Keeping DSPs Fired Up But Not Burnt Out: What Every Provider Should Know

Direct Support Professionals (DSPs) are trained to do some of the most demanding, most undervalued work in the Intellectual and Developmental Disability (IDD) field. They show up every day for the people who need them, often for low pay, long hours, and little public recognition, yet their stability directly affects the health, safety, and health outcomes of people with IDD.

So, what actually keeps a DSP motivated? And what can organizations, families, and DSPs themselves do to prevent burnout before it happens?

That was the focus of a recent IDD Perspectives webinar featuring Dr. Craig Escudé, family physician and President of IntellectAbility, and special guest, John Raffaele, a nearly 40-year veteran of IDD services, education, and workforce development, who holds a Master of Social Work (MSW). John also serves as the Director of Educational Services at the National Alliance for Direct Support Professionals (NADSP).

This discussion examines what keeps DSPs motivated, what pushes them toward burnout, and what helps prevent it—from self-care and ethical practice to the role of supervision, team culture, and even new technologies such as AI.

What Actually Motivates a DSP?

Ask any DSP why they stay in the field — whether they’re brand new or 30 years in — and you’ll almost always get the same answer:

It’s the people.

That’s the number one reason DSPs keep doing this work, even when the pay is low and the hours are long: 90% say they enjoy making a difference in clients’ lives. But passion for the people they support isn’t enough on its own to prevent burnout. A few other factors matter just as much:

• Good supervisors — not just managers, but mentors, teachers, and coaches who improve the employee experience, and 84% of DSPs say appreciation from supervisors is key.
• A healthy team — most DSPs work in residential or day program settings alongside other staff, and a toxic team can drive even the most dedicated DSP to leave.
• Bringing your best self to work — easier said than done when DSPs may also be juggling caregiving of their own families at home.

Those meaningful connections can also give staff members a stronger sense of purpose and resilience.

Some organizations are taking this seriously by supporting DSPs’ lives outside of work, too — helping with things like childcare, or even offering staff reduced rates on retired fleet vehicles. Professional growth and opportunities for advancement also help DSPs see a future in the field and reduce turnover. It’s a reminder that supporting the workforce is just as important as supporting the people they serve.

Why The Work Matters More Than DSPs May Realize

It’s easy for DSPs to get buried in documentation and day-to-day tasks and lose sight of the impact they’re having. But that impact is real — and often lifesaving.

DSPs are frequently the first to notice that “something’s off” with the person they support; they often have strengthened their ability through person-centered relationships and knowing clients as individuals. For example, a change in bowel habits, a person holding their mouth strangely, or a shift in mood or behavior — this kind of pattern recognition, built on genuine relationships and familiarity, has led to emergency interventions that saved lives.

As Dr. Escudé put it, some of the most important diagnostic input he’s ever received as a physician started with a DSP saying, “He’s just not acting right.” Physicians who listen to that instinct — and take it seriously — get better outcomes for the people they treat. The Health Risk Screening Tool through IntellectAbility can help identify health risks for people with IDD and support earlier action. The result is improved consistency in care delivery, enhanced clinical oversight, and reduced exposure to preventable health complications and outcomes. The HRST is a validated health risk screening and stratification instrument designed for people with intellectual and developmental disabilities (IDD) and other at-risk populations. It enables organizations to identify, quantify, and proactively manage health risks that can lead to destabilization, adverse outcomes, avoidable suffering, and premature mortality. Learn more by visiting the Health Risk Screening Tool Overview.

The COVID-19 pandemic didn’t just validate how essential DSPs are — it also clarified that their role goes far beyond medical tasks, into emotional and psychological support. DSPs quarantined alongside the people they supported served as emotional lifelines during isolation, and helped communicate critical context to hospital staff when family and other visitors weren’t allowed in.

What Can DSPs Do to Protect Themselves from Burnout and Compassion Fatigue?

Self-care is one of the most underused tools DSPs have — largely because DSPs tend to be selfless people who put others first. That selflessness is part of what makes them so good at their job, but it also makes them vulnerable to overextending themselves. Some stress is normal in this work, but when it goes unmanaged, burnout or compassion fatigue can happen.

