DSP Year 1 Pre-Service Training

A developmental disability is a disability that:

• Begins before someone reaches 18 years of age
• Lasts throughout an individual's life
• Greatly limits three or more major life activities
• Often means there is a need for some kind of assistance

Types of developmental disabilities include:

• Intellectual Disability (ID): Significant limitations in intellectual functioning and adaptive behavior
• Autism Spectrum Disorder (ASD): A range of conditions involving challenges with social interaction, communication, and repetitive behaviors. Characteristics vary widely from person to person.
• Cerebral Palsy (CP): Affects muscle coordination and body movement. One characteristic is involuntary movements. Does not affect intelligence.
• Epilepsy: A condition characterized by recurring seizures — uncontrolled electrical activity in the brain.
• Down Syndrome: A condition caused by the presence of an extra chromosome, associated with some degree of intellectual disability and characteristic physical features.

The Lanterman Developmental Disabilities Services Act establishes the values that guide DSP work in California:

• Inclusion: People with disabilities belong in and contribute to the community
• Self-Determination: Individuals have the right to direct the course of their own lives
• Equity: People with disabilities deserve equal respect, opportunities, and rights as all citizens
• Advocacy: DSPs advocate with individuals for justice, inclusion, and full community participation
• Dignity and Respect: Every individual deserves to be treated with dignity and humane care

As a DSP you use five tools every day:

• 👁️ Observation: Looking and listening for things that could affect an individual's health and well-being. You notice changes in behavior, health, and environment.
• 🗣️ Communication: Sharing information clearly and listening actively. Essential for working with individuals, families, and your team.
• ⚖️ Ethics: Using your values to make the right decisions. Asking: "What is best for this individual? What is the right thing to do?"
• 🧠 Decision Making: Gathering information, thinking about options, and choosing the best course of action.
• 📝 Documentation: Recording accurate, objective information about individuals, incidents, and care provided.

The Platinum Rule:

"Treat others the way they want to be treated" — not just the way you would want to be treated. This means getting to know each individual's preferences, communication style, and values.

Professional Boundaries:

• Your role is as a professional support person — not a personal friend or family member
• Do not share personal phone numbers or social media with individuals
• Do not accept gifts or money from individuals or their families
• Keep all information about individuals confidential — do not discuss with friends, family, or others not involved in care
• Your attitudes and beliefs about disability directly impact your work — examine and challenge negative assumptions

• Department of Developmental Services (DDS): State department that administers California's developmental services system. Writes and revises Title 17 regulations. Contracts with regional centers.
• Regional Centers (21 in California): Private nonprofit organizations that determine eligibility, develop IPPs, and purchase services. Your facility is a vendor for regional center consumers.
• Disability Rights California: Legal advocacy organization that protects the rights of individuals with disabilities.
• State Council on Developmental Disabilities: Works with regional centers to ensure quality services under the Lanterman Act.
• Department of Social Services (DSS) / Community Care Licensing (CCL): Licenses and monitors ARFs, group homes, and other community care facilities. Enforces Title 22.

The IPP is a legally binding written agreement between the individual and the regional center.

The IPP contains:

• Goals: Things the individual wants in his or her future
• Objectives: A time frame for achieving the goals
• Plans: The steps to achieve the goal — who will do what and by when

Your role as a DSP:

• Follow the directions in the IPP about how to support the individual
• Document your implementation of IPP goals and objectives
• Help the individual prepare for their IPP meeting — ask them about their hopes, dreams, and goals
• Report any changes in the individual's needs to your supervisor

IPP Review:

• Reviewed at least once per year (or sooner if needed)
• Service coordinator visits the individual at least once every three months to monitor implementation

Under the Lanterman Act, individuals with developmental disabilities have the same rights as everyone else, including:

