CQL | The Council on Quality and Leadership

Empowering the Direct Support Professional Workforce

Posted 9/25/18
By Mary Kay Rizzolo | CQL President & CEO

Direct Support Professionals (DSPs) play a critical role in helping to empower and equip people receiving services to lead independent, meaningful, and full lives. Through person-centered approaches that promote self-determination, the responsibilities of a DSP are vast. This work can include providing supports for relationship-building, financial management, personal care, household tasks, transportation, communication, advocacy, and so much more. 

Despite the depth of these work demands and the complex skill sets necessary to complete them, DSPs face low wages, lack benefits, have insufficient training, and have inadequate career development – just to name a few. While the culmination of these issues has led to the label of a ‘DSP Crisis,’ this is a decades-long systemic failure to recognize and resolve very clear, yet quite complex, problems confronting a vital workforce.

The numbers are staggering for DSPs:

  • $11.76 average hourly wage
  • 46% average state-wide turnover rate
  • 12% overall vacancy rate
  • 38% of DSPs left their position in fewer than 6 months
  • 15% of agencies provide DSPs with health insurance (Hewitt et al., 2018)

These statistics, especially those related to turnover, have not only a negative effect on the DSPs themselves, but also on the organizations that employ them. As non-profit organizations already struggle with limited resources available, the costs of turnover are significant. Filling vacancies of open positions can cost up to $5,000 per DSP due to recruitment, training, and more (Raustiala et al., 2015). Overall, estimates indicate that DSP turnover costs around $784 million annually in the United States (Hewitt & Larson, 2007).

Beyond the impact on human service organizations, there are clear implications for people receiving supports from these DSPs. They are significantly affected by turnover, not just by the staffing change itself, but by the resulting effects on those staff members supporting them to achieve their outcomes.


The Impact on Quality of Life for People With IDD

By Carli Friedman | CQL Director of Research

CQL conducted a study of approximately 1,300 Personal Outcome Measures® interviews with people with IDD to find out how DSP turnover impacted quality of life outcomes. Overall, we discovered that the majority of people (55.9%) experienced DSP turnover within the past two years. Of those who experienced turnover, provider organizations or support staff were the most responsible for the change (86%), followed by the person with disabilities (5%), employers/co-workers (1%), family (1%), guardians (1%).

We also looked at individual outcomes within quality of life. To explore this relationship, we ran binary logistic regression models between DSP turnover and each of the 21 indicators within the Personal Outcome Measures® factors. DSP turnover significantly predicted 17 out of the 21 outcomes; with each of the 17 outcomes, people with IDD that experience DSP turnover are less likely to have outcomes present than people who do not experience DSP turnover (see figure).

Impact of DSP Turnover on Outcomes

DSP turnover impact on outcomes

Personal outcomes are highly dependent on the individualized organizational supports people with IDD receive. For this reason, we also explored the impact of turnover on the supports organizations are able to provide to people. According to the findings, people who experience turnover receive significantly fewer supports from organizations than people who do not experience turnover (see figure).

Impact of DSP Turnover on Supports

DSP turnover impact on supports

As indicated by our findings, DSPs are central to the quality of life of people with IDD, including human security, community, relationships, choice, and goals. Those people with IDD who experience DSP turnover are less likely to achieve individualized outcomes. They are also less likely to have organizational supports in place to help them achieve their outcomes. Because of their importance, not only for health and safety, but also for community integration, systemic change is needed to address the causes of this critical issue and its exponential turnover rate.


Confronting The Workforce Issues

By Angela Rapp Kennedy | CQL Vice President of Accreditation and Training

The statistics are not only startling, but certainly demonstrate just how important the DSP workforce is in human services. Once again data provides a window into the world that allows us to see it more clearly. While what we see may feel overwhelming in scope and magnitude, efforts across the country to identify solutions, implement strategies, and develop tools, bring hope regarding these workforce issues and ultimately the people supported.

Petition to Establish a Standard Occupational ClassificationAdvocacy Campaigns

There are a multitude of state-specific and nationwide advocacy efforts to remedy some of the most pressing workforce problems. For example, in New York there has been the #bFair2DirectCare campaign, which fights for a fair, living wage for nearly 100,000 DSPs across the state. At a broader level, ANCOR has established a national advocacy campaign to confront factors negatively affecting DSPs.

To enact change at the federal level, CQL has signed on as a founding partner to issue a change.org petition for the Office of Management and Budget to Establish a Direct Support Professional Standard Occupational Classification. This initiative from the National Alliance for Direct Support Professionals (NADSP) could help in setting reimbursement rates, improving data analysis about workforce issues, and demonstrating the contributions of DSPs.

