Thirtieth Anniversary Issue on Progress and Priorities in Direct Support
Building Stronger Teams
How Self-Managing Teams are Changing the Work of DSPs and Peoples' Lives
Time for a Revolution in HCBS
The world is changing—faster and more profoundly than most of us expected. For the Home and Community-Based Services (HCBS) system, this moment demands more than adaptation. It calls for transformation.
At the heart of that transformation is a simple truth: Systems designed to support people with disabilities cannot be person-centered if they aren’t also people-centered for those providing the support.
Direct support professionals (DSPs)—the backbone of the workforce—do the most essential work in HCBS. Yet too often, they remain underpaid, undervalued, and constrained by rigid hierarchies that stifle their potential.
If we want different outcomes, we must work—and pay—differently.
Going First—Again
For more than two decades, Values Into Action (Values) has partnered with people using services to advance the ideals of autonomy, choice, and control.
Along the way, we’ve often chosen to “go first.” Values was one of, if not, the first Pennsylvania organization to:
- Provide residential habilitation without owning homes, ensuring separation of housing from services;
- Act as the Demonstration Partner with the Institute on Disabilities, Temple University to lead a Developmental Disabilities Council grant that advanced the Supports Broker service in Pennsylvania and impacted the service definition, qualifications and the rate of reimbursement;
- Offer the Supports Broker service. The Supports Broker Service enables assistance and support for people who are self-directing one or more of their HCBS services. Supports includes helping people with employer-related tasks, compliance with regulations and rules and developing natural supports.;
- Contract with independent Certified Investigators to assure conflict-free abuse investigations;
- Influence the Pennsylvania Office for Developmental Programs in expanding the Housing Transition and Tenancy Sustaining Service, evidencing the need for expanded qualification requirements, raising the rate of reimbursement and the Supportive Housing Pilot by demonstrating the efficacy of the Housing Transition and Tenancy Sustaining Service in HCBS.
Our move to self-managed teams (SMTs) is the next step in that legacy. This is not a rebranding exercise. It’s a redesign—of how power, responsibility, and resources (including wages), are distributed in service organizations.
When those closest to the person hold authority, better outcomes follow—for everyone.
"Slow and steady…some teams excelling in self-managing the team schedules, covering for one another and communicating updates without using management support, facilitating their team meeting and recording the decisions they make for action accountability."
Values’ work builds on a growing international movement, including the Buurtzorg model 
in the Netherlands, and initiatives like Human Learning Systems, and the Self‑Managed Support Network. All share a core idea: When authority and accountability are shared, human services thrive.
What Is a Self‑Managed Team?
A self-managed team is a group of employees—and people participating in services—who share responsibility for day-to-day decisions, problem-solving, and operations. Instead of relying on supervision to direct their work, teams are supported through coaching, transparent information, and shared decision-making structures. The idea draws inspiration from Buurtzorg, where small, self-steering nursing teams—supported by minimal hierarchy—deliver higher-quality care, greater staff satisfaction, and lower administrative costs.
At Values, teams are organized into geographic “neighborhoods.” We also consider the support needs of each person who requires specialized knowledge and skill, as well as established relationships. Each team includes people using services, direct support professionals (DSPs), and community support facilitators (CSFs). CSFs act as mentors and coaches, not managers. This structure creates new opportunities for DSPs to grow professionally and financially without leaving direct support. Paying living wages isn’t aspirational, it’s essential.
Flipping the Hierarchy
Traditional hierarchies centralize authority and isolate decision-making. They also normalize stagnant wages. Self-managed teams (SMTs) challenge both assumptions.
When DSPs hold real authority, poverty wages become indefensible. SMTs realign compensation with contribution, building both equity and accountability.
The economics of trust and autonomy are not abstract—they’re performance drivers.
Research from self-managed organizations shows lower turnover, stronger relationships, and improved satisfaction for staff and people supported alike.
What It Means for DSPs
In an SMT, DSPs help shape plans—not just implement them. With that influence comes shared accountability: participation in budgeting, scheduling, planning, and continuous improvement. In return, SMTs offer what traditional hierarchies rarely do—autonomy, dignity, pay progression, and professional respect.
How Decisions Get Made
Self-managed teams use structured, consensus-based decision-making. The process is built for resolution, not endless discussion. Once decisions are made, accountability is shared. Transparency is key. Teams review outcomes, share information, and adapt their practices together. This approach not only strengthens trust but ensures responsible use of public funds.
The Real Challenges
Transitioning to self-management is not simple. Budget systems, compliance expectations, and long-standing habits make it complex work.
But complexity is no excuse for inaction. Values is addressing these challenges through clear, strategic and tactical planning, honest communication, direct and honest feedback, and deep trust. Change takes time, but it’s worth it. We are working with an external evaluator to track progress as well as challenges and to adapt as needed, based on the data. When people experience shared ownership of their work, energy shifts—from compliance to commitment.
Values That Ground the Work
Self-managed teams are not just an operational model—they embody VIA’s values: respect, kindness, accountability, openness, and partnership.
“In my head, it always just goes to empowered. Just empowering employees to make decisions.”
Fair pay and shared responsibility are not separate from these values; they are proof of them. By aligning how we work with what we believe, we build a more human system for everyone involved. The challenge continues to provide a livable wage when the organization is reliant on Medicaid funding. While the Pennsylvania Department of Human Services Office of Developmental Programs has been committed to raising the rates of reimbursement specifically for community-based services, the living wage for one adult without children is $23.32/hour. Our starting wage is $19.00/hour although most of the DSPs begin at $20.00/hour or above. DSPs earn more from there. A component of the SMT Transition Plan includes the development of an incentive structure for high performing teams.
A Call to DSPs…and to the Field
DSPs have always played the most important role in HCBS. It’s time our systems reflected that truth.
Know your value. Question assumptions. Lead through relationships.
When decisions and resources are entrusted to those closest to the person, outcomes improve—consistently and measurably. Self-managed teams ask more, but they also give more: influence, dignity, wage growth, and a real seat at the table.
The future of HCBS depends on reimagining not just how we serve, but how we lead—together.