Direct support professionals (DSPs) often are the backbone of support for many adults with intellectual and developmental disabilities (IDD). DSPs provide not only physical assistance but also emotional support and daily stability. Despite their essential role, DSPs often face significant challenges that affect their ability to provide high-quality, safe, and sustained support.
A recent statewide study led by the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (VKC TRIAD), in partnership with the Tennessee Department of Disability and Aging (DDA), highlights the urgent need to support DSPs more effectively. The project, titled Building Direct Support Professional’s Capacity to Support Individuals with Intellectual and Developmental Disabilities and Complex Behavioral Needs, sought to understand the training and support gaps faced by DSPs and the agencies that employ them.
The VKC TRIAD team, led by Brooke Shuster, M.Ed., BCBA, conducted an extensive community evaluation across Tennessee. Through eight focus groups and an electronic survey with 184 respondents – including DSPs, Medicaid waiver provider agency administrators, family caregivers, and individuals receiving support – the study aimed to gather insights directly from those most affected.
“What emerged was a clear and consistent message: current training, communication, and systemic support for DSPs are falling short, especially when it comes to managing complex behavioral challenges,” said Shuster. “High turnover, burnout, and low hourly wages are contributing to a nationwide shortage of DSPs.”
The study’s findings, outlined in a new report, highlight several critical themes:
- Safety and Preparedness: DSPs often feel unprepared to manage dangerous or complex behaviors, creating risks for both themselves and the individuals they support.
- Ineffective Training: Current training programs are frequently seen as too general and not sufficiently practical or relevant to the day-to-day realities DSPs face.
- Communication Breakdowns: A lack of communication between DSPs and other agency staff can impede effective support.
- Financial Barriers: Low wages and limited funding – especially for higher levels of care – contribute to high staff turnover and burnout.
- Policy Disconnects: Many of the challenges identified point to systemic issues at the state policy level that directly affect service quality and staff well-being.
The DSP workforce is in crisis, and the stakes are high. The number of adults diagnosed with autism and other developmental disabilities is rising, leading to increased demand for services and support. Yet without a stable, well-trained, and adequately supported workforce, the system risks collapsing under the weight of this growing need.
“Strengthening the DSP workforce isn’t just about improving care,” said Shuster. “It’s about ensuring safety, continuity, and dignity for people with disabilities and the professionals who support them.”
In response to findings, the VKC TRIAD team is launching a pilot program in Fall 2025 to test an innovative implementation framework aimed at addressing these gaps. The initiative includes:
- Partnerships with agencies in all three grand regions of Tennessee to deliver targeted training and technical assistance.
- Supplemental resources, including online modules and printable materials tailored for residential managers and DSPs.
- Consultation and coaching modules that provide case-specific guidance and support.
- An advisory council to guide the model’s development and ensure it meets the needs of all stakeholders.
The pilot aims not only to improve DSP training and confidence but also to reduce turnover and crisis events—two critical indicators of system health.
To access the full community evaluation report and stay updated on the project, visit the Vanderbilt Kennedy Center’s Research Reports page.
Top photo by Adobe Stock
