Certification/Accreditation for IDD/MH: Raising the Bar

Dan Baker, PhD, NADD-CC

Melissa Cheplic, MPH, CHES, NADD-DDS

Robert Fletcher, DSW, NADD-CC

Terrence McNelis, MPA, NADD-DDS

Donna Nagy McNelis, PhD, NADD-CC

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November 2015

2Standards for Quality-

ID/MH

4 Separate but interrelated competency-based quality standards programs:

Certification for direct support professionals (DSP) Certification for specialists Certification for clinicians Accreditation for programs

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3 Quality Standards are Important to:

Provide monitoring and feedback on state-of the art and best practice support & treatment;

Assist organizations, clinicians, person receiving services, families/advocates & insurance companies to make informed choices about quality of services;

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4 Purpose of Program

Provide a workforce and system with a demonstrated level of expertise;

Assure that public and private healthcare dollars are purchasing effective services;

Assist families/advocates to make informed choices about services.

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5 Purpose of Program

Promote & advance the field of DD/ID & MH by establishing competencies to ensure the highest standard of care;

Develop & coordinate a system of evaluation and credentialing for programs and personnel;

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6Purpose of Program

Increase effectiveness of supports, diagnosis, and treatment ;

Recognize programs, clinicians, specialists and support staff that achieve full certification through the NADD review process.

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7 What Is Accreditation

Designation that a program is providing quality services;

“Seal of Quality” that reflects that a program of an organization has met a standard of care, support, and/or treatment.

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8What Is Credentialing

Review process designed to establish standards of practice;

Identifies skills, knowledge, values, and attributes needed in a particular field.

•Partner

• The Accreditation and Certification Programs were developed by NADD in association with the

National Association of State Directors of Developmental Disability Services (NASDDDS)

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Committee Participants

Contributors from United States and Canada

Professionally diverse

Different agency/program types represented

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Direct Support Professional Credentialing

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DSP Certification

Develop certification for Direct Support Professionals working with individuals who have IDD/MI;

Identify competencies to evaluate the DSP’s knowledge, values, skill, and ability working with people with IDD/MI;

Increase the capacity of DSPs to work with individuals with IDD/MI;

Acknowledge the importance of the DSP in providing treatment and support to people with IDD/MI.

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DSP Considerations

Workforce

Age / Education / Background

Earnings

Turnover

Variability in Experience

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Credential

• Affordable

• Achievable

• Comprehensive

• Meaningful

Goals

Ensure use of best practices in providing supports to individuals who are dually diagnosed;

Evaluate existing curricula and certification programs, supplemented with relevant IDD/MI information;

Identify competency areas, operationalize applicable skills, and develop an application and evaluation process for credentialing.

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Skills & Key Indicators

Acknowledge diverse backgrounds Person-centered language Self-directed supports Agency/state or province policy & guidelines Elements of critical thinking & communication in

each area

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Competency Standards in Five Areas

Assessment and Observation Behavior Supports Crisis Prevention and Intervention Health and Wellness Community Collaboration and Teamwork

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Assessment and Observation

Knowledge and assessment of the observation process;

Use of assessment and observational tools; Behavior assessment; Documentation and communication related to

assessment and observation.

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Behavior Support

Knowledge and assessment of the causes and functions of challenging behavior;

Maintaining a supportive physical and social environment;

Responding to challenging behavior; Teaching new behaviors and skills.

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Crisis Prevention and Intervention

Knowledge and use of crisis prevention strategies;

Knowledge and use of crisis intervention strategies;

Documentation and communication related to crisis situations;

Managing stress and burnout.

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Health and Wellness

Knowledge of health and wellness; Knowledge of intellectual and developmental

disabilities, mental health and co-occurring disorders;

Use and implications of medication; Illness management and recovery; Documentation and communication related to

health and wellness.

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Community Collaboration

and Teamwork

Knowledge of Service Systems; Communication Across Systems; Building Positive and Cooperative Relationships; Promoting Person-Centered Support, Informed

Consent and Advocacy.

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Certification ProcessPrerequisite Criteria

Employment history:

Completed 1000 hours of work with individual(s) with IDD or MI (either paid or unpaid);

Must have worked for at least one full calendar year.

Is an employee in good standing:

• in compliance with all agency and state/provincial requirements;

• completed required pre-service /pre-employment trainings;

• not under disciplinary review or employee probation.November 2015

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Code of Ethics

Person-Centered Supports Promoting Physical and Emotional Well-Being Integrity and Responsibility Confidentiality Justice, Fairness, Equity Respect Relationships Self-Determination Advocacy

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On-line Application

Summary of experience; Summary of education/continuing education

coursework; Letter of recommendation from supervisor; Letter of recommendation from a person

supported or the person’s representative; Letter will be used to assure that knowledge, skills, values, and ethical

behavior are addressed.

