DSPATHS
CERTIFICATE OF ADVANCED
PROFICIENCY
(CAP)
PORTFOLIO
Certificate of Advanced Proficiency (CAP) Portfolio
Table of Contents
Section Contents
1
Portfolio Title Page
2
DSPaths Credentialing Program Elective Worksheet & Signed
Acknowledgment
3
Resume and Cover Letter
4
Letter/Communication of Support (at least one letter of support
from a person the participant supports, or their family
member, or if a person is unable to verbally communicate
and does not have family members, then a member of
their support network)
5
Training/Education Records – (DSPaths CAP Transcript)
6
Signed Pledge to the NADSP Code of Ethics
7
Required Elective Work Sample and Summary 1
Portfolio Permission Form (s)
8
Required Elective Work Sample and Summary 2
Portfolio Permission Form (s)
9
Required Elective Work Sample and Summary 3
Portfolio Permission Form (s)
10
Required Elective Work Sample and Summary 4
Portfolio Permission Form (s)
11
*Required Elective Work Sample and Summary 5
(*For candidates that completed CIP prior to January 1, 2014, see section 2 for more details.)
12
13
Statement of Portfolio Authenticity
Candidacy Application for the Certificate of Advanced
Proficiency
Effective- 1/1/2014
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 2
Portfolio Title Page - Certificate of Advanced Proficiency (CAP)
Candidate’s Name:
Candidate’s Home Telephone Number:
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Candidate’s Work Telephone Number:
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Candidate’s Cell Phone Number:
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Candidate’s Email Address:
Candidate’s Address:
Candidate’s Employer:
Employer Telephone Number:
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Please Check Employer Type:
Organization:
Individual Provider:
Candidate’s Skill Mentor Name:
Candidate’s Skill Mentor Work Telephone Number:
Candidate’s Skill Mentor Cell Phone Number:
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Candidate’s Skill Mentor Email Address:
Candidate’s Skill Mentor Address:
Date of Submission:
Effective- 1/1/2014
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/
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 3
CAP Worksheet and Signed Acknowledgement
Beginning January 1, 2014, the DSPATHS Certificate of Initial Proficiency (CIP) and Certificate
of Advanced Proficiency (CAP) portfolio requirements have been realigned. Each level (CIP
and CAP) now requires a portfolio that details four work samples. Anyone that completed a
Certificate of Initial Proficiency portfolio prior to 1/1/2014 containing THREE work samples,
will need to complete FIVE work samples for their CAP portfolio. This document will assist
you with determining how many work samples you need to complete for your CAP portfolio. In
addition, you will need to determine what competency areas you will be providing work samples
for. As both levels now offer the option to select ‘electives’, it is important to make sure each
competency area is only addressed one time. Please use the worksheet below to determine what
topics are available to you for your CAP portfolio.
What work sample topics did you complete in your CIP portfolio?
Communication
Community Living Skills and Supports
Documentation
Assessment
Supporting Health and Wellness
Person Centered Supports
If you completed three work sample topics for your CIP portfolio, please select FIVE work
sample topics below to complete in your CAP portfolio. If you completed FOUR work sample
topics in your CIP portfolio, please select FOUR work sample topics below to complete in your
CAP portfolio. *You may not repeat any work sample topic you completed in CIP for your CAP
portfolio.
Documentation
Assessment
Supporting Health and Wellness
Person Centered Supports
Participant Empowerment
Community and Service Networking
Education, Training & SelfDevelopment
Facilitation of Services
Advocacy
Vocational, Educational & Career
Support
Crisis Prevention and Intervention
Organizational Participation
Building and Maintaining Friendships
and Relationships
You can find the requirements for all of these work sample topics in the ‘Work Sample Elective’
section of this portfolio. Any areas that you do not choose should be deleted from the portfolio.
******************************************************************************
Signed Acknowledgment
OADSP and NADSP reserves the right to audit all or portions of your CIP and CAP portfolios to
ensure these, and other guidelines set forth in this program are adhered to.
Candidate Signature
Effective- 1/1/2014
Date
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 4
(Insert Cover Letter Here *Template can be found in the CAP Workbook)
Effective- 1/1/2014
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 5
(Insert Resume Here *Template can be found in the CAP Workbook)
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© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 6
Recommendation from Individual Served
Signature: ______________________________________________________________
Please note: Recommendation may be supplied in an audio or video format accompanied by this
form that is signed by the individual or the individual’s representative.