A few practical starting points:

• Actually take time off. Even something as simple as an afternoon off can matter — though this is often easier said than done. Adequate sleep, recovery time, and stepping back before physical exhaustion sets in all matter for reducing long-term health risk.
• Lean into what nourishes you. For many DSPs, that’s faith, spiritual practice, or community involvement.
• Move your body. Regular exercise doesn’t mean training for a marathon — a short walk on a break, or exercising alongside the person you support, can shift your mood and energy.
• Set boundaries between work and home. This is one of the hardest parts of the job. No individual habit matters more than leaning on supervisors and teammates to help you “hand off” emotionally at the end of a shift — especially if you’re on call on weekends or find yourself in the habit of taking work emotions home with you.
• Protect a workable routine. A predictable schedule and a more stable week can reduce fatigue and make it easier to recover between shifts.

Compassion fatigue can show up as irritability, reduced empathy, and increased absenteeism. It can also contribute to anxiety, depression, and other health issues.

Organizations play a role here too — by making self-care genuinely accessible, not just encouraged in theory. Effective strategies include access to mental health resources, regular recognition, and monitoring staffing and schedules to ensure predictable shifts and a stable week, reducing fatigue. When recovery and support do not happen consistently, burnout can interfere with a DSP’s ability to provide care.

What Role Does a Code of Ethics Play?

Just as physicians take the Hippocratic Oath, DSPs have their own guiding code: the NADSP Code of Ethics, first published in 2002 and recently revised for 2026.

The updated code is written directly to DSPs — using “I will” language — and centers on values like professionalism, accountability, and growth. It’s designed to act as a compass for the countless “oh no moments” DSPs face: situations they weren’t specifically trained for, where they still have to make an ethical, dignity-preserving choice in real time, while helping establish clear guidance and boundaries rooted in respect across the workplace. Leaders and supervisors should use the code to talk openly about what is expected, so staff know what they are responsible for.

While it’s written for DSPs, the code is a valuable resource for anyone who works with people with intellectual and developmental disabilities — including clinicians. Psychological safety and open communication also help teams apply the code consistently and stay engaged, and a supportive culture keeps Direct Support Professionals motivated.

Will AI Replace Direct Support Professionals?

Short answer: no.

AI can’t hold someone’s hand, offer a hug during a crisis, or build the kind of trust that comes from years of a relationship. What it can do is take some of the burden off tasks like documentation — a genuine pain point. Practical documentation systems and better tools can strengthen documentation skills, build confidence, and improve retention, especially for a new DSP still learning the role.

That said, both speakers were clear-eyed about the risks. AI-generated notes still require human review — DSPs remain accountable for anything they sign off on, AI tools can get details wrong, and supervisors need a clear plan for how staff should review and use them. Technology should support, not replace, the human judgment DSPs use in direct support services. Used carefully, technology can free up more time for the human connection that actually defines great direct support. Used carelessly, it can create new problems.

The Bottom Line

Direct support work is demanding, often thankless, and chronically undervalued as a profession — but it’s also work that changes, and sometimes saves, lives. Preventing burnout isn’t just an individual responsibility or self-care issue; it requires a long-range retention plan, supervisors who mentor, teams that support each other, organizations that invest in their workforce, fair compensation, and competitive pay, and understanding just how essential this work really is. Investing in professional development increases job satisfaction, providing opportunities for advancement reduces turnover, and helps staff see a bright and impactful future as a DSP.

Learn More

• • Watch the full webinar, Keeping DSPs Fired Up but Not Burnt Out
  • National Alliance for Direct Support Professionals (NADSP)
  • Watch John Raffaele’s appearance on the IDD Health Matters Podcast with Dr. Craig Escudé
  • Explore upcoming IDD Perspectives Webinars!

 

Trauma-Informed Care for People With IDD: What It Means and Why It Matters 

From the IDD Perspectives Webinar featuring Dr. Karyn Harvey and Dr. Craig Escudé on Trauma-Informed Care

When someone with an intellectual or developmental disability (IDD) acts out, eats too fast, lashes out, or shuts down, our first instinct is often to ask: What’s wrong with them?

Dr. Karyn Harvey, a psychologist with nearly 40 years of experience supporting people with IDD, says we need to ask a different question entirely: What happened to them?

That shift — from labeling behavior as a problem to understanding it as a response — is at the heart of Trauma-Informed Care. This Trauma-Informed Approach, or Trauma-Informed Care (TIC), focuses on understanding what happened, addressing the underlying causes of behavior, and promoting healing and well-being. For supporters, direct support professionals, clinicians, supervisors, administrators, care teams, and family members, that shift matters because people with IDD experience trauma at disproportionately high rates and seeing behavior through a trauma-informed perspective can change support, relationships, and quality of life. The following parts of this blog will discuss how common trauma is in people with IDD, where it comes from, how common trauma is in people with IDD, the key principles of Trauma-Informed Care that support recovery, and the trauma-informed practices organizations can use to put it into daily care.

