Introduction to the Special Issue: Understanding the Direct Support Workforce in the United States.

The authors scanned the research on direct-support professionals (DSPs) in the United States. They looked at pay, training, turnover, and how these gaps affect people with intellectual or developmental disabilities. The paper is a narrative review, so it sums up earlier studies instead of running new experiments.

DSP jobs pay close to minimum wage and offer little career growth. High turnover leaves many people with IDD without steady support. The review warns that these shortages threaten safety and community inclusion.

Hewitt et al. (2013) showed that unpaid family carers already fill big gaps. Sievers et al. (2020) shifts the spotlight to paid staff and says the system is still cracking.

Rosales et al. (2023) gives you a fix list: fair pay, mentorship, and inclusive hiring. Their field report extends the warning by showing small ABA agencies that cut turnover with these exact steps.

Johnson et al. (2025) narrows the lens further. They find DSP training on psychotropic meds boosts knowledge, but it is unclear if that changes pill use. Together the papers draw a straight line: keep staff, train them well, then check if training changes client outcomes.

If you supervise DSPs, treat retention as part of the intervention. Start Monday by adding a ten-minute check-in at every shift: ask what support they need, note it, and act before the next schedule posts. Small steady listens cut turnover faster than one-time bonuses.