Effective- 1/1/2014
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Page 7
Training/Education Records
(DSPATHS CAP Class Transcript)
Date
Module
Effective- 1/1/2014
Class Title
Instructor
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Time
Page 8
Pledge to the NADSP Code of Ethics
I
have read and understand the NADSP Code of Ethics. I hereby pledge to uphold and
honor the NADSP Code of Ethics in my daily practice and follow the guiding principles
contained within the Code. Those principles include:
Person Centered Supports: I will pledge my first allegiance to the person(s) I support.
Promoting Physical and Emotional Well-Being: I am responsible for supporting the emotional,
physical and personal well-being of the individuals receiving support.
Integrity and Responsibility: I will support the mission and vitality of my profession.
Confidentiality: I will safeguard and respect the privacy of the people I support.
Justice, Fairness and Equity: I will affirm the human rights, civil rights and responsibilities of
the people I support.
Respect: I will respect the human dignity and uniqueness of the people I support.
Relationships: I will assist the people I support to develop and maintain relationships
Self Determination: I will assist the people I support to direct the course of their own lives.
Advocacy: I will advocate with the people I support for justice, inclusion, and full community
participation.
I agree to accept this Code of Ethics as my standard of practice in this field.
Candidate’s Signature
Effective- 1/1/2014
Date
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 9
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Required Competency Area: Participant Empowerment
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 10
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 1: Participant Empowerment
The Direct Support Professional enhances the ability of the participant to lead a self-determining
life by providing the support and information necessary to build self-esteem, and assertiveness;
and to make decisions.
Skill Statements
1A. The competent DSP assists and supports the participant to develop strategies, make
informed choices, follow through on responsibilities, and take risks.
1B. The competent DSP promotes participant partnership in the design of support services,
consulting the person and involving him or her in the support process.
1C. The competent DSP provides opportunities for the participant to be a self-advocate by
increasing awareness of self-advocacy methods and techniques, encouraging and assisting the
participant to speak on his or her own behalf, and providing information on peer support and
self-advocacy groups.
1D. The competent DSP provides information about human, legal, civil rights and other
resources, facilitates access to such information and assists the participant to use information
for self-advocacy and decision making about living, work, and social relationships.
Explain how the actions you took demonstrate your skills in THREE skill standards of
your choice in the area of Participant Empowerment.
1A. How did you assist and support the individual(s) to develop strategies, make informed
choices, follow through on responsibilities, and take reasonable risks?
1B. How did you promote individual empowerment by facilitating the individual’s leadership
in the design of his or her support own support process?
1C. How did you provide opportunities for the individual(s) you serve to be self-directed by
increasing awareness of self-advocacy methods and techniques, encouraging and assisting the
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Page 11
individual(s) to speak on their own behalf, and by providing information on peer support and
other self-advocacy groups?
1D. How did you provide information about human, legal, civil rights, and other resources,
facilitate access to such information and assist the individual to use information for selfdirection and decision making about living, work, and/or social relationships.
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Participant Empowerment.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 12
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Assessment
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
Effective- 1/1/2014
© Ohio Alliance of Direct Support Professionals. All rights reserved.
Page 13
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 3: Assessment
The Direct Support Professional should be knowledgeable about formal and informal assessment
practices in order to respond to the needs, desires and interests of the participants.
Skill Statements
3A. The competent DSP initiates or assists in the initiation of an assessment process by
gathering information (e.g., participant's self‐assessment and history, prior records, test
results, additional evaluation) and informing the participant about what to expect throughout
the assessment process.
3B. The competent DSP conducts or arranges for assessments to determine the needs,
preferences, and capabilities of the participants using appropriate assessment tools and
strategies, reviewing the process for inconsistencies, and making corrections as necessary.
3C. The competent DSP discusses findings and recommendations with the participant in a
clear and understandable manner, following up on results and reevaluating the findings as
necessary.
Explain how the actions you took demonstrate your skills in standards A, B, and C in the
areas of Assessment.
(3A) How did you Initiate or assists in the assessment process by gathering information (i.e.,
individuals’ self-assessment and history, prior records, test results, evaluation results,
additional evaluations) and informing the individual about what to expect throughout the
assessment process?
(3B) How did you conduct or arrange for assessments to determine the needs,
preferences, and capabilities of the individual using appropriate
assessment tools and strategies, reviewing the process for inconsistencies,
and making corrections as necessary?
