DSPs as a Social Determinant of Health of People with IDD

Posted on January 13, 2026

By Carli Friedman, CQL Director of Research

Direct support professionals (DSPs) play a vital role in helping promote the health, safety, community integration, and quality of life of people with intellectual and developmental disabilities (IDD). On the other hand, the instability of the DSP workforce – what’s often referred to as the DSP ‘crisis’ – results in people with IDD having worse outcomes.

That’s why I believe the availability, stability, and quality of the DSP workforce should be considered a social determinant of health of people with IDD. Social determinants of health are factors in our lives that, while not necessarily directly related to our health, can either hurt or improve our health. Social determinants of health as a concept are important because they remind us that we have to do so much more than just provide health services in order to promote people’s health and quality of life; as such, we need large structural solutions, rather than individual ones, to improve people’s lives. In this study, to further examine my argument that the DSP workforce should be considered a social determinants of health for people with IDD, I analyzed Personal Outcome Measures^® data from 5,457 people with IDD to examine the impact the workforce can have on the health outcomes, health supports, and social determinants of health-related outcomes of people with IDD.

Between 2018 and 2024, 64% of people with IDD experienced DSP turnover. Those people with IDD who experienced DSP turnover were significantly less likely to have the best possible health, including being less likely to have health care professionals identify their best possible health situation, be involved in selecting health interventions, have effective health interventions, and have the health devices and equipment they need (see figure below). For example, regardless of their other demographics, people with IDD who experienced DSP turnover were 1.63 times less likely to have effective health interventions compared to people with IDD who did not experience turnover.

DSP Turnover and Health Outcomes

When people with IDD experienced DSP turnover, they were also significantly less likely to receive individualized supports to promote their best possible health. When there was DSP turnover, organizations were less likely to know about people with IDD’s wants and needs, provide them adequate support and access to care, and involve the person in their care (see figure below). For example, people with IDD who experienced DSP turnover were 1.55 times less likely to obtain regular medical and health services than people with IDD who did not experience DSP turnover, regardless of their demographics.

DSP Turnover and Health Supports

In addition, DSPs also had an impact on outcomes which serve as social determinants of health. In fact, regardless of people with IDD’s demographics, when people with IDD experienced DSP turnover, they had a 19.10% decrease in social determinants of health-related outcomes present, compared to people with IDD who did not experience DSP turnover.

“Our findings suggest the DSP workforce not only has an impact on health and health services, but also on other outcomes which serve as social determinants of health. People with IDD in our study had significantly more social determinants of health-related outcomes when they did not experience DSP turnover, while experiencing turnover hindered their outcomes. Thus, the harms of an unstable workforce can be two-fold, in that it both negatively impacts people with IDD’s health outcomes and health services that aim to promote those health outcomes, and it negatively impacts other areas of people with IDD’s lives that serve as social determinants of health (e.g., employment, community, rights, safety, etc.), which also go on to hinder people with IDD’s health outcomes. The ways the DSP workforce can both directly and indirectly impact people with IDD’s health is precisely why we believe the availability, stability, and quality of the DSP workforce should be considered a social determinant of health for people with IDD” (Friedman, 2025, p. 5).

This article is a summary of the following journal manuscript: Friedman, C. (2025). The direct support professional (DSP) workforce as a social determinant of health of people with intellectual and developmental disabilities. Disability and Health Journal, 102023. https://doi.org/10.1016/j.dhjo.2025.102023