• Right to services and supports to live the most independent, productive life possible — including choices about where to live, work, and spend time
• Right to dignity and humane care — DSPs must treat individuals with respect and ensure a safe, comfortable environment with privacy in personal care, mail, phone, and personal space
• Right to participate in public education
• Right to prompt medical care and treatment
• Right to religious freedom and practice — DSPs cannot tell individuals what to believe or stop them from practicing their religion
• Right to social interaction and community participation — choosing who they spend time with and where they go
• Right to physical exercise and recreation
• Right to be free from harm — no abuse, neglect, restraint, or seclusion
• Right to be free from hazardous procedures (e.g., electric shock to change behavior is prohibited)
• Right to services in the least restrictive environment
• Right to make choices about where they live, who they live with, relationships, how they spend time, and future goals

• The Department of Social Services (DSS) licenses homes for adults through its Community Care Licensing (CCL) Division
• DSS writes regulations called Title 22 — the rules for how you do your job in a licensed facility
• CCL facility evaluators visit homes at least yearly to ensure Title 22 compliance
• Capozzi Residential is licensed under Title 22 as an Adult Residential Facility (ARF)

The most important principle of risk management: Prevention is the number one priority.

Types of risk:

• Environmental risks: Objects or activities that may cause harm where an individual lives or works (unlocked medications, slippery floors, unlocked hazardous chemicals)
• Health risks: Medical conditions, allergies, or physical factors that require monitoring and management
• Behavioral risks: Behaviors that may cause harm to the individual or others

Risk Assessment Process:

1. Identify the risk — this is the first step
2. Evaluate the risk — how likely and how serious?
3. Get more information about the risk
4. Get help from the planning team to develop a risk management plan
5. Remove or reduce the risk
6. Monitor the situation

• 1. Physical Abuse: Hitting, pushing, hurting, or causing pain to an individual
• 2. Neglect: Refusing to help individuals who need help to eat, go to the bathroom, or stay clean. Failing to provide necessary care, food, medications, or shelter.
• 3. Financial Abuse: Taking or misusing an individual's money or property
• 4. Emotional/Psychological Abuse: Scaring, threatening, humiliating, or isolating an individual
• 5. Physical Restraint/Isolation: Falsely imprisoning someone; physically restraining a person without authorization; stopping an individual from going somewhere important to them
• 6. Sexual Abuse: Any unwanted sexual contact or exposure. Individuals with developmental disabilities are at significantly increased risk — more than 90% will experience sexual abuse at some point in their lives (Schwartz, 1991).

As a DSP working in a licensed care facility, you are a mandated reporter under California law.

What you must report:

• Any known or suspected abuse or neglect of a dependent adult
• Physical abuse, neglect, financial exploitation, isolation, sexual abuse

How to report:

• Report by telephone immediately to Adult Protective Services: 1-833-401-0832
• Send a written report to the Regional Center within 48 hours
• Notify your supervisor immediately

Special Incident Reports (SIR) must be filed whenever:

• An individual is missing
• There is a death of an individual, regardless of the cause
• An individual is injured and requires medical care
• An allegation of abuse or neglect occurs
• Law enforcement is involved

Community Care Licensing regulations say that a DSP may only assist with self-administration of medications that have been ordered or prescribed by a doctor, dentist, or nurse practitioner.

Key rules:

• DSPs may assist individuals to self-administer their medications — they do not administer medications (that requires a nurse)
• You may only assist with medications that are in their original pharmacy container with the original label
• Never change or scratch out any information on a medication label — only a pharmacist can change a label
• All medications must be stored in a locked, safe place not accessible to unauthorized individuals
• Over-the-counter medications may only be assisted with when ordered by a physician

Every medication label contains critical information you must verify before assisting:

• Individual's name: Is this the right person?
• Medication name: What is the drug?
• Prescribing doctor: Who ordered this medication?
• Dose: How much is given at one time?
• Frequency and timing: How often and when is it given?
• Route: How is it taken? (oral, topical, inhaled, etc.)
• Duration: For how long? (7 days, 10 days, ongoing)
• Expiration date: Is the medication still valid?
• Refills: How many refills are authorized?
• Warning labels: Any special instructions? (Take with food, avoid dairy, may cause drowsiness)

Before assisting with any medication, you should know:

• What is the medication and why is it prescribed?
• What is the proper dosage, frequency, and method of administration?
• What are the possible side effects and who should they be reported to?
• What should be done if a dose is missed?
• Are there special storage requirements?
• Are there foods, drinks, or other medications to avoid?
• What improvements should be expected, and when?