(3C) How did you discuss the findings and recommendations with the individual, the
Xteam, and or their family in a clear and understandable manner?
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How did you follow up on the results and reevaluate the findings if necessary?
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Assessment.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and describe what
you learned.
Effective- 1/1/2014
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Page 15
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Community Service and Networking
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern, or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
Effective- 1/1/2014
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Page 16
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 4: Community and Service Networking
The Direct Support Professional should be knowledgeable about the formal and informal
supports available in his or her community and skilled in assisting the participant to identify and
gain access to such supports.
Skill Statements
4A. The competent DSP helps to identify the needs of the participant for community supports,
working with the participant's informal support system, and assisting with, or initiating
identified community connections.
4B. The competent DSP researches, develops, and maintains information on community and
other resources relevant to the needs of participants.
4C. The competent DSP ensures participant access to needed and available community
resources coordinating supports across agencies.
Explain how the actions you took demonstrate your skills in standards A, B, and C in the
area of Community Service and Networking.
4A. How did you help to identify community supports needed by the individual(s) you
serve by working with the individual’s informal support system, and assisting with, or
initiating identified community connections?
4B. How did you research, develop, and maintain information on community and
other resources relevant to the needs of the individual(s) you serve?
4C. How do you ensure individual access to needed and available community
resources coordinating supports across agencies and/or departments?
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Page 17
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Community Service Networking.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and describe what
you learned.
Effective- 1/1/2014
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Page 18
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Facilitation of Services
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
Effective- 1/1/2014
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Page 19
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 5: Facilitation of Services
The Direct Support Professional is knowledgeable about a range of participatory planning
techniques and is skilled in implementing plans in a collaborative and expeditious manner.
Skill Statements
5B. The competent DSP assists and/or facilitates the development of an individualized plan
based on participant preferences, needs, and interests.
5C. The competent DSP assists and/or facilitates the implementation of an individualized plan
to achieve specific outcomes derived from participants' preferences, needs and interests.
5D. The competent DSP assists and/or facilitates the review of the achievement of individual
participant outcomes.
Explain how the actions you took demonstrate your skills in standards B, C, and D in the
area of Facilitation of Services.
5B. How did you assist and/or facilitate the development of an individualized plan based on
individual preferences, needs, and interest?
5C. How did you assist and/or facilitate the implementation of an individualized plan to
achieve specific outcomes based on the individual’s preferences, needs, and interest?
5D. How did you assist and/or facilitate the review of the achievement of the individual’s
outcomes?
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Page 20
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Facilitation of Services
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
Effective- 1/1/2014
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Page 21
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Education, Training and Self Development
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What types of education, training, and self-development have you participated in during the
last twelve months?
2. What types of education, training, and self-development do you plan on participating in
during the next twelve months?
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 7: Education, Training & Self-Development
The Direct Support Professional should be able to identify areas for self-improvement, pursue
necessary educational/training resources, and share knowledge with others.
Skill Statements
7A. The competent DSP completes required training education/certification, continues
professional development, and keeps abreast of relevant resources and information.
7B. The competent DSP educates participants, co-workers and community members about
issues by providing information and support and facilitating training.
Explain how the actions you took demonstrate your skills in standards A and B in the area
of Education, Training, and Self Development.
7A. How do you complete required training, education and certification(s), while continuing
your professional development and staying abreast of relevant resources and information.
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Page 22
7B. How do you educate individuals, co-workers and community members about issues by
providing information, support and training?
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Education, Training, and Self-Development below.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 23
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Advocacy
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 24
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 8: Advocacy
The Direct Support Professional should be knowledgeable about the diverse challenges facing
participants (e.g., human rights, legal, administrative and financial) and should be able to identify
and use effective advocacy strategies to overcome such challenges.
Skill Statements
8A. The competent DSP and the participant identify advocacy issues by gathering information,
reviewing and analyzing all aspects of the issue.
8C. The competent DSP facilitates, assists, and/or represents the participant when there are
barriers to his or her service needs and lobbies decision-makers when appropriate to overcome
barriers to services.
8D. The competent DSP interacts with and educates community members and organizations
(e.g., employer, landlord, civic organization) when relevant to participant's needs or services.
Explain how the actions you took demonstrate your skills in standards A, C, and D in the
area of Advocacy.
