Posted on September 28, 2026

By Mary Kay Rizzolo, CQL President & CEO

“Quality is defined at the point of interaction between the staff member and the individual with a disability.” This is a quote from John F. Kennedy Jr., the ideological founder of the National Alliance for Direct Support Professionals (NADSP). It captures the importance of direct support professionals (DSPs) in the lives of people with disabilities who receive services.

We can all recognize that the focus of the disability services sector should be on improving the quality of our supports so that people receiving services can live meaningful and fulfilling lives of their choosing. Some challenges in making that a reality involve limited resources, financial constraints, and staffing issues – just to list a few. With that, the reality is that we can’t always do everything. At times, we need to prioritize the efforts that will make the biggest impact. 

So how do organizations, and especially DSPs, know where to start? In this Capstone article, we’re looking at Personal Outcome Measures® (POM) data to find which four outcome areas have the most positive effect on overall quality of life. Then, our friends from NADSP share guidance and tips that DSPs can use for supporting those four outcome areas.

Insight Into Outcome Correlations

By Carli Friedman, CQL Director of Research

In our most recent annual Personal Outcome Measures® Benchmarks Report (2025), we found the quality of life outcomes that have the highest correlations with total outcomes were:

• People exercise rights
• People are treated fairly
• People interact with other members of the community
• People are respected

What this means is that people with these outcomes present are significantly more likely to have a better overall quality of life. We know that DSPs are tremendously important, including when it comes to improving outcomes, such as health and safety. But what impact can they play when it comes to these four outcomes?

The data shows that people with disabilities who experience DSP turnover are 1.7 times less likely to exercise their rights, be treated fairly, interact with other members of the community, and be respected. So not only do these outcomes help improve quality of life, but DSPs also play a very important role in helping make that happen and, by extension, improving people’s lives! Considering that these four outcomes can have such an impact on overall quality of life, we’re turning to our partners from NADSP to share tips on how DSPs can better support people in these areas.

Applying Ethics & Competencies To Support Outcomes

By John Raffaele, National Alliance for Direct Support Professionals (NADSP), Director of Educational Services

CQL’s Personal Outcome Measures^® (POM), the NADSP Code of Ethics, and the NADSP Competency Areas offer complementary tools to enhance and guide person-centered support. Together, they help connect what really matters to a person with how direct support professionals put those values into practice. 

The POM provides a framework for understanding whether people are experiencing the outcomes they want in their lives and if services are facilitating those outcomes. It covers topics such as relationships, choices, rights, inclusion, health, and meaningful participation in their communities and lives. The NADSP Code of Ethics provides the ethical and professional values-based foundation for how direct support professionals should approach their work. Finally, the NADSP Competency Areas describe the knowledge, skills, and practices that direct support staff need to provide effective, person-centered support.

Used together, these tools can create a powerful “ethics + practice = outcomes” approach. The POM can help people, as well as teams and organizations, identify what is important to the person and determine whether supports are actually contributing to meaningful life outcomes. The NADSP Code of Ethics can help direct support professionals consider how they support those outcomes with person-centered respect and integrity. The NADSP Competency Areas then can provide practical guidance for turning those commitments into everyday actions.

CQL and NADSP resources can certainly reinforce one another: 

• The POM helps us ask, “Is the person experiencing the life they want?” and “Are services in place to make that a reality?”
• The Code of Ethics asks, “Are we supporting that person in an ethical and respectful way?”
• The Competencies ask, “What do DSPs need to know and do to make it happen?”

Let’s ask some questions now in how we can align these tools to elevate direct support practice. We’ll explore how the merging of ethics, competencies, and the Personal Outcome Measures^® can be practically done by direct support professionals on a daily basis.

POM: People Exercise Rights

Direct support professionals should actively support people in exercising their rights. This means moving beyond simply knowing that people have rights and making sure those rights are respected in everyday situations. They can do this by consistently asking, “What would I do differently if this were my life?”

Ensure that people have real choices throughout the day – not just choices that are convenient or predetermined by staff. Ask what someone wants to eat, where they want to go, who they want to spend time with, what they want to wear, or how they want to spend their free time. For those of us who are not receiving daily supports, these types of choices may be easily taken for granted.

People cannot exercise their rights or make informed choices without information they can truly understand. Use tools and techniques such as plain language. Use age-appropriate pictures and the latest technology, as well as demonstrations, interpreters, or other communication supports when appropriate. Give people time to process information and respond.

Avoid automatically saying “no” because something seems risky. Talk with the person about potential risks, benefits, alternatives, and supports that could make the choice safer. Seek assistance when needed, rather than automatically taking control away from the person.

It is so important to encourage people to express their own opinions, to make requests, and to ask questions to advocate for what they want. When someone can communicate for themselves, be sure they are empowered to do so. As the great Dave Hingsburger once said, “Be my microphone, not my voice.”

The NADSP Competency Areas such as Participant Empowerment, Advocacy, Communication, and Provide Person Centered Supports offer professionals concrete ways to support rights:

• Participant Empowerment helps people direct their own lives and make decisions. 
• Communication skills help you to discover how each person expresses preferences and choices. 
• Advocacy can help people understand and exercise their rights and address barriers that may be in place.
• Person-Centered Practices make sure your direct support reflects what is important to the person rather than what is easiest for staff or the organization.

A useful daily question is “Am I supporting this person to make their own decision, or am I making the decision for them?” DSPs can turn rights into reality when they provide information and support choice. When they encourage self-advocacy and step back when the person is ready to take the lead, one’s rights will flow freely. 