Trauma Is More Common Than We Think

For a long time, there was a prevailing assumption in the field: people with intellectual disabilities are somehow less affected by trauma than the general population. The research tells a very different story, and trauma has a widespread impact on physical and mental health across a person’s life, including in many people who have experienced trauma without ever receiving a formal diagnosis.

According to the Bureau of Justice Statistics, people with intellectual disabilities are seven times more likely to experience sexual abuse than people without disabilities. An international study found that one in three adults with IDD will encounter some form of sexual abuse in their lifetime. And Dr. Julie Gentile, a psychiatrist who runs a specialized clinic for people with IDD, reports that PTSD is not only underdiagnosed in this population — it’s likely the most common mental health diagnosis she sees. Trauma can also contribute to mental illness, post-traumatic stress disorder, and higher rates of substance use or substance abuse, especially when prior traumatic experiences go unrecognized.

“People who have IDD are more impacted by trauma, rather than less,” Dr. Harvey explained during the webinar. “The research is now coming out supporting that.”

Part of why it goes undetected: the field has historically overdiagnosed conditions like psychotic disorders while underdiagnosing depression, anxiety, and PTSD — the very conditions most connected to trauma. Failure to recognize trauma can also reduce engagement, leading to missed appointments and poor treatment adherence across behavioral health services, mental health services, and other service systems.

Adverse childhood experiences, or ACEs, include abuse, neglect, and household dysfunction; they are linked to poor health outcomes in adulthood, and higher ACE scores are associated with greater PTSD risk.

Where Trauma Comes From

The sources of trauma for people with IDD are wide-ranging, and trauma exposure and traumatic experiences are shaped not only by single incidents but also by duration, context, and social interactions.

Abuse and exploitation are the most obvious. Sexual abuse — including peer-to-peer and staff-to-individual abuse in congregate settings — remains alarmingly common. Physical abuse, bullying, and harassment are also pervasive. Dr. Harvey noted that nearly everyone she has worked with has, at some point, been called a derogatory name or been the target of bullying.

Exclusion and marginalization cause deep wounds of their own. As the late disability advocate Mel Baggs once said, “Rage is nothing in comparison to erasure.” To not be seen, not be heard, not be counted — this is its own form of trauma, one that accumulates over a lifetime of being left out.

Ableism — systemic discrimination against people with disabilities — shows up in everything from school policies to medical settings. Dr. Harvey described families who received repeated pressure from their physician’s office to terminate a pregnancy following a prenatal diagnosis of Down syndrome. “That is institutional ableism,” she said, “and people with Down syndrome are aware of it.” Less obvious experiences, including microaggressions, can also cause further harm and become re-traumatizing over time.

Institutional trauma is another category that often goes unrecognized. Consider something as seemingly simple as eating quickly. Dr. Harvey shared that she has worked with many people who stuff food or eat at a dangerous pace — a traumatic stress response, not a quirk — a behavior that can lead to choking. In five separate cases across her career, she lost clients because of it. In each case, the root cause was traced back to food deprivation in institutional settings, where meals were rushed, and food could be stolen. The rapid eating wasn’t a quirk. It was a survival strategy that never had a reason to stop, and re-traumatization can reactivate survival responses tied to a past traumatic event.

Loneliness and isolation are perhaps the most overlooked sources of vulnerability. When people don’t have meaningful relationships, they are at far greater risk of exploitation. Dr. Harvey shared the story of a woman named Tamika, who asked for one thing every year at her person-centered planning meeting: a boyfriend. That goal was repeatedly set aside. Eventually, a predatory man noticed her loneliness and exploited it — telling her the words she’d been longing to hear.

“The real source of vulnerability,” Dr. Harvey said, “was the isolation.”

Assume Trauma. Start There.

One of the most practical takeaways from the webinar: don’t wait for a diagnosis before applying a trauma-informed lens. Dr. Harvey’s recommendation is to assume trauma as a baseline, recognize traumatic stress symptoms, and understand behavior in light of past trauma and prior traumatic experiences.

Everyone with IDD has experienced some version of ableism, exclusion, or being devalued. Even the universal experiences of middle school — a mean comment, being left out — are amplified dramatically for students with disabilities who may experience versions of that every single day. PTSD symptoms, like a sense of defeat before even trying, negative beliefs about oneself, or emotional withdrawal, are common expressions of that accumulated experience. Trauma may also affect a person’s life across generations within a family system, especially for trauma survivors facing repeated exclusion.