(8A) How did you identify advocacy issues by gathering information, reviewing, and
analyzing all aspects of the problem?
(8C) How did you you facilitate, assist, and/or represent the individual(s) you serve with
barriers to their service needs while enlisting the support of decision makers when appropriate?
(8D) How did you interact with and educate community members and organizations (i.e.,
employer, landlord, civic organization) when relevant to individuals’ needs or services?
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Page 25
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Advocacy.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 26
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Vocational, Educational, and Career Support
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 27
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 9: Vocational, Educational & Career Support
The Direct Support Professional should be knowledgeable about the career and education related
concerns of the participant and should be able to mobilize the resources and support necessary to
assist the participant to reach his or her goals.
Skill Statements
9A. The competent DSP explores with the participant his/her vocational interests and aptitudes,
assists in preparing for job or school entry, and reviews opportunities for continued career
growth.
9B. The competent DSP assists the participant in identifying job/training opportunities and
marketing his/her capabilities and services.
9C. The competent DSP collaborates with employers and school personnel to support the
participant, adapting the environment, and providing job retention supports.
Explain how the actions you took demonstrate your skills in TWO standards in the area
of Vocational, Educational, and Career Supports.
9A. How did you explore the individual’s vocational interests and aptitudes, and assist them in
preparing for job or school entry and review opportunities for continued career growth?
9B. How did you assist the individual in identifying job or training opportunities and help
them with marketing their capabilities and services?
9C. How did you collaborate with employers and/or school personnel to support the
participant, help adapt the environment, and provide job/school retention supports?
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Page 28
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Vocational, Educational, and Career Supports.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 29
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Crisis Prevention and Intervention
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 30
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 10: Crisis Prevention and Intervention
The Direct Support Professional should be knowledgeable about crisis prevention, intervention
and resolution techniques and should match such techniques to particular circumstances and
individuals.
Skill Statements
10A. The competent DSP identifies the crisis, defuses the situation, evaluates and determines
an intervention strategy and contacts necessary supports.
10B. The competent DSP continues to monitor crisis situations, discussing the incident with
authorized staff and participant(s), adjusting supports and the environment, and complying with
regulations for reporting.
Explain how the actions you took demonstrate your skills in standards A, and B in the
area of Crisis Prevention and Intervention.
10A. How did you identify the actual or potential crisis, defuse the situation, evaluate and
determine an intervention strategy, and contact the necessary supports?
10B. How do you continue to monitor crisis situations, discussing the incidents with relevant
staff and individuals, adjust supports and the environment, and comply with regulations for
staff reporting?
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Page 31
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Crisis Prevention and Intervention.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
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Page 32
Elective Competency Area: Organizational Participation
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 33
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 11: Organizational Participation
The Direct Support Professional is familiar with the mission and practices of the support
organization and participates in the life of the organization.
Skill Statements
11A. The competent DSP contributes to program evaluations, and helps to set organizational
priorities to ensure quality.
11B. The competent DSP incorporates sensitivity to cultural, religious, racial, disability, and
gender issues into daily practices and interactions.
11C. The competent DSP provides and accepts co-worker support, participating in supportive
supervision, performance evaluation, and contributing to the screening of potential employees.
11D. The competent DSP provides input into budget priorities, identifying ways to provide
services in a more cost-effective manner.
Explain how the actions you took demonstrate your skills in THREE of the skill
standards below in the area of Organizational Participation.
11A. How do you contribute to program evaluations and help set organizational priorities to
ensure quality?
11B. How did you incorporate sensitivity to cultural, religious, ethnic, disability, and gender
issues into your daily practices and interactions.
11C. How do you provide and accept co-worker support, participate in supportive supervision,
and contribute to the screening of potential employees?
11D. How did you provide input to budget priorities, identifying ways to provide services in a
cost effective manner?
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Page 34
Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Organizational Participation.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Documentation
Candidate:
Skill Mentor:
Please complete the following questions by typing your answers in text fields.
1. What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 12: Documentation
The Direct Support Professional is aware of the requirements for documentation in his or her
organization and is able to manage these requirements efficiently.
Skill Statements
12A. The competent DSP maintains accurate records, collecting, compiling and
evaluating data, and submitting records to appropriate sources in a timely fashion.
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12B. The competent DSP maintains standards of confidentiality and ethical practice.
12C. The competent DSP learns and remains current with appropriate documentation
systems, setting priorities and developing a system to manage documentation.
