DSP Training Compliance

Completion of this survey is required for all providers who receive Home and Community Based Waiver funds from Illinois Department of Human Services. The completed survey is to be returned before June 20, 2023, to DHS.BQMQE@illinois.gov. Responses will be audited by the Bureau of Quality Management during an official review of the agency. Providers are required to maintain evidence to support the information provided in the survey.

Agency Name:

DSP

1. Total number of DSP working at your agency (as of the date you completed this survey):

2. Total number of new DSPs working at your agency (New is defined as hired since July 1, 2022, and still currently employed with your organization):

3. Of those identified in #2 above, how many received training in accordance with state/Medicaid requirements* prior to providing waiver services:

4. Of those identified in #2 above, how many received training on alternative practices to restrictive interventions, including restraints and seclusion:

5. Total number of all DSPs who received training in accordance with state/Medicaid requirements* prior to providing waiver services (All DSPs is defined as employees hired before June 30, 2022, and still currently employed with your organization):

6. Total number of all DSPs who received training on alternative practices to restrictive interventions, including restraints and seclusion (All DSPs is defined as employees hired before June 30, 2022, and still currently employed with your organization):

Required Training to include:

• Rule 50 every two years
• DSP Training
• CPR/First Aid every two years

Detail the steps your agency will take to remedy training gaps for each of the above responses that do not equal 100% of your staff. All corrective action steps must be completed by August 1, 2023.

The Executive Director attests by signing below that the information is accurate and complete as of the date of signature. Failure to maintain records to support the data on this form can impact funding and/or licensure or certification status.

Executive Director:

Executive Email: