Abstract

This special issue sheds light on the needs of the direct support professionals (DSPs), as well the possibilities when positive practices are implemented. A commitment to quality services and quality lives requires a commitment to finding solutions that better support DSPs so they can afford (emotionally, physically and financially) to keep doing the work they love. Improving supports to people with IDD is contingent on improving the compensation, working conditions, professional development, and career opportunities of DSPs.

A commitment to quality services that contribute to a good quality of life requires a commitment to finding solutions that better support direct support professionals (DSPs) so they can afford (emotionally, physically, and financially) to continue the work they love. Improving supports for people with intellectual and developmental disabilities (IDD) is contingent upon improving the compensation, working conditions, professional development, and career opportunities for DSPs.

In this special issue on the direct support workforce, the critical role of DSPs in promoting the quality of life of people with IDD in the United States was highlighted. The intent was to help readers better understand the current challenges facing this workforce and to offer evidence-based approaches to address staff instability and DSP health and wellness, as well as increase the understanding of how important DSPs are to implementing interventions and approaches that help people with IDD to enjoy good lives. Key findings across the articles include:

  • Houseworth, Pettingel, Kramme, Ticha, and Hewitt discussed the high turnover rate within organizations. The higher turnover rate in the last 12 months was significantly related to lower DSP wages and lack of employer-provided health insurance. Additionally, a higher percent of leavers within 6 months of tenure, was significantly related to not offering paid time off and health insurance, higher vacancy rates in agencies, higher proportion of part-time DSPs, and lower overall staff sizes.

  • Houseworth et al., also showed that within states, a higher turnover rate in the last 12 months was significantly related to a lower percentage of people living in individualized settings and lower per capita Medicaid spending.

  • Barnhart, Smith, Ellsworth, Coleman, Lorenz, Riddle, and Havercamp studied tobacco use among people with disabilities and their paid caregivers. They found a higher likelihood of tobacco use. Creating a targeted smoking cessation plan for people with disabilities and their caregivers is possible using the Living Independent from Tobacco (LIFT) program. LIFT offers an evidence-based tobacco cessation intervention that should be replicated. Participants valued the dyadic approach and the opportunity to learn coping skills to help with smoking cessation.

  • Trauma-informed care (TIC), as discussed by Keesler, has emerged as a model for developing organizational culture. TIC practices offer positive implications for organizations serving people with IDD and their DSPs.

  • Keesler and Troxel, discussed stress and burnout, which are common among DSPs and present a significant risk to the quality of services that are delivered to people with IDD. Although DSPs do use a variety of self-care techniques, there was considerable variability in and frequency of self-care behaviors among DSPs. Spiritual behaviors and a sense of optimism were the most commonly used self-care behaviors. DSPs least often endorsed getting supervision, taking a break, taking time off when ill, and declining additional responsibilities. There are undisputed challenges in recruiting, nurturing, and maintaining a robust DSP workforce. For over two decades, issues of high turnover, early turnover, low wages, high vacancy rates in position, lack of access to affordable health insurance, burnout, and increasing demand have been well documented. These issues are often referred to as a crisis. However, crises do not last decades, they are defined as being sudden and of short duration and require solutions. The DSP challenges are embedded in system-wide challenges in the manner in which services are funded and the choices that are made in terms of the qualifications, training, and compensation that are deemed appropriate for this workforce. Changes at a systems level are critically needed.

The research findings reported in this special issue shed light on the needs of this workforce, and the possibilities when positive practices are implemented. Strategies such as trauma- informed care and wellness can be used to better support DSPs and people with IDD. The research findings in this issue also clarify the relationship of organizational and systems issues related to wages, benefits, and per capita investment and to high rates of turnover within organizations and states. Collectively, the implications across these articles is clear –pervasive problems negatively influence the quality of services and supports that are provided to people with IDD, and significantly hinder their opportunities to live well with a sense of belonging in their communities. Solutions are required to meet demand at a time when there are fewer people in typical recruitment pools and very low unemployment rates.