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Web-based Examination

Applicants will be given 5 case scenarios related to individuals with IDD/MI and asked to respond to 25 multiple choice questions (5 each).

Questions have been designed to address: values and ethics; knowledge of key indicators; skill in the competency areas.

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Examination

Online – multiple choice; Scenario questions focus on competence in

knowledge, values and ethics in overlapping competency areas ;

Questions elicit knowledge of key indicators ; Passing 80% overall, 60% minimum in each area; May retake test three times; Three month delay between retakes.

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Cost

Initial application/exam fee

$60

Renewal (every 2 years)

$30

NADD Member or Employee of Member Organization

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Renewing Certification

Maintain membership (individual or organizational); Renew every two years; Requires eight hours of continuing education related

to wellness and mental health of people with IDD.

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“I remember how humbling it was to receive the recommendation from one of my clients.  It helped me realize what we were working on was making a difference in his life. To have my training and work validated when I passed the test was very rewarding.  To explain to other what my letters (NADD-DSP) meant and why I got them let others know that there are people out there who are dedicated to working with this population so much that they are willing to go through a process like this in order to provide the best care possible. That kind of feedback helped to strengthen my belief and pride in what we do.”

-Erin Paul BS, OBHP, NADD-DSP

Meridian Services Corp

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Curriculum

Training for Direct Support Professionals in preparing for the online certification test, as well as building overall competence;

45-60 minute lessons will review the area and skills presented in each respective competency ;

Best practice learning strategies for DSPs, including sample questions reflective of the exam;

Includes Intro to Certification Process/NADD and Dual Diagnostics Basics as orientation to other lessons

Contributors

Professionals across the country with versatile backgrounds have volunteered their time and knowledge;

Each lesson has a leader to act as facilitator, editor, and organizer of the content area.

Lessons

Five lessons to correspond with each competency standard; Lessons are reflective of benchmarks and key indicators; Case study vignettes to demonstrate content area; Lesson content is culturally & linguistically competent and

diverse , inclusive of different types of community living/work settings;

Consistency across lessons; Includes critical thinking and practice tests; Currently objectives and outlines developed for each lesson.

Specialist Credential

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Purpose of Credential

To validate the expertise of the professional and provides assurance to people receiving services, colleagues, and employers;

To attest to competency in providing or administering or training in

the area of dual diagnosis;

To provide employment opportunities, job security, and promotions;

To improve the quality and effectiveness of services provided to

individuals with a dual diagnosis - “raise the bar” in services delivered for people who have a dual diagnosis.

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Who is Eligible

Specialist is an individual who: Delivers

Manages

Trains

Supervises

services for persons with intellectual/ developmental disabilities and mental health needs.

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Who is Eligible

Examples of roles considered for application for the NADD-DDS

Staff working in units of county, state or provincial government;

Government administrators;

QIDPs;

Program directors; Program supervisors;

Case/care managers;

Program specialists;

Supports coordinators;

Peer specialists;

Trainers.

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Who is Eligible?

Professionals who have a combination of education and experience in the field are preferred; Experience can include volunteering, internships and

externships in addition to employment.  

A post secondary degree is not necessary; Other types of accreditation and certifications are

acceptable.  

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Competencies

Multimodal Bio-Psycho-Social Approach; Application of emerging best practices; Knowledge of therapeutic constructs; Respectful and effective communication; Knowledge of dual role service delivery &

fiduciary responsibilities; Ability to apply administrative critical thinking.

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Competencies

Multimodal Bio-Psycho-Social Approach

Familiarity with the bio-psycho-social/multi-modal approach and;

Able to incorporate recovery and resiliency;

Identify the inter-relationships among a person’s biological, social, and psychological domains;

Apply a holistic approach;

Formulate information to enable delivery of accurate/relevant medical, psychological, psychiatric, behavioral information to others;

Appreciate the environmental contextual and individual learning styles;

Utilization of the above model to guide all service/treatment planning.

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Competencies

Application of emerging best practices

Overall understanding of assessments, their purpose, when they may be needed and how to obtain them;

Knowledge of effective tools for this population;

Ability to add to this tool-box when warranted.

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Competencies

Knowledge of therapeutic constructs :

An understanding of trauma and how it affects the brain and body;

An appreciation of neurosensory issues;

An understanding of genetic underpinning and advances to guide treatment;

Knowledge of psychotherapeutic skills that can be useful.

