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