The Changing Roles & Expectations of Direct Support Professionals


Joseph M. Macbeth is the executive director of NADSP. He can be reached at

Several years ago, I worked on a project that gave me an opportunity to interview dozens of Direct Support Professionals (DSPs) about their work. During those travels, I met a man who was a refugee from Rwanda. He had escaped its civil war and moved to this country. He told me that in his home country, he cared for people dying from the AIDS epidemic of the early 1990s. As he reflected on his work as a caregiver in Rwanda, he said that he was admired. He was respected and honored by his community for doing important work. Once he moved to the United States, he got a job providing direct support to people with disabilities in one of the wealthiest countries in the world. Yet he felt that the work was not respected or honored. He was unable to support his family on the low wages he earned. At the time, this interview shook me. I was reminded of it when we decided to dedicate this issue of Frontline Initiative to the changing roles of DSPs. There is much to be said about how DSPs are perceived in our society.

About 2 years ago, I listened to a senior official from the United States Department of Labor’s Bureau of Labor Statistics (BLS). The BLS is the principal fact-finding agency for the federal government in labor, economics, and statistics. This senior official was asked why "caregivers" in the United States earned such low wages. She said, "according to our surveys, caregivers earn low wages because the job requires low cognitive ability." Her response floored me. It reflected that she did not understand the true nature of the work of DSPs. DSPs make important decisions to support people. They help uphold peoples’ dignity and rights. They often support life-sustaining medical tasks. However, I now believe it is not uncommon for people to underestimate the importance of skilled DSPs from people who have never done it.

We need to change the public perception that society has about the DSP. We are advocating that the BLS recognize a standardized occupational code (SOC) for this growing and changing workforce. Sign the petition to the U.S. Office of Management and Budget . That’s the first step. We need to adopt a comprehensive approach to influencing public policy. This includes improving wages and ensuring access to professional training and career pathways.

Join us in taking a bold stance by banding together for a Standard Occupational Classification with the U.S. Bureau of Labor Statistics. Sign the petition!

Recent stories by the Philadelphia Inquirer and National Public Radio have educated the general public on abuses against children, youth, and adults with intellectual and/or developmental disabilities (IDD). Further, the United States Office of the Inspector General (OIG), in partnership with the Department of Health and Human Services (HHS) and the Administration on Community Living (ACL) recently released a joint report. This report found that up to 99% of critical incidents were not reported to the appropriate law enforcement or state agencies as required.

The serious nature of these reports is getting some attention they deserve. The long-term supports and services model for people with IDD is at a crossroads. DSPs are at the intersection. Last February, the President’s Committee for People with Intellectual Disabilities (PCPID) released its 2017 Report to the President - America’s Direct Support Workforce Crisis: Effects on People with Intellectual Disabilities, Families, Communities and the U.S. Economy. I’m so pleased that the PCPID identified that many of the issues that NADSP has been advocating to implement for years. In this report, the identified issues are now addressed in formal recommendations for policy implementation. I’m also proud that NADSP played a role in writing this report. We asked people that we’ve met across the country to share stories. These stories matter greatly. It’s important to continue telling them.

I hope you enjoy this issue of Frontline Initiative. I hope you agree with us that the roles and expectations of DSPs are changing. I hope you’ll help us usher in a new era of direct support work that fosters inclusion, self-determination, choice and freedom from abuse and neglect for those we support.


  • NADSP accredited education curricula for DSPs
  • NADSP member organizations

    Member organizations who employ DSPs can support them by joining NADSP’s membership,which, among other things, offers access to much of NADSP materials, archived webinars, news flashes, policy initiatives and other important information geared toward Direct Support Professionals and Frontline Supervisors. It’s important for professionals to be engaged with their professional membership organization.

  • NADSP industry partners

    National organizations who have a history of supporting our mission, values and promote our guiding principles that DSPs require a large scale advancement of the knowledge, skills and values of the direct support workforce.

  • NADSP membership form

NADSP Annual Conference: The Fourth One

Make your plans now to celebrate DSP Recognition week!

September 7 & 8, 2018
St. Louis Union Station Hotel, Curio Collection by Hilton
1820 Market St.,St Louis, Missouri, 63103

Join NADSP in St. Louis, Missouri on September 7 and 8, 2018 to ring in DSP week. You will have an opportunity to learn about best practices, share stories, network and gain insight on building direct support excellence. If you can’t make it this year, join us for The Fifth One in 2019!

We will also be awarding of The John F Kennedy, Jr Award for Direct Support Advocacy & Leadership at our Cocktail Hour reception.

Visit for more information.