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Competencies

Employ respectful and effective communication in rapport building

Assure that the person is “in the driver’s seat;”

Understand the importance of communication between stakeholders and supporters that is relevant to the person’s care and well being.

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Competencies

Demonstrate knowledge of dual role of service delivery/fiduciary responsibility

Report on progress in respect to therapeutic goals and outcomes;

Identify the connection between funding & good care;

Ability to work with others if outcomes are not being achieved.

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Competencies

Ability to apply administrative critical thinking

Recognition of training needs for DSPs/teams/families to implement treatment/support plans;

Ability to assess and resource effective strategies in meeting persons wants and needs;

Ability to signal that behavior plans may be too complicated to be implemented;

Ability to signal that behavior plan may not meet the needs of the person.

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Application

Personal Information

Education and/or Credential

Experience

Ethical Behavior

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Requirements

Work Sample

Ability communicate effectively;

Understanding of programmatic issues having an impact on individuals with dual diagnosis;

Understanding of inter-systems issues and how differences can be resolved.

Interview

7 behaviorally oriented questions;

Demonstration of 6 competency areas;

Letters of recommendation.

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Cost & Continuing Education

Fee

$295 for 2 year certification

$75 renewal cost

Continuing Education

10 hours /2 years

Maintain NADD membership

Attest ethical standards

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Clinical Credential

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Purpose of Clinical Credential

To recognize clinical personnel who have documented quality care and treatment for persons with ID and MI;

To create an awareness of best practices;

To promote excellence in clinical treatment & support for persons with ID/MI.

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50 Who Is Eligible?

This effort targets professionals who either provide or design clinical supports for persons with ID and MI

Mental health clinicians

Behavioral health clinicians

Who Is Eligible?

Clinicians must have one of the following licenses in the USA or Canada: (equivalent accepted)

State/provincial license as a PhD, PsyD, or EdD Psychologist;

State license, BCBA, or governing body recognition as an Applied Behavior Analyst;

State license as a Physician;

State license as a Master’s level: Mental Health Counselor; Marriage & Family Counselor: Addictions Counselor.

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Who Is Eligible?

State license as a Licensed Independent Clinical Social Worker;

State license as a Physician’s Assistant, Advanced Practice RN, or Nurse Practitioner (or clinical equivalent);

Other similar credentialing.

We recognize that there is a huge variety of professionals with very different educational backgrounds to provide clinical support to persons with ID/MI who may qualify for this certification

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Alternative Qualifications

Professionals with a Master’s level degree in a related field or RNs are eligible with additional experience as noted below and a through explanation of the experience base.

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Required Experience

The applicant will have 5 years experience in support of persons with intellectual disabilities and mental health issues This can include internships and externships

With Master’s Level professionals or RNs, 7 years is required.

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Application & clinical portfolio

Submission of work sample

Interview

Response to case vignette provided by NADD

Stages of Clinical Certification Process

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Application

3 letters of reference about the applicant’s clinical skills, ethics, and experience with DD/MI persons

1 copy of the license (unless waived)

1 complete resume

Application fee, $375

NADD membership number

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Application Process

The certification committee shall review the materials and respond to the applicant within 60 days;

If accepted, the applicant will then be required to submit 1 work sample of clinical supports designed/provided by the applicant.

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Possible Information for Work Sample

Diagnosis

Multi-modal or biopsychosocial approach

Positive Supports

Modification of the Environment

Therapy

Psychopharmacology

Lifespan issues

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Application Process

If the work sample is accepted, the candidate will participate in an interview with 2 members of the certification committee or other designees.

This interview shall include resolution of any remaining questions from the work sample.

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Vignette Format

Presenting problem & goals Social history Family psychiatric history Mental health history Current diagnosis Mental health conditions Other co-morbid conditions Medical history Current medications, psychiatric medications and side effects Legal involvement, if any Person-centered description Mental status description

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Also in the Interview

The applicant will be presented 1 vignette and then be required to verbally respond with a case formulation and treatment plan;

This interview may occur in person, at a conference, via web-based video conferencing, or telephone.

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Additional Benefit

“The NADD competency-based clinical certification has provided me with an avenue to verify a dual diagnosis specialty. My ability to provide clinical supports to individuals supported both by medical assistance and private insurances has been expanded by allowing me to gain access to closed insurance networks. These networks had been closed to me prior to receiving this certification, allowing this population to remain largely unserved outside of community mental health centers.”