Reliable sources for medication information:

• The prescribing doctor or pharmacist — ask questions using a Medication Safety Questionnaire
• Medication information sheet from the pharmacy
• Physician's Desk Reference (PDR)
• www.drugs.com

The MAR is the legal record of every medication given to each individual.

Best Practice Standard:

Record every medication dose and every medication error.

• Document immediately after giving the medication — never before
• The MAR must be updated as indicated by directions on the medication label
• If a dose is missed or refused — document it with the reason
• Never pre-sign the MAR before the medication is given
• Errors: draw a single line through the entry, initial, date, and write a note
• Never use white-out or black out entries

A medication error must be reported as a Special Incident to the Regional Center and Community Care Licensing.

Steps when a medication error occurs:

1. Stay calm — do not panic or try to hide the error
2. Monitor the individual for any adverse reactions or changes
3. Notify your supervisor immediately
4. Contact the individual's doctor
5. If life-threatening — call 911 immediately, then notify doctor and supervisor
6. Call Poison Control (1-800-222-1222) if instructed
7. Complete a Special Incident Report

When a medication is discontinued:

• The facility must follow CCL regulations for medication destruction
• Discontinued medications may not be given to another individual
• Medications may be returned to the pharmacy in some cases — follow facility policy

When medication is taken away from the facility:

Medication taken away from the care facility must be packaged with a label containing:

• Facility name, address, and phone number
• Individual's name
• Name of medication and instructions for administration

Drug interactions can occur between:

• Two or more drugs — the most common type
• Drugs and certain foods (e.g., some medications cannot be taken with grapefruit juice or dairy)
• Drugs and supplements (e.g., St. John's Wort can interact with many medications)
• Drugs and alcohol

Drug interactions can cause a medication to be less effective, more potent than intended, or cause new unexpected side effects.

Examples of healthy habits DSPs support:

• Daily exercise — walking, biking, swimming, gym
• Adequate sleep and rest
• Balanced nutrition — following any dietary orders in the IPP
• Regular medical and dental checkups
• Practicing good hygiene — bathing, oral care, hand washing
• Avoiding smoking, excessive alcohol, and unsafe behaviors

A health history is documentation of an individual's past health and current health care needs. It includes:

• Medical diagnoses and conditions
• Current medications and prescribing physicians
• Allergies and food sensitivities
• History of hospitalizations and procedures
• Immunization records

The IPP and health care:

The document that explains the DSP's specific responsibilities in helping individuals maintain their best possible health is the Individual Program Plan (IPP). It contains:

• Goals, objectives, and plans for health care needs
• Specific DSP responsibilities
• A way to evaluate the success of health plans

How germs spread:

• Direct spread: Direct contact with an infected person
• Droplet spread: Coughing or sneezing near another person — the most common way respiratory illness spreads
• Indirect spread: Touching a contaminated surface then touching your face
• Biological spread: Through insects (mosquitoes, ticks)

Standard Precautions — Always:

• Hand washing: The #1 standard precaution. Wash for at least 20 seconds before and after direct care, after using the bathroom, before preparing food
• Disposable gloves: Wear when coming into contact with an individual's body fluids (blood, urine, feces, vomit, saliva)
• Proper glove disposal: Used disposable gloves must be thrown away — never recycled, stored, or washed for reuse
• Disinfecting surfaces: Use a solution of bleach and water to kill germs on surfaces

• Physical Obstacle: The individual is not physically able to brush their own teeth (limited hand control, wheelchair use, motor impairment). Your role: help them with only what they cannot do — support independence wherever possible.
• Behavioral Obstacle: The individual refuses to open their mouth for tooth brushing. Your role: use behavioral techniques — offer choices, use positive reinforcement, make it as comfortable as possible.
• Informational Obstacle: The individual does not know how to brush or floss. Your role: show them the proper way to brush, describe steps, give instructions at their level of understanding.