“Bullying is trauma. Exclusion is trauma,” Dr. Harvey said simply.

What Recovery Looks Like

The good news — and Dr. Harvey was emphatic that there is good news — is that people heal.

Recovery from trauma, in her experience and in the research, rests on the key principles — of Trauma-Informed Care, including safety, trustworthiness, peer support, collaboration, empowerment, and cultural responsiveness:

Safety. People need to genuinely feel safe, not just physically, but emotionally. They need to know they won’t be mocked, dismissed, or ignored. Trauma-Informed Care actively works to avoid re-traumatization by creating safe environments and interactions for people receiving supports. When that safety is established, Dr. Harvey said, the transformation can be remarkable. She described a woman who had been labeled a “spitter” and arrived at a new agency with staff in protective gear. Once the team took time to understand her story — she had been suddenly removed from her home and separated from her daughter by child protective services — everything changed. “Once we listened to her, we realized there’s a beautiful person inside who just needs to know she’s going to be okay.”

Connection. Relationships are not a luxury for people with IDD — they are essential. The Harvard Study of Adult Development, which followed people across their entire lifespans, found that the happiest, most fulfilled people were those with the strongest relationships — not the wealthiest or most educated. Trustworthiness and collaboration matter here: relationships help us heal from trauma, bring us into the present, and protect us from future harm. This means actively supporting people with IDD to have friendships, romantic relationships, and community ties — not just paid supports — and building resilience and well-being, not just reducing symptoms.

Empowerment. People need a voice that is genuinely heard. Dr. Harvey emphasized that this includes people who communicate without words. “All behavior is communication,” she said, “but it shouldn’t have to be.” Investing in AAC (augmentative and alternative communication) technology, truly listening, and responding to what people are trying to communicate — this is Trauma-Informed Care in action. Empowerment also grows when peer support and cultural responsiveness are part of recovery, so people are supported in ways that fit their identities, histories, and communities.

Beyond Recovery: Post-Traumatic Growth

Dr. Harvey also spoke about what can happen after healing — something she calls post-traumatic growth. People who have survived significant trauma often develop deep wells of empathy and compassion. They can become exceptional friends, fierce advocates, and powerful peer supporters.

“Sometimes the trauma can become a superpower,” she said. “If you recover, if you move forward.”

Group therapy and peer support, she noted, are among the most effective interventions — not because professionals have all the answers, but because trauma survivors bring strengths, and peer support helps build resilience and healing.

What This Means for Organizations and Supporters

Trauma-Informed Care isn’t just a clinical framework for therapists. It’s a way of operating for care teams, medical professionals, mental health providers, and broader service systems and health systems, as well as direct support professionals, supervisors, administrators, and family members who support people with IDD. A trauma-informed organization aligns policies, environments, and daily trauma-informed practices with the goal of preventing re-traumatization.

Organizations need policies, safe environments, and ongoing staff training to recognize signs and symptoms of trauma in both patients and staff. Implementing TIC is gradual and typically takes three to five years, especially when systems update training, supervision, and policies. A few practical starting points:

• Provide relationship and sexuality education. Studies show that when people with IDD receive this education, rates of abuse go down. Organizations like Elevatus (formerly led by Katherine McLachlin) and Planned Parenthood have provided this kind of support.
• Re-examine staff roles. Staff are not caregivers, controllers, or substitute friends. They are coaches — people who help individuals build real, unpaid relationships in their communities.
• Ask “what happened?” before “what’s wrong?” Every behavior has a history. Understanding that history is the first step to supporting someone effectively and should also shape the person’s treatment plan through collaboration, not just assessment.
• Prioritize person-centered planning that actually centers the person — not just on paper, but in practice.

A Final Word

Trauma-Informed Care is not about lowering expectations for people with IDD. It’s about understanding where people have been — so we can better support where they want to go.

As Dr. Harvey put it: “People heal when they have real relationships, when they have the life they’ve dreamed of — even in a simple way. Having someone they can call up and just shoot the breeze with.”

That’s not a clinical goal. That’s just a life worth living.

Additional Resources:

• Watch the full webinar, Trauma-Informed Care for People
• Explore the Trauma-Informed Support eLearn Course with Dr. Karyn Harvey
• Watch Dr. Karyn Harvey’s appearance on the IDD Health Matters podcast with Dr. Craig Escude
• Explore upcoming IDD Perspectives Webinars!