Alyse Kerr, MS, NCC, LPC, NADD-CC

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Areas of Consideration

Ethics

Lifespan

Positive environment/behavior support

Psychopharmacology

Ruling out medical issues

Substance abuse

Assessment/Diagnosis

Therapy

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Receiving & Maintaining Clinical Certification

If an applicant completes all stages successfully, NADD Clinical Certification is granted.

All applicants shall attest to following the ethical standards of their profession as well as state, province, or country ethics and regulations.

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Continuing Certification

All NADD-CC members shall obtain 10 hours of CE/CME activity every 2 years in ID/MH This may be obtained in any manner that is recognized by the

profession of the member. e.g., a psychologist must obtain CEs approved by the American Psychological Association;

Attending conferences, special training sessions, or web based learning are all acceptable;

Published scholarly activity in ID/MH and training others in ID/MH is accepted.

The member must retain these records for 5 years as the Certification Committee will conduct random checks of members each year.

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Frequently Asked Questions

We addressed many of the Frequently Asked Questions here:

 

http://acp.thenadd.org/manuals/ccp-faq.pdf

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Program Accreditation

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Purpose of Program Accreditation

Enable program to demonstrate continual improvement in IDD/MH areas;

Provide recognition to programs who meet and exceed NADD best practice standards;

Provide NADD expert consultation services aimed at quality improvement during the course of the survey.

What is Program accreditation?

Program accreditation is the result of a formal process through which NADD reviews the intent, structure, and functioning of a program, service, or group of services and certifies that the designated entity meets the NADD’s standards for program design, operations, and quality.

The Mission of Program Accreditation

To advance mental wellness for persons with developmental disabilities through the promotion of excellence in mental healthcare and promote the quality of best practice, evidenced and outcome based interventions and support services for Programs in supporting individuals with Dual Diagnoses (IDD/MI) through national accreditation standards.

This instrument is to be used by NADD surveyors who are evaluating programs to determine the extent to which the program has met the criteria established by NADD for Dual Diagnosis Accreditation.

Based on NADD’s years of experience we understand that programs seeking Dual Diagnosis Accreditation will vary widely and that not all survey standards will apply equally to all programs.

A community-based residence may have different needs and responsibilities concerning medication certification standards than an acute in-patient or out-patient mental health facility.

It is the responsibility of the surveyor to keep in mind the specific standard and the relative weight to the competency areas

Objective

To improve the current systems of care within an organization with standards that are current, state of the art evidenced based and best practice.

Provide monitoring and feedback in state of the art and best practice care for programs serving individuals with dual diagnosis that will improve the level of IDD/MH expertise for an Organization

The Accreditation standards will assist Organization / Programs who provide service and support for individuals with Dual Diagnosis to make informed choices about quality of care and treatments and services.

Standards in dual diagnosis

Importance of Program Accreditation:

Receiving a NADD accreditation ensures that a program has demonstrated a commitment to delivering quality service and support for person’s with Dual Diagnosis. It represents a “seal of quality” awarded to recognize the quality of services provided by the program.

Program benefits of the NADD Accreditation

Accreditation Benefits

Programs/Facilities gain potential for being identified as a preferred provider and increased reimbursement fees from third party payers.

Regulatory agencies, parents, and other provider agencies will know the quality of services offered by the program to be greater if the program has been accredited by NADD.

Program’s Eligibility for Accreditation

Be located in North America;

The Program provides assessment, treatment and support services for individuals with dual diagnosis, intellectual and developmental disabilities and mentalis illness (IDD/MI);

The Program clearly lists services provided to person’s with

dual diagnoses, both direct and contracted services;

The Program provides services considered to be evidenced based and/or best practice by NADD, NASDDPD or American Association for Intellectual/Developmental Disabilities (AAIDD)

The Process of Accreditation

Recognizes that Program Accreditation is best accomplished through a combination of tools: On site visit;

Review policies and program specific data;

Interview of staff and families and persons receiving service;

Direct observation of staff interactions with the person’s being served.

Four Components of The Survey Process

1) Interview Format

2) Clinical Chart Review

3) Policy Review

4) Consultation Service

Four Components of The Survey Process

1) Interview format – The NADD surveyors will have face to face interviews specifically with:

the person receiving services/supports;

treatment team members;

medical and behavioral health staff;

program administrators and;

direct care staff.

 

Four Components of The Survey Process

2) Clinical Chart Review – The NADD surveyors will complete chart reviews and interview treatment team members on specific cases to ensure clear documentation that reflects the individualized goals of the treatment plan.