Explain how the actions you took demonstrate your skills in standards A, B, and C in the
area of Documentation.
(12A) What were the results of the documentation you collected? (Evaluate and
summarize the data your documentation form collected.)
How, and with whom, did you share the results of your data?
What process did you go through in getting the collaboration of the individual(s)
and/or staff to participate in this work sample?
(12B) In general, how do you maintain standards of confidentiality and ethical
practices?
(12C) In general, how do you learn and remain current with appropriate documentation
systems?
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Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Documentation.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
Effective- 1/1/2014
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Page 38
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Building and Maintaining Friendships and Relationships
Candidate:
Mentor:
Please complete the following questions by typing your answers in the field provided
underneath each question.
1.
What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 13: Building and Maintaining Friendships and Relationships
The Direct Support Professional supports the participant in the development of friendships and
other relationships.
Skill Statements
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13A. The competent DSP assists the individual as needed in planning for community activities
and events (e.g., making reservation, staff needs, money, materials, accessibility).
13B. The competent DSP assists the individual as needed in arranging transportation for
community events.
13C. The competent DSP documents community activities and events.
13D. The competent DSP encourages and assists the individual as needed in facilitating
friendships and peer interactions.
13E. The competent DSP encourages and assists the individual as needed in communication
with parents/family (e.g., phone calls, visits, letters).
13F. The competent DSP implements individual supports regarding community activities.
13G. The competent DSP provides incentive or motivation for consumer involvement in
community outings.
13H. The competent DSP assists the individual as needed in getting to know and interacting
with his/her neighbors.
13I. The competent DSP encourages and assists the individual as needed in dating.
13J. The competent DSP encourages and assists the individual as needed in communicating
with social workers and financial workers
Explain how the actions you took demonstrate your skills in SIX skill statements of your
choice in the area of Building and Maintaining Friendships and Relationships.
(13A) How did you assist the individual(s) you serve as needed in planning for community
activities and events?
(13B) How did you assist the individual as needed in arranging transportations for community
events?
(13C) How did you document community activities and events?
(13D) How did you encourage and assist the individual as needed by facilitating friendships
and interactions with others?
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(13E) How did you encourage and assist the individual(s) you serve as needed in
communication with family and friends (i.e., phone calls, visits, letters, emails, texting, etc…)
(13F) How did you implement individual supports regarding community activities?
(13G) How did you provide incentive or motivations for individual involvement in community
activities?
(13H) How did you assist the individual(s) as needed in getting to know and interacting with
their neighbors and other members of their immediate community?
(13I) How did you support and assist the individual(s) as needed in forming intimate
friendships and other relationships (i.e., dating, marriage, etc).
(13J) How did you encourage and assist the individual(s) as needed in communicating with
medical, social service, financial service and other professionals?
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Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Building and Maintaining Friendships and
Relationships.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 42
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Person Centered Supports
Candidate:
Mentor:
Please complete the following questions by typing your answers in text fields.
1. What is the problem, concern or goal you are addressing?
2. How did it come to your attention?
3. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
4. What was the outcome of your actions?
5. What process did you go through in getting the collaboration of the person served and, if
applicable, their representative(s) to participate in this work sample?
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Page 43
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 14: Providing Person Centered Supports
Skill Statements
14A. The competent DSP provides support to people using a person centered
approach.
14B. The competent DSP modifies support programs and interventions to ensure they are
person centered.
14C. The competent DSP challenges co‐workers and supervisors to use person centered
practices.
14D. The competent DSP is knowledgeable about person centered planning
techniques.
14E. The competent DSP assists individuals in developing person centered plans.
Select three standards of your choice and explain how the actions you took demonstrate
your skills in the area of Person Centered (Directed) Supports.
Person Centered (Directed) Supports
(14A) How did you provide support to people using a person centered (directed)
approach?
(14B) How did you modify support program(s) and interventions to ensure they
are person centered?
(14C) How did you encourage co-workers and supervisors to use person centered
(directed) practices?
(14D) How did you use person centered (directed) planning techniques?
(14E) How did you assist individuals in developing person centered (directed) plans.
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Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Person Centered Supports.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
Effective- 1/1/2014
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Page 45
Work Sample Summary - Certificate of Advanced Proficiency (CAP)
Elective Competency Area: Supporting Health and Wellness
(Candidates MUST choose two elective work sample areas.)