Training and Professional Development

There are numerous training options available to improve the knowledge, skillsets, and practices of DSPs. Here at CQL, we offer a host of on-site training and workshops that will integrate best practices into daily supports and services. Among these options, CQL has a one-day training titled ‘Personal Outcome Measures® for Direct Support Professionals,’ where DSPs can learn about person-centered discovery through this tool and how it can help people achieve their individually-defined outcomes.

For online training options, there are some helpful e-Learning courses available through DirectCourse’s College of Direct Support, as well as Relias, which also features some e-Learning overview courses about the Personal Outcome Measures®.

Competency-based training and credentialing have also been cited in various reports and journals as a critical component in establishing career ladders and creating professional advancement opportunities. One of CQL’s Member Organizations, the National Alliance for Direct Support Professionals (NADSP), offers various credentialing options for DSPs to promote and advance core competencies of the workforce.

Recognition and Celebration Efforts

Melissa attends a Backstreet Boy concertA lack of understanding and appreciation for the important work of DSPs is often highlighted as a hindrance to the advancement of the workforce. Oftentimes, those outside of the human services field are not familiar with what a DSP position entails and the critical role those employees play in the lives of people receiving services. 

In an effort to improve the acknowledgement of the contributions of DSPs, a national Direct Support Professional Recognition Week was established during the middle of September every year. Throughout this week, people supported, families, organizations, colleagues, and other stakeholders celebrate DSPs by presenting awards, hosting parties, offering gift giveaways, and more.

For the last three years, CQL has partnered with NADSP for an annual campaign to feature articles and videos of DSPs who are providing exemplary supports for people to achieve their individually-defined outcomes. Through the use of CQL’s Personal Outcome Measures®, these DSPs are discovering what really matters in people’s lives, and then supporting them to make those dreams a reality.

You can browse all of these DSP Recognition Week stories, or check out a few examples:

  • Rosa Mackie has taken proactive steps to ensuring that Jerry's dreams and desires are understood, and steps are taken to achieve these outcomes.
  • Tabitha Hatten was involved in Lisa's Personal Outcome Measures® interview. She was able to hear first-hand Lisa's desire for improving her quality of life.
  • With especially dedicated supports by DSP Bill Murphy, Josh is working to improve his independence and opportunities.
  • Allen Selby has been one of the DSPs working at Core Services of Northeast Tennessee, supporting Carl to explore the outcomes most important to him.


Celebrating CHI Friendship’s Direct Support Professionals

CHI Friendship recognizes DSPsBy Dori Leslie | President/Vice President, CHI Friendship

CHI Friendship could not think of a better group of people to praise and recognize than our very own Direct Support Professionals. Putting our inverted organizational chart into action, we strive to exemplify what it means to be servant leaders. This philosophy is not only shown during DSP Recognition Week, but is lived out each and every day towards the employees we truly value.

“You feel appreciated by your peers for the things that you do. You are often recognized by management for going above and beyond,” says Irma Moran, a Direct Support Professional from CHI Friendship.

We realized that the way employees are treated leads to higher employee morale, better retention, and most importantly, better services for people supported. Giving recognition to our staff is our culture and it is an expectation.

During DSP Recognition Week, we try to take recognition to a whole new level. We have a full agenda of activities planned for DSPs which includes a breakfast buffet each day of the week, car wash event for DSPs put on by the leadership team, a food truck, discounts, T-shirts, prizes, and more. Then, the week gets wrapped up with an award ceremony including the ‘DSP of the Year Award’.

CHI Friendship bakes cookies for DSPsTo ‘walk a mile in someone else’s shoes,’ this year our leadership team also put in some hours working alongside Direct Support Professionals. We had around 40 staff from the leadership team who each completed some hours of direct support responsibilities. While it wasn’t a lengthy period of time, it did serve an important purpose. It reminded our leadership team what it is like to be a DSP, and helped build cohesion and comradery throughout the organization.

We cannot say enough about how grateful we are for our Direct Support Professionals and this week was just a small token of our appreciation!



  • Hewitt, A., & Larson, S. (2007). The direct support workforce in community supports to individuals with developmental disabilities: Issues, implications, and promising practices. Developmental Disabilities Research Reviews, 13(2), 178-187.
  • Hewitt, A., Macbeth, J., Merrill, B., & Kleist, B. (2018). The direct support workforce crisis: A systemic failure. Impact, 31(1), 3-9.
  • Raustiala, M., Crosier, B., Drexelius, J. R. j., Schiff, W., Mayo, K., Golden, B., & Seereiter, M. (2015). Supporting people with developmental disabilities: The impact of low wages and the minimum wage debate on the direct support professionals workforce. New York: The Alliance of Long Island Agencies for Persons with Developmental Disabilities, Cerebral Palsy Association of New York State, Developmental Disabilities Alliance of WNY, Interagency council of developmental disabilities agencies inc., NYSACRA, NYSARC, and NYSRA.



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