POM: People Are Treated Fairly

The NADSP Code of Ethics asks direct support professionals to promote fairness, equity, and inclusion. In practice, this means making sure people have meaningful opportunities to participate in their own lives and communities. Fairness does not always mean treating everyone exactly the same. It means providing each person with the individualized support they need to have equitable opportunities.

Don’t make assumptions based on one’s disability or their diagnosis. The age of a person you support needs to be considered. Their communication style and ability must be weighed. Each person you support has a set of behaviors unique to them. Ask questions. Learn what the person likes and what matters to them. Ask them what they are good at and what they want to accomplish. Fairness must be relative to the person’s situation in life. 

When someone is not participating, don’t immediately assume they are uninterested or unable to participate. Sometimes people are shy or intimidated. Ask yourself or ask them, “What’s getting in the way?” Perhaps the person needs transportation that they are unable to get. They may need some communication assistance. Adaptive equipment can sometimes be an issue, whether the equipment is damaged, broken, or non-existent. Sometimes people need a little more time and some additional information to process a situation. Just being there to help them understand their options can result in fairness and ‘leveling a playing field,’ as the saying goes. 

Notice if and when you are making assumptions. Never ever assume someone cannot make a decision, either because they communicate differently or cannot participate in something because they have needed support in the past. This is a cornerstone of direct support practice and leads to ensuring people have a ‘fair shot’ in life.

Speak up when something isn’t fair. If policies or routines create unnecessary barriers, ask questions and bring concerns to the appropriate people. Consult with your supervisors or clinicians and always with the person you support, if you sense a situation is unfair. Fairness sometimes requires direct support professionals to intervene and to advocate for change.

Ask this… “What support does this person need to have the same opportunity that others have?” Fairness means recognizing barriers, challenging assumptions, and providing the individualized support that allows each person to participate, contribute, and succeed.

POM: People Interact With Other Members Of The Community

Direct support professionals encourage people to develop meaningful connections and participate as valued members of their communities. This means more than taking someone somewhere. They help people develop relationships, discover interests, participate in everyday activities, and contribute to community life.

Ask what the person enjoys and what they would like to try. Explore classes, clubs, volunteer opportunities, sports, music, libraries, community events, restaurants, businesses, and other places that match the person’s interests. Look for opportunities to connect people with neighbors, coworkers, classmates, teammates, volunteers, and other community members. Paid staff should not become someone’s only social network. 

If a cashier, server, neighbor, or community member asks the person a question, give the person an opportunity to answer. Provide communication assistance when desired, but don’t automatically take over the conversation. Standing directly beside someone, answering every question, or directing every interaction can unintentionally signal that the person cannot speak or act for themselves. Instead, step back and ensure the person is interacting independently.

Use the following NADSP Competency Areas to support this outcome:

• Community Inclusion and Networking can help identify places where people can participate as valued community members.
• Building and Maintaining Friendships and Relationships will help people develop and sustain relationships that are not based on paid services. 
• Communication supports people to express themselves and connect with others.
• Advocacy is applicable to remove barriers to participation. 
• Facilitation of Services is applicable to coordinate supports that make meaningful community participation possible.

A practical goal is to move from “taking someone into the community” to “helping someone become part of the community.” Always have these questions in your mind when supporting people to interact with other members of the community:

• Who does the person I support know here?
• What does this person contribute to the situation/community setting?
• What relationships and friendships are they developing?
• What can I do (and what can I stop doing) to help those relationships grow?

Direct support professionals create belonging by opening doors and reducing barriers. They support relationships and give people room to develop their own community connections.

POM: People Are Respected

Respect is not just an attitude or ideal. It is something direct support professionals demonstrate through their words, their actions, and their everyday decisions. A practical question to ask is “Am I treating this person the way I would want to be treated?” When discussing someone’s life, speak to them and not around them. If another person asks you a question about someone you support – whenever possible – include the person in the conversation. Give people time to express themselves. Pay attention to verbal and non-verbal communication. Learn about a person’s gestures, facial expressions, technology, and behavior. Explore what other communication methods may mean to that person.

Respect personal space and privacy. Knock before entering someone’s bedroom or personal space. Ask permission before touching or assisting with personal care. Protect people’s confidentiality in conversations, documentation, social media, and electronic communication. There is an ethical responsibility to promote confidentiality and privacy. 

People may have preferences, beliefs, relationships, cultural practices, lifestyles, and opinions that are different from yours. You do not have to agree with someone’s choices to respect their right to have them. When someone is upset or communicating through behavior that others find challenging, don’t shame, threaten, ridicule, or talk about the person as though they aren’t there. Ask what the person might be communicating and what support they need.

Respect is demonstrated in hundreds of small moments every day. Be sure to listen. Ask questions and be curious. Be patient and wait for a person to fully answer and respond to you. Try to explain in terms and words that the person you support can follow and understand. Under all circumstances, protect privacy and disclose only information or details about a person that is appropriate and is done with that person’s consent. Do your best to honor personal preferences and tastes. 

Embracing The NADSP Competency Areas and Code of Ethics

The NADSP Competency Areas and Code of Ethics are practical tools for helping to ensure supports and services are delivered at their highest level. At the end of the day, ask “Did my work today, as a direct support professional, communicate to the person that they are valued and respected?” The answer must always be a resounding, “Yes.”