The goal of the oral hygiene session:

To remove plaque and prevent gum disease, tooth decay, and bad breath.

Correct brushing steps:

• Use a soft-bristled toothbrush and fluoride toothpaste
• Brush gums and teeth together — not just the tooth surfaces
• Brush for at least 2 minutes
• Use gentle circular motions — not side to side
• Brush all surfaces: outer, inner, and chewing surfaces
• Rinse thoroughly after brushing
• Floss daily to remove plaque from between teeth

Infection control during oral hygiene:

• Always wear disposable gloves — this prevents the spread of germs during the session
• Use a new, clean toothbrush for each individual
• Never share toothbrushes between individuals

In order to recognize a change that may be a sign of illness, the DSP must know the individual and what is normal for them.

Examples of changes in daily routine:

• Sleeping much later than usual
• Refusing food or drinking much less
• Unusual quietness or withdrawal
• Changes in bowel or bladder habits
• Increased irritability or agitation

When reporting changes, document:

• What the individual said or did that communicated the change
• Specific observations — not your opinions or diagnoses
• Date, time, and context

Call 911 immediately for:

• Choking
• Uncontrolled bleeding
• Unconsciousness or unresponsiveness
• Difficulty breathing or stopped breathing
• Seizure lasting more than 5 minutes or a first-time seizure
• Suspected heat stroke (102°F+, hot dry skin, rapid pulse)
• Suspected poisoning or overdose

Call the doctor for:

• Infection of a wound
• Fever below 102°F that persists
• Unusual symptoms you're unsure about

Treat at home with routine care:

• Minor cuts and scrapes
• Mild headache

What to do:

• Place the individual on their side to prevent choking — this is the correct first response
• Move hazards away from them
• Cushion their head
• Time the seizure
• Stay with them and remain calm
• Call 911 if the seizure lasts more than 5 minutes or the person is injured

What NOT to do:

• Do NOT restrain the individual's movements
• Do NOT place anything in the individual's mouth — this is a dangerous myth that can cause injury
• Do not leave the room during the seizure

Who is at risk for skin breakdown?

• Individuals who use wheelchairs
• Individuals who don't change positions often
• Individuals who are bedridden
• Individuals with limited sensation who cannot feel pressure

Prevention:

• Reposition individuals who cannot reposition themselves at least every 2 hours
• Keep skin clean and dry
• Use cushions or pressure-relieving devices as prescribed
• Check skin daily especially at bony prominences (heels, hips, tailbone)
• Report any redness or skin changes immediately

The correct way to prevent poisoning from household chemicals:

• Keep all poisonous products in locked cabinets — this is the required standard
• Never store household chemicals with food or medications
• Keep products in their original containers with original labels
• Dispose of old chemicals properly — do not pour down the drain without checking instructions

If you think an individual may have been poisoned — the FIRST thing you must do:

Call the Poison Control Center: 1-800-222-1222

• Do NOT make the individual vomit — this can make some poisonings worse
• Do not call neighbors for help
• Do not wait to call your administrator first if the situation is serious

Preventing falls:

• Use a rubber mat or bench in the shower — one of the most effective fall prevention strategies
• Keep floors clear — no loose rugs, cords, or clutter in walkways
• Clean up spills immediately
• Ensure adequate lighting in all areas
• Use appropriate assistive devices (walkers, grab bars)

