Frontline Initiative Code of Ethics

Continuing the tradition of bridging gaps:
Why the Code applies to everyone in policy and services


Richard Cohen, Esq. is the Executive Director of the Disabilities Rights Center of New Hampshire.

The National Alliance for Direct Support Professionals (NADSP) Code of Ethics captures the modern values of the disability rights movement. The standards in the Code represent best practices. Many have been widely accepted in the field for at least 40 years. Below are some excerpts from the Code. With these are examples of important movements that the Code has been built upon.

Direct Support Professionals (DSPs) commit to person-centered supports... focusing first on the person. DSPs understand that the role requires flexibility and creativity. These related principles came about in the 1980s. They have formed the essence of person-centered planning.

DSPs encourage growth and recognize the autonomy of individuals…while being attentive and energetic to reducing their risk of harm by, among other actions, reporting alleged abuse or neglect. These principles represent the legal obligation to help protect individuals from harm. They also balance individuals’ “dignity of risk.” These principles date back to the early 1970s. They have formed the basis of landmark cases such as Willowbrook and Romeo v. Youngberg.

DSPs consistently address challenging behaviors proactively, respectfully and by avoiding…aversive or deprivation… techniques. In 1981, TASH adopted a resolution calling for the removal of aversive and deprivation practices. The resolution advocated for positive approaches to challenging behaviors. More clinical and scientific work was conducted in this field. This showed the effectiveness of positive approaches. Now it is standard to use functional behavioral assessment. 

The implementation of the Code of Ethics principles and their historical counterparts have moved mountains. 

DSPs advocate with the people they support… including finding additional advocacy services when needed. The initial 1977 Pennhurst case is a prime example of the importance of advocacy. This case ordered the replacement of a 1200-person institution with community services. It was required that each Pennhurst resident be assigned a “friend-advocate”. This raised awareness that advocacy helps meet individuals’ needs in the community. 

The implementation of the Code of Ethics principles and their historical counterparts have moved mountains. Hundreds of institutions have closed. Individuals with challenging behaviors or health conditions are living in the communities. The lives of many people have improved. 

Despite these standards, inadequate services remain. There continues to be a gap between what is written in regulations and the Code, and what happens in reality. One reason for this is funding. For example, in New Hampshire per person funding has steeply declined from $75,000 annually in 1994 to $29,000 in 2010 (taking into account inflation). The impact has been significant for DSPs. Workforce training has been significantly cut, and wages have remained low. 

There is another reason for the gap between what should ideally happen in direct support and reality. That is a lack of full organizational commitment to the Code of Ethics principles. This can create a dilemma for the well-intended and committed DSP. The efforts of DSPs are consistent with the Code in many situations. However, the other parts of the system may not follow through in an ethical manner. For example, there was one case where a DSP tried to address poor housing conditions. The DSP filed a number of incident reports. The DSP ultimately made a report of neglect to the state adult protective service agency. Unfortunately, the recipients of those reports failed in their responsibility. The result was a tragic fire in which a person receiving supports died. This heartbreaking example further emphasizes that it is essential for everyone to live by the Code of Ethics. This includes both DSPs and all those who provide supports and services. The lives and well-being of our fellow citizens depend on it.