The Physician-Direct Support Professional Relationship

By Vincent Siosoco, MD, MBA

A Day In a (Previous) Life as a Direct Support Professional

As the sun would rise outside the group home, the evening shift would finish updating their reports as they waited for the morning staff to arrive. As the next shift trickled in, each staff member signed in, and would begin to read the previous shift’s reports and briefly meet with some of the outgoing staff members to obtain updates and start the new day. Individuals were then assigned to a staff member on the new shift, with each member having an important role and responsibility in the activities of these individual’s’ daily living. This included getting clothes ready for the day, assisting in dressing, cooking, getting ready for school, programs, or their jobs. Trips would include those that were recreational, educational, cultural, and spiritual. Then there were those that would require a trip to their primary care physician, dentist, and other health care providers. In time, through the job, individuals weren’t only your assignment but became an extended family member who you were responsible for, taking care of, looking after, and advocating on their behalf. More important, you became a part of their extended family as well. So went the day of a Direct Support Professional (DSP), something that was so familiar to me as I worked as one (though the title back then may have been different) in a previous life, during my college years, many years ago.

What is a Direct SupportProfessional?

As defined by the National Alliance of Direct Support Professionals, “Direct Support Professionals (DSPs) assist people with intellectual and developmental disabilities in realizing their full potential and becoming valued and participating members of their communities. Their work is complex and goes well beyond caregiving, requiring skills including independent problem solving, decision making, behavioral assessment and prevention, medication administration, health and allied health treatment, teaching new skills, crisis prevention and intervention and more.”

History of Direct Support Professionals

In the past, DSPs functioned mainly as caregivers. However, with the growth in the field of developmental disabilities and an aging and underserved population, so did the roles and responsibilities of a DSP, which soon included supporting those individuals to lead self-directed lives when possible.

In 1996, the National Alliance for Direct Support Professionals was established. Their mission is to “Elevate the status of direct support professionals by improving practice standards, promoting system reform, and advancing their knowledge, skills and values.” As one of NADSP’s founders, John F. Kennedy, Jr. wrote “Quality is defined at the point of interaction between the staff member and the individual with a disability.” Since then, NADSP has set the standards for being a DSP, providing credentialing, education, training, and advocacy. In 2012, NADSP’s Code of Ethics was adopted by the New York State’s Office for People with Developmental Disabilities which is as follows:

1. Person-Centered Supports

2. Promoting Physical and Emotional

    Well-Being

3. Integrity and Responsibility

4. Confidentiality

5. Justice, Fairness and Equity

6. Respect

7. Relationships

8. Self-Determination

9. Advocacy

A Day in the Life (Today) of a Physician and Direct Support Professional

As staff get settled in, the waiting room begins to buzz and fill up with patients, caregivers, and DSPs lining up to sign in and be seen by me. A lone DSP with her assigned individual sits to the side after signing in and patiently waits their turn to be seen. Many times, a fellow DSP is waiting outside in the van that brought them there, most likely double parked, due to lack of parking in the streets of NYC. The patient’s turn comes up and he and his DSP enter the examination room. After greeting him, I turn to the DSP to greet her who then begins to open up her plastic folder from the group home that they nickname, “the Grab n’ Go.” Slowly, the DSP shuffles through the folder and hands me a stack of documents that include copies of the patient’s medication list, blood pressure logs, bowel movement logs, copies of outside Specialty reports and a recent ER visit including discharge diagnoses and follow up recommendations.

The DSP hands me a Consult form where the space titled, “Reason for the Visit,” is completed for me to read, and done so on behalf of the patient who is non-verbal and can’t communicate in any way, nor comprehend his situation. Aside from the documents, the DSP gives me her own insights and experiences of being with the individual on a regular basis since the last visit. She’s able to tell me how the Specialist’s visit went the previous week, how their experience was, how it was going at the group home with staff, his roommate, and whether he’s been compliant with his diet.

Many, if not most of the time, the social determinants of health information comes from these conversations. Through this information, I’m able to obtain as best a “history” as I can for the visit. After completing the physical exam, I speak with both the patient and DSP, give my recommendations, and document them on the Consult form for the DSP to bring back and share with her team at the group home and follow up on his care.

Future

It’s been a long time since I worked in the role of a DSP in my college years. The role has since expanded, and their importance and value have been magnified especially through their heroic work throughout the pandemic on the front-lines. As a physician today, I see them through different eyes and as an asset in ensuring our patients receive quality healthcare. The importance of the physician-patient relationship has expanded to include that of the DSP. I look to DSPs as partners in providing the health care that is so needed for this population. Whether it’s conveying information to the team or vice versa, ensuring patients receive their medications, or getting them to their next medical or dental appointment, DSPs are crucial to health care needs of these individuals.

I’ve been fortunate to know some DSPs for years now. Unfortunately, this dedicated workforce is at a critical shortage level. Their importance may not always be recognized and often not compensated in a meaningful way. Efforts are underway to address this in New York through a partnership with NY state and the NADSP to expand opportunities for DSPs.1 Much more is needed though, to support, retain, and recruit new DSPs for the future to provide support to the individuals they serve and work alongside the physicians, dentists, nurses, and clinicians that serve those same individuals.

About the Author

Vincent Siasoco, MD, MBA is an Assistant Professor, Department of Family Medicine | Pediatrics, Albert Einstein College of Medicine, New York, NY. He is a Board Member at AADMD.

Reference

1. https://www.governor.ny.gov/news/governor-hochul-announces-10-million-partnership-assist-direct-support-professionals