Direct Support Professionals Orientation

Partnership for People with Disabilities

 

Direct Support Professional Assurance

[To confirm successful completion of testing and competency requirements for the DD Waivers]

I,   (print) recognize that, as a condition of providing direct support under the BI, FIS, and/or CL Waivers, the following requirements must be met. I hereby assure that, as a direct support professional delivering one or more of these services, the following events have occurred as described:

  1. I have received instruction in the characteristics of developmental disabilities and Virginia's DD Waivers, person-centeredness, positive behavioral supports, effective communication, DBHDS-identified health risks and the appropriate interventions, and best practices in the support of individuals with developmental disabilities.
  2. I have taken and passed (with a total score of 80% or better) the "Orientation Manual Test."
  3. I will work with my supervisor on the completion of a DBHDS competency checklist (DMAS P241a) that is maintained in agreement with DBHDS requirements including annual updates and my Supervisor's signature and, if working in a DBHDS-licensed service, the appropriate additional competencies checklist(s) (DMAS P244a, DMAS P240a, and/or DMAS P201) when supporting individuals at Tier Four based on their completed Supports Intensity Scale.
  4. The following conditions will be met prior to my providing direct reimbursable support services under the BI, FIS, or CL Waivers:
    • I will receive instruction as described in #1 above
    • I will take and pass the test as described in #2 above
    • I will demonstrate competence with Competency 3 related to health and safety as included on the DSP and DSP Supervisors Competencies checklist (DMAS P241a)
  5. The following conditions will be met within 180 days of my hire:
    • I will demonstrate an ongoing ability to provide support in accordance with all required competencies (proficiency) as described in the DSP and DSP Supervisors Competencies checklist (DMAS P241a),
    • If needed, I will work with my supervisor to complete any additional required checklists, which may include Health Competencies (DMAS P244a), Behavioral Competencies (DMAS P240a), and/or Autism Competencies (DMAS P201) as referenced in #3 above, and
    • I will participate in an annual update to confirm my ongoing ability with competencies

My signature and date below indicate the date I passed the "DSP Orientation Test."

Direct Support Professional's Signature
Date
Supervisor's Signature
Date
Trainer's Signature (if applicable)
Date
Agency Name
Agency Address

Please keep this assurance and a copy of the scored test on file for viewing during a DMAS Quality Management Review. Keep a copy for your own records.

(DMAS P242a)
7.1.21
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