes (Traci, Seekins, & Seninger, 2001). Specifically, individuals with IDD experienced increased limitation due to psychological, social interaction, hygiene, allergy, memory, and balance problems, as well as injuries due to accidents or seizures. These findings were consistent with other research showing that adequate personal assistance services were associated with better health outcomes, such as fewer pressure sores and infections, better fitness, and uninterrupted sleep (Kaye, Chapman, Newcomer & Harrington, 2006; Kay, Harrington, & LaPlante, 2010; LaPlante, Kay, Kang, & Harrington, 2004; Rimmer & Rowland, 2008; and Nosek, Fuhrer & Potter, 1995). Increasing DSP stability, and the communications and routines they support, is an essential part of sustaining health and wellness of individuals with IDD.

One approach to reducing turnover is to attend to the health and wellness of DSPs by creating a culture of wellness in service provider agencies. In Montana, for example, we have promoted health and wellness resources to DSPs, including models to increase their access to health insurance and better pay, and awareness of public health programs such as the Quit Line, cancer screening programs, and health education classes. Recently, we have begun promoting Worksite Wellness as a comprehensive approach to improve the health and wellness of DSPs because a reduction in absenteeism, and an increase in staff retention, are among the demonstrated outcomes of comprehensive Worksite Wellness programs (U.S. HHS, 2015; Baicker, Cutler & Song, 2010). We see this approach as a possible means for increasing stability in the DSP workforce, thereby improving health and wellness for the individuals they support.

The Montana Worksite Health Promotion Coalition gives employers bronze, silver, and gold awards in recognition of excellence in Worksite Wellness programs at three levels: basic, enhanced, and comprehensive. With our partners, we have begun to ask, “What if service provider organizations that support individuals with IDD were counted among those employers?” Consider, for example, the potential to integrate health and wellness training resources for staff into existing DSP training systems. (For ideas of how this might work, see information on NIOSH’s Total Worker Health® , and the CDC Workplace Health Promotion toolkit. These kinds of initiatives could link service organizations to a community’s culture of wellness in ways that would facilitate DSPs’ fulfillment of wellness roles and responsibilities for others, as well as their own well-being.

Designing effective and principled guidance to support DSP performance in these areas is very much the work of our time.

The Role of Supervision and Training

Another component of assisting DSPs to provide stable health and wellness support for individuals with IDD is training and supervision of DSPs. Within the National Frontline Supervisor Competencies (Sedlezky, Reinke, Larson, & Hewitt, 2013) are 16 competencies specifically dedicated to supporting the health and wellness of persons with IDD. In most of the health and wellness competencies, frontline supervisors are to provide guidance to DSPs on their roles and responsibilities related to the following items:

• Individualized risk management in all areas of health and safety (e.g., assist with maintaining assistive technologies such as eye glasses, mobility and communication devices).
• Medication administration (e.g., maintain current training on medication administration).
• Health monitoring, documentation, and response (e.g., support routine use of paper or electronic activity logs for exercise, sleep, food intake, water consumption, etc).
• Infection control (e.g., follow handwashing and sick leave policy).
• Health communications (e.g., post menus in accessible formats and read food labels, explaining as necessary).
• Patient rights and protection, including end-of-life care (e.g., know and represent organizational policies to health care providers).
• Emergency preparedness and response (e.g., support individuals to participate in fire drills and other emergency exercises).
• Culturally-competent health care for persons with IDD (e.g., support consistent, repeated use of health care provider instructions in plain language and with illustrations as needed).
• Support plans designed to promote wellness (e.g., communicate daily progress on goals and objectives).
• Behavioral and environmental arrangements to increase healthy choices (e.g., help plan and prepare healthy food options; arrange environment to promote sleep hygiene).
• Community-based health promoting activities and social support (e.g., support walks or hikes with friends).

Designing effective and principled guidance to support DSP performance in these areas is very much the work of our time. For instance, the agenda set forth in the Affordable Care Act to improve health care outcomes has increased the readiness of health care practitioners to partner with disability stakeholders on the health of persons with IDD, as well as on clinical-community linkages . Investments in health care systems to strengthen these linkages are leading to a variety of care management and care coordination resources that may support the competencies of frontline supervisors and their capacity to provide effective and principled guidance to DSPs.

Conclusion

The roles and activities of DSPs have evolved as a complex and core set of supports for self-determination, freedom, and choice within community service systems. Integrating evidence-based, health management and promotion knowledge into effective guidance for DSPs should build on this foundation. In combination with adopting Worksite Wellness programs, these approaches can support persons with IDD to be well, strengthen service provider organizations’ capacity to recruit and retain DSPs, and contribute to development of community health and wellness resources.

• Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings. Health Affairs, 29(2), 304–311.

• Kaye, S. H., Chapman, S., Newcomer, R. J., & Harrington, C. (2006). The personal assistance workforce: Trends in supply and demand. Health Affairs, 25(4), 1113–1120.

• Kaye, S. H., Harrington, C., & LaPlante, M. P. (2010). Long-term care: Who gets it, who provides it, who pays, and how much? Health Affairs, 29, 11–21.

• LaPlante, M. P., Kay, S. H., Kang, T., & Harrington, C. (2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journal of Gerontology: Social Sciences, 59B(2), S98–S108.

• Noesk, M. A., Fuhrer, M. J., & Potter, C. (1995). Life satisfaction of people with physical disabilities: Relationship to personal assistance, disability status, and handicap. Rehabilitation Psychology, 40(3), 191–202.

• Rimmer, J. H., & Rowland, J. L. (2008). Health promotion for people with disabilities: Implications for empowering the person and promoting disability-friendly environments. American Journal of Lifestyle Medicine, 2(5), 409–420.

• Sedlezky, L., Reinke, J., Larson, S., & Hewitt, A. (Eds.). (2003). National Frontline Supervisor Competencies. National Frontline Supervisor Competencies. Minneapolis: University of Minnesota, Research and Training Center on Community Living Institute on Community Integration.

• Traci, M. A., Seekins, T., & Seninger, S. (2001). Relationships between direct service staff turnover and the experience of secondary conditions. Paper presented at the annual meetings of the American Public Health Association.

• U.S. Department of Health and Human Services (HHS). (2015). Assessment of health risks with feedback to change employees’ health. Washington, D.C.: Author.