Thirtieth Anniversary Issue on Progress and Priorities in Direct Support

For nearly 40 years, I have devoted my career to finding solutions to high turnover and vacancy rates among direct support professionals (DSPs) and to increasing their professional recognition and status. To truly ensure inclusion for ALL people with intellectual and developmental disabilities (IDD), our top priority must be to build and respect the workforce that makes inclusion possible. This means ensuring there are enough professionals in health, allied health, education, social work, and other fields who are trained and able to provide culturally responsive services and support to people with IDD. Perhaps most importantly, it also means focusing on DSPs who deserve the same recognition and stability as nurses, teachers, and first responders. DSPs are the backbone of community support, yet the system was built on their labor and out of their pocketbooks. Investing in this workforce is how we safeguard the billions of dollars already invested in our human services. Without DSPs, there is no system of support.

Amy Hewitt

There are many accomplishments to celebrate in the direct support profession. Over the past three decades, progress has been made toward greater professional recognition. Yet more is needed to stabilize this workforce. It is one of the largest and fastest-growing workforces in the United States. People choose this profession because they value the strengths, contributions, and uniqueness of each person they support. They stay because of the deep, reciprocal relationships they build with the people they support, even in the face of many difficult realities.

Three decades of accomplishments

Much has happened over the past three decades to bring needed professional recognition and respect to direct support professionals. None of this progress happened overnight. It has been slow, incremental change.

Competencies. In the early 1990s, the U.S. Departments of Labor and Education funded efforts to develop skill standards for emerging and growing industries, such as manufacturing, health care, and information technology. The Human Services Research Institute developed and validated the Community Support Skill Standards (CSSS) for the direct support workforce. Published in 1996, the CSSS were intended to be a relevant and forward-thinking identification of the knowledge, skills, and abilities required of this workforce. This was the first comprehensive description of skills required of DSPs across community service sectors.

Others have built on this work, including:

• Validation of the CSSS in community residential services for people with IDD
• A National Alliance for Direct Support Professionals (NADSP) version drawing heavily on the CSSS and the IDD competencies
• Competencies targeting employment support staff
• A U.S. Department of Labor skills pyramid for long-term services and supports
• Frontline supervisor competencies
• National Association for the Dually Diagnosed (NADD) competencies for supporting people with IDD and mental health needs
• Centers for Medicare and Medicaid Services-funded core competencies across long-term services

Each of these has been used in training and credentialing programs for the direct support workforce.

Shortly after the CSSS were developed, national leaders met to discuss how to promote their use, leading to broader recognition of the need to professionalize the direct support workforce.

DSP title. One of the greatest challenges facing this workforce in the 1990s was the wide range of titles used by national organizations, policymakers, and employers. Any effort to professionalize the workforce would require a common occupational title. After lengthy debate, direct support professional (DSP) was adopted. Some objected to the term “professional,” arguing their wages did not reflect that status or thought the term was too closely aligned with the medical model, while others supported it. Today, direct support professional is the most commonly used title for staff supporting people with intellectual and developmental disabilities.

Code of ethics. Most professions have a code of ethics to guide expected conduct. In 2001, NADSP created the first code of ethics for this profession, which was updated in 2026. Because DSPs frequently experience ethical dilemmas in their work, using this code to guide daily decision-making can improve the quality of the support they provide.

Professional association. The National Alliance for Direct Support Professionals, established in 1996, works to “elevate the status of direct support professionals by improving practice standards, promoting system reform, and advancing their knowledge, skills, and values, through certification, credentialing, training, professional development, and accreditation services.” Like other professional associations, it offers programs and services to support the field and has played a key role in influencing policy, promoting best practices, and raising awareness of this critical workforce.

State and national DSP conferences. Promoting the professional development of this workforce is essential, and state- and national-level conferences for this profession are now common. Conferences raise awareness, help DSPs see themselves as part of something much bigger than where they work, and provide valuable opportunities to network and learn from one another.