Candidate:
Mentor:
Please complete the following questions by typing your answers in text fields.
1. What is the problem, concern or goal you are addressing? How did it come to your
attention?
2. What specifically did you do to resolve the problem, address the concern, or further the goal
you have presented?
3. What was the outcome of your actions?
4. What process did you go through in getting the collaboration of the person served to
participate in this work sample?
Effective- 1/1/2014
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Page 46
The skill standards of this competency area are listed below. These are the specific
areas the portfolio review team will use to evaluate your work sample.
Area 15: Supporting Health and Wellness
The competent DSP promotes the health and wellness of all consumers.
Skill Statements
15A. Administers medications accurately and in accordance with agency policy and
procedures.
15B. Observes and implements appropriate actions to promote healthy living and to
prevent illness and accidents.
15C. Uses appropriate first aid/safety procedures when responding to emergencies.
15D. Assists individuals in scheduling, keeping, and following through on all health
appointments.
15E. Assists individuals in completing personal care (e.g., hygiene and grooming)
activities.
15F. Assists with identifying, securing and using needed adaptive equipment (i.e.
adaptive equipment) and therapies (e.g., physical, occupational, speech, respiratory,
psychological).
15G. Assists individuals in implementing health and medical treatments.
15H. Assists individuals to take an active role in their health care decisions.
Select five standards of your choice and explain how the actions you took demonstrate
your skills in the area of Supporting Health and Wellness.
(15A) In general, how do you administer medications accurately and in accordance with
applicable policies and procedures?
(15B) How did you observe and implement appropriate actions to promote healthy living
and to prevent illness and accidents?
(15C.) In general, how do you use appropriate first aid and safety procedures when
responding to emergencies.
(15D) How do you assist individual(s) in scheduling, keeping, and following through on
all health appointments?
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(15E) How do you assist individuals in completing personal care activities (hygiene,
grooming, etc…)?
(15F) How did you assist with identifying, securing, and using needed health
equipment and therapies (i.e., physical, occupational, speech, respiratory,
psychological)?
(15G) How do you assist individuals in implementing health and medical treatments?
(15H) How did you assist individuals to take an active role in their health care
decisions?
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Please provide an actual sample of the work you did to demonstrate your competency in
this area. Work samples can be in the form of videos (must be able to be viewed by
graders via private You Tube link, Google Drive, Dropbox, etc..), documentation,
pictures, diagrams, testimonials, etc…
Please insert your work sample for Supporting Health and Wellness.
Reflective Statement:
Please write a statement reflecting on your experience with this work sample and
describe what you learned.
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Page 49
Statement of Portfolio Authenticity
Candidate:
Skill Mentor:
Candidates in the PATHS Credentialing Program must assure that the work they have submitted
in their portfolios is authored and compiled by the candidate only. Additionally, Skill Mentors
must provide assurance that they have seen the work and believe it to be the candidate’s
authentic work.
These assurances MUST be included in the portfolio.
I attest that I have completed the work included in my portfolio. I have not represented any
other person’s or organization’s work as my own.
__________________________________________
Signature of Candidate
_____________
Date
I have reviewed this candidate’s portfolio and to the best of my ability and knowledge believe
it to be the original work of this candidate.
__________________________________________
Signature of Skill Mentor
Effective- 1/1/2014
_____________
Date
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Page 50
Candidacy Application for the Certificate of Advanced Proficiency (CAP)
Candidate’s Name:
Date:
DSPATHS Region or Licensed Entity:
I meet the following requirements:
Maintenance of an acceptable BCII Check.
Completion of at least 3000 hours of work experience as a Direct
Support Professional in the field or Intellectual and Developmental
Disabilities.
Completion of the 60 hours of classroom instruction in the Certificate of
Advanced Proficiency (CAP).
Completion of all requirements of the Certificate of Advanced Proficiency
(CAP) Portfolio.
I give the Ohio Alliance of Direct Support Professionals (OADSP) permission to utilize my
portfolio for teaching purposes, which may include but may not be limited to, posting all or
portions of it on the www.oadsp.org website.
Yes
No
I give the Ohio Alliance of Direct Support Professionals (OADSP) permission to include my
name on a list of Direct Support Professionals who have earned the Certificate of Advanced
Proficiency (CAP) that will be published on the www.oadsp.org website.
Yes
No
Signature of DSPATHS Candidate:
Effective- 1/1/2014
Date:
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