Direct support workforce

Direct Support Professionals (DSPs) are the paid staff who support individuals with IDD to live their lives and enjoy the same opportunities and experiences as people without disabilities. DSPs support people in whatever ways they need to enhance inclusion and independence. Their work promotes informed decision-making, understanding risk, and exercising rights and choices.Providing direct support is highly complex and requires significant skills, including sound judgment,  independent problem-solving, decision-making, behavioral assessment, crisis prevention and intervention, and communication. Many DSPs are isolated, without co-workers, supervisors, or clinical professionals on-site to provide assistance or guidance. DSPs are interdisciplinary professionals whose duties resemble many tasks typically completed by teachers, nurses, allied health professionals, social workers, counselors, and others. Highly-effective DSPs are skilled at developing strong relationships with those they support and their families, and are flexible enough to change, depending on each person’s needs and abilities.

DSPs work in family and individual homes, intermediate care facilities, small community residential group homes, community job sites, vocational and day training programs, and other locations. Two-thirds work full time, and half rely on means-tested public assistance. With an average age of 42, they are predominantly women (89%), but are racially and ethnically diverse. White (non-Hispanic) workers make up 47% of the workforce, while 30% are African American, and 16% are Hispanic/Latino. Nearly a quarter were born outside the United States, compared with 16% across the total U.S. workforce. About 45 percent have completed some college coursework or have a college degree. Most employers use the occupational title of Direct Support Professional, yet many DSPs may have different titles including direct support specialist, personal care assistant, habilitation specialist, job coach, residential counselor, family care provider, personal assistant, and others.

Through online and in-person training courses and applied research that identifies best practices, the Institute commits significant resources to elevating direct support work to the professional status it deserves. 

Data on the workforce crisis

In 2013, there were about 880,000 full-time equivalent (FTE) DSP positions dedicated to providing assistance to 1.4 million people. Given that approximately 30% of the DSP workforce is part-time, and estimating that 2.5 part-time workers are needed to fill one full-time equivalency, there were an estimated 1.3 million DSPs supporting individuals with IDD. In order to sustain services at the current levels, given current turnover rates, 574,200 new DSPs need to be hired into the workforce every year. To provide services to the approximately 200,000 people with IDD on waiting lists, an additional 167,001 new DSPs would need to be hired. Given the high growth and demand in need, the persistent turnover rates, and a strong U.S. economy, the number of new DSPs that will need to enter the workforce is expected to grow each year between now and 2030.

Wages for DSPs pose a significant problem. At $11.76 per hour, the average DSP who works full-time is paid less than the federal poverty level for a family of four. Many organizations provide health insurance to employees, but most cannot afford the premiums. Most organizations offer paid time off to full-time DSPs, but part-time workers often have no paid benefits. Almost half of DSPs receive publicly-funded benefits, such as medical, food or housing assistance. Most DSPs work a second (or third) job to earn enough money to pay their bills. Unacceptably low wages and limited benefits often correlate with low value, respect, and status. DSP wages are so low and their accountability so high, that far too often good people leave a highly-skilled profession they love.

High turnover has been well-documented in the DSP workforce for nearly three decades. The annual turnover rate in the DSP workforce is an estimated 46%, with about 38% leaving in the first six months and approximately 21% leaving within 6-12 months. Costs associated with replacing DSPs range between $2,413 and $5,200.

The health, safety, and well-being of people with IDD are at risk daily because of the workforce problems. A revolving door of strangers coming in and out of a person’s life, often required to support in the most intimate personal care routines, means that far too often they may not trust or develop a meaningful professional relationship with the DSP. Signs and symptoms of illness are missed, opportunities for community participation are lost, and people with an IDD have few choices other than congregate models, such as group homes or sheltered work settings, because community staffing is unstable.

Strategies for recruitment, retention, and training

While high turnover seems like an insurmountable problem to employers, strategies are available to address the challenges.

Attracting and selecting the best candidates for a position involves communicating the qualifications needed to complete the tasks of the role they are accepting. By sharing information through Realistic Job Previews (RJPs) and utilizing behavioral interview questions, the recruitment process can provide both job seekers and employers with the needed information to make an informed decision.

Understanding organizational culture and how it enhances job satisfaction, and making changes and enhancements as needed, can lead to higher levels of job retention. High-quality staff training is another effective tool in staff retention. A comprehensive employee training and onboarding plan supports employees in knowing their roles and responsibilities and in feeling confident on the job.

Advocacy

Advocacy is an important competency for direct support professionals. This requires speaking up and taking action to create change that improves people's lives. DSPs play an important role in advocating for and with the people they support, on both the individual and systems level.

As advocates, DSPs must be able to speak out when they see discrimination happening. This may include something on an individual level, like a person receiving supports not being served in a restaurant, or it may include something on the systems level, such as lack of accessible transportation or access to appropriate healthcare. Working at both individual- and systems-level advocacy creates the social change needed to improve the lives of all people with disabilities.

DSPs always need to think about how and why they advocate, making sure to respect an individual's right to self-determination. They must support the advocacy efforts by and for the people they support while making sure they do not impose their personal desires or opinions. In this sense, the DSP’s advocacy role is similar to that of an ally or advisor, offering expertise, advice, and information, but not making decisions for the people supported.

Developing the skills and attitudes to support advocacy efforts takes practice. Some of the key skills and attitudes are: 1) believing in yourself; 2) being assertive without being aggressive; 3) being positive and committed; 4) being "in the know" about the issues; and 5) taking a leadership role when needed.

Advocacy is also required for professionalizing the role of the direct support professional. This may include advocating on behalf of wage increases, better training, benefits, and opportunities for career advancement.

Frontline supervision

Frontline supervisors play an important role in the delivery of services and supports to people with intellectual and developmental disabilities. Their duties may include hiring, training, and supervising staff, program planning and evaluation, advocacy, working with families, and working with community members, among other responsibilities. The role of frontline supervisors has become increasingly complex because of the movement toward individualized services in the community (instead of in group settings) and more people with IDD directing their own services. The Research and Training Center on Community Living led a national process to develop and validate the National Frontline Supervisor Competency set, an important step in professionalizing the direct support workforce.