Four Components of The Survey Process

3) Policy Review – The NADD surveyors will examine policies and procedures to ascertain if there are program guidelines of evidence based and best practice as established by the NADD accreditation standards.

Four Components of The Survey Process

4) Consultation Service The NADD Surveyors will provide feedback

during exit interview:

Review the positive aspects of the program;

Research specific ideas for program improvement;

Articulate the challenges identified by the reviewers;

Recommend specific procedures and processes regarding program improvement.

0 No evidence of meeting minimal best practice standards 1 Some evidence (verbal, written, observational) in meeting minimal evidenced based and best practice standards 2 Significant evidence/support (written, standards, protocols, observations) in meeting evidenced based and best practice standards 3 Evidence/support (written, standards, protocols, observations) that exceeds best practice standards N/A Item does not apply to this program

Directions: In each of the module competency areas, the reviewer will rate items that are relevant to each area and best describes the program’s ability in meeting best practice standards and competency for providing services for people with IDD/MI.

Scoring

Reviewing all aspects of the Programs in its ability to provide quality care for individual’s with IDD /MI

Direct Observation within the Programs services including but not limited to; staff- individual interactions, staff ratios, Positive Approaches Philosophy, Recovery, Positive Behavior Supports and least restrictive practices

Interviews with individuals being served, family, clinicians / therapists and Direct Support Staff (DSP)

The NADD clinical reviewers will assess standards by:

Review standards continued

Assess policies, procedures or plans of the program to meet the needs of individuals with intellectual and developmental disabilities and mental Illness

Reviewing records, outcome data / response to interventions (RTI), treatment and behavior support plans and other documents such as Individual Service Plans, Social, Emotional and Environmental Support Plans, as well as restrictive treatment plans.

Competency Areas Score

I Medication Evaluation and Reconciliation

II Holistic Approach (Bio-Psych-Social Model)

III Database/outcomes

IV Diagnostic Assessments

V Treatment / habilitation planning

VI Basic Health Care

VII Treatment Planning - Interdisciplinary Team Members

VIII Training -Staff/family/ person receiving services

IX Crisis Prevention / Intervention

18 Module / Competency Areas and Scoring

18 Module CompetencyAreas and Scoring (cont)

X Cultural Competency/Family Values Score

XI Trauma

XII Quality Assurance / Improvement

XIII Evidenced Based Treatment Practices

XIV Ethics, Rights, Responsibilities

XVI Interagency & cross systems collaboration

XVI Long term living/service coordination

XVII Advocacy / Rights

XVIII Informatics (technology)

Modules

There are 18 Module areas that fall under the NADD Accreditation, however, not all programs will be required to meet all of the Module areas

Example: Residential and community programs will not fall under the reviews for the Modules that pertain to an Acute Inpatient Hospital program or programs that may be seeking accreditation for case management services.

Modules that will be reviewed

The specific modules to be reviewed will be determined by the initial application that identifies the organization service areas and discussion between the NADD surveyors and the program prior to the actual on-site survey.

 

ACCREDITATION DECISIONS

Three Years – A 3 year is awarded to Programs that meet or exceed the NADD accreditation standards and additionally demonstrate that they meet or exceed standards in the critical module areas, if appropriate to the program being surveyed, including; (1) Medication Evaluation, (2) Holistic (Bio-psych-social) approaches, (3) Diagnostic Assessments, (4) Treatment Planning, (5) Crisis prevention / Intervention and (6) Evidenced Based Treatment Practices.

 Two Year Accreditation- A 2 year Accreditation is awarded to Programs that meet the NADD accreditation standards for support for people with Dual Diagnosis (IDD/MI). To receive a 2 year accreditation, the Program must demonstrate substantial compliance with Best Practice standards.

One Year / Provisional – A 1 year certification is awarded to programs who score below NADD accreditation standards. 

Non Accreditation – A Program will not receive NADD Accreditation if the mission, values, treatment and services of the Program directly interferes with the health, safety, welfare and rights of the individual being served

 Program Name: _______ Date of Survey: _________

Accreditation Score: _______  Program Strengths: _____________________________________________ Program Areas for improvement:___________________________________ General Comments: _____________________________________________  Goals for follow-up or next review period: ____________________________

  

Summary of Review

Cost

Application fee $ 500

Surveyor fee $ 2000/per surveyor/day

Annual fee $ 1000 for 3 years

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Training for Certification

Curricula under development:

DSP

Clinicians

Specialists

Modularized

Web-based and live

live training offered at annual conferences

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For more information

Visit the NADD website

www.thenadd.org

Or call Ed Seliger, MA at 845 331-4336 or 800 331-5362