The direct support professional (DSP) workforce as a social determinant of health of people with intellectual and...

Direct support professionals (DSPs) play a key role in supporting the health and quality of life of people with intellectual and developmental disabilities (IDD). Despite the importance of their roles, the DSP workforce also represents a major threat to the health and quality of life of people with IDD due to the instability of the workforce, and the consequences of this instability.

We theorize and purport that the status, availability, and quality of the DSP workforce should be considered a social determinant of health of people with IDD. Thus, the aim of this study was to examine the relationship between DSP turnover, and people with IDD's health and social determinants of health-related outcomes.

We analyzed secondary Personal Outcome Measures (POM) data from 5457 people with IDD (January 2018 and December 2024) using descriptive statistics, binary logistic regressions, and negative binomial regression models.

People with IDD who experienced DSP turnover were significantly less likely to have health outcomes present, and to receive person-centered health supports (odds ratios ranged from 0.50 to 0.77). People with IDD who experienced DSP turnover also had a 19.10 % decrease in other social determinants of health-related outcomes.

The harms of an unstable DSP workforce can be two-fold, in that it both directly negatively impacts people with IDD's health outcomes and health services, and it negatively impacts other areas of people with IDD's lives that also serve as social determinants of health, which also go on to hinder people with IDD's health.