Recognition events. At the organization, local, state, and national levels, recognition events honor the work of DSPs. There is a national DSP recognition week, which is echoed in many states by most providers. This is a time of celebration and recognition for this workforce. It raises awareness and promotes information about the importance of DSPs in our communities. Marketing campaigns, events, awards, gifts, and other strategies are often used to bring attention to their valuable work during this week.

Credentialing. In the United States, requiring credentials or certification is a key strategy for professionalizing the workforce and improving wages and access to benefits. Many state programs are emerging, along with a national credential program and an apprenticeship program, typically requiring specific training and demonstrated competence. These programs benefit DSPs, employers, and people with IDD who receive support. Employers gain a more skilled workforce and higher-quality services. DSPs benefit by learning and applying best practices and developing new skills. People receiving services partner with trained professionals committed to ethical and effective support.

Promising practices to increase stability. High turnover and vacancy rates are detrimental to the quality of supports. For far too long, the U.S. has accepted high turnover in these positions. Rates are improving – turnover is about 37% and vacancies around 10% – but remain too high. Wages are among the top reasons DSPs leave, along with limited access to affordable health insurance, paid time off, and good supervision. Evidence-based interventions at the employer level across marketing, recruitment, selection, onboarding, orientation, retention, and performance management can reduce turnover and vacancies. These include marketing campaigns, realistic job previews, structured behavioral interviews, standardized curriculum, onboarding checklists, competency-based job descriptions and performance reviews, supervisor training programs, and employee resource networks. Used with fidelity, these tools promote stability.

Much left to do

While there is much to celebrate, persistent challenges remain. Vacancies remain too high, and wages and access to affordable benefits remain too low. This has been a fight for incremental change over the past 30 years, and that fight will likely not go away. A short list of what remains to be done to continue the progress made to date is offered here.

Update the core competencies. The most comprehensive competencies for the direct support workforce were published in 2014 and have not been updated. As work and community support have evolved, these competencies need to be updated and aligned with contemporary language, services, and supports. Related curricula that embed the core competencies also need updating.

Standard Occupational Classification. This profession needs to be recognized by the U.S. Department of Labor with a standard occupational classification (SOC). Legislation and continued advocacy efforts must continue until this becomes a reality. SOCs are used to collect data and help all levels of government identify employment trends. Currently, DSPs are inconsistently categorized into a variety of SOCs, which do not accurately capture the scope of their work. An SOC for DSPs would enable more accurate data and better-informed workforce policies.

DSPs are the backbone of community support, yet the system was built on their labor and out of their pocketbooks. Investing in this workforce is how we safeguard the billions of dollars already invested in our human services. Without DSPs, there is no system of support.

Increased recognition. Although recognition of DSPs has improved, it must be consistent and ongoing, not limited to DSP Week. This starts with employers that foster a culture where supervisors and managers support, engage, and recognize DSPs year-round.

DSP voices need to be heard. Advancing policy requires elevating DSP voices. No one can describe the work of DSPs better than the people who do this work. With roughly 1.3 million DSPs in the U.S., their collective perspective is powerful. Expanding opportunities, training, and support for DSPs to share their stories will strengthen advocacy and influence policymakers.

The cost of being ignored

The need for progress is never-ending as barriers persist – low wages, limited benefits, high demands, insufficient training, and a lack of professional identity. Despite loving what they do and being committed to the people they support, many DSPs leave their positions, creating costs for employers and, more importantly, instability for people with IDD who rely on them. A revolving workforce limits service quality. Addressing this is a matter of social justice that cannot be ignored.

After nearly 40 years in this work, I remain convinced that the path forward is both clear and unfinished. We have made real progress, but those gains are still fragile without continued effort. My work has always been grounded in a simple idea: when we invest in and support direct support professionals, we strengthen the entire support system for people with intellectual and developmental disabilities. The next step is moving from recognition to real action, and I plan to keep working toward that.