If an individual who has fallen appears seriously injured or is bleeding:

• Call 911 for assistance
• Do NOT move the individual — moving someone with a spinal or hip injury can cause additional damage
• Stay with them and keep them calm until help arrives

Preventing fire injuries:

• Check smoke detectors monthly and replace batteries annually
• Keep a charged fire extinguisher on every floor
• Never leave cooking unattended
• Smoking only in designated areas — or not at all in your facility

If you smell smoke or discover a fire:

• Help ALL individuals out of the home — meet at the designated meeting place
• Do NOT go back for papers or belongings
• Do NOT take some individuals out and go back for others — get everyone out together
• Call 911 once everyone is safely outside

• PREPARE: Have the right things available — emergency kit with water, food, medications, first aid supplies, battery-powered radio, flashlight, individual records, and personal items for each resident
• PLAN: Decide who will do what. Know the disaster plan. Know evacuation routes and assembly points. Know which individuals need extra assistance.
• PRACTICE: Hold disaster drills so everyone knows what to do before an emergency happens. Knowing what to do is only useful if you know how to do it.
• PERFORM: Complete the right action in an emergency. Stay calm. Follow the plan.

72-Hour Emergency Kit must include for each individual:

• List of current medications and prescribing physician
• Currently prescribed medications on hand
• Emergency contact information
• Change of clothing, blankets
• Medi-Cal or insurance card and signed consent-to-treatment form

People communicate to give and get information.

The four parts of verbal communication:

1. Organizing the message
2. Sending the message
3. Receiving the message
4. Processing the message

Examples of nonverbal communication:

• Using facial expressions and gestures
• Body language and posture
• Eye contact or avoidance
• Moving toward or away from someone

Common communication barriers for individuals with developmental disabilities include:

• Limited verbal speech or unclear articulation
• Poor muscle control affecting voice quality
• Hearing loss
• Cognitive differences affecting message organization

DSP strategies:

• Give extra time for the individual to process and respond
• Face the individual and make eye contact
• Use simple, clear language — one idea at a time
• Use visuals, gestures, or AAC devices if used by the individual
• Confirm understanding — ask the individual to repeat back key information
• Never finish sentences for someone or assume you know what they want to say

When managing conflict, it is important to:

• Separate the person from the problem — focus on behaviors and situations, not personal character
• Listen to understand — not just to respond
• Stay calm and use a neutral tone
• Focus on solving the problem, not winning the argument

"I" Statements:

An "I" statement describes a problem from your perspective without blaming:

• ❌ "You" statement (blaming): "You never listen to me."
• ✅ "I" statement: "I feel unheard when I share my concerns and they aren't acknowledged."

Challenging behavior is usually an attempt to communicate.

Examples of what behavior may communicate:

• Making loud noises to get attention from staff — communicate a need or desire
• Refusing an activity to avoid something uncomfortable or unpleasant
• Hitting to express frustration, pain, or being overwhelmed
• Self-injurious behavior to communicate distress or seek sensory input

Proactive strategies address the cause before challenging behavior occurs:

• Follow consistent routines — predictability reduces anxiety and challenging behavior
• Offer choices whenever possible — even small choices support self-determination
• Modify the physical environment to be organized for easy access and comfort
• Ensure the individual's basic needs are met (hunger, thirst, sleep, pain)
• Teach replacement behaviors — acceptable ways to get the same need met
• Use positive reinforcement — acknowledge and reward positive behavior

The physical setting should be:

• Organized for easy access — items individuals need are within reach
• Calm and comfortable — not overly stimulating or chaotic
• Safe and predictable

Research shows that when individuals with challenging behaviors are placed in a group of people without challenging behaviors, the behavior often improves because the individuals:

• Learn how to behave from their peers — social modeling is powerful
• Have more meaningful activities and social connections
• Experience greater choice and self-determination
• Have their communication needs better met