Unlocking Solutions to North Carolina’s Direct Support Professional Crisis

How Justice Involved Individuals Can Solve NC’s DSP Crisis

The current Direct Support Professional (DSP) crisis is negatively impacting many people in the disability community, and major changes are clearly required. DSPs are in short supply due to low pay and stringent hiring policies. DSPs are people who offer support and accommodations to individuals of all ages and disabilities, according to the U.S. Department of Labor. They make a significant difference in the daily lives of people with disabilities, assisting them with personal care, employment, and community involvement. 

In North Carolina, some provider agencies will not allow people with disabilities to hire potential DSPs. That policy has recently had a significant negative impact on me. I was going to hire someone who had some criminal involvement in the past that was not related to the job, but my provider refused to hire them because of their background check. I only had one DSP at the time, so I desperately needed backup staff. If I am unable to hire a DSP, my health and overall well-being will suffer. I would be unable to perform daily activities such as eating, dressing, bathing, getting to and from work, and a variety of other tasks. As a last resort, due to a lack of community-based care, I would be forced into an institution against my will.

I understand why some providers would feel a duty to shield their community members against all justice involved individuals even if it is in the past. Personally, I would feel differently if the criminal activity had anything to do with the job itself such as abuse, neglect, or fraud but the disability community is experiencing the worst DSP crisis it has faced in over 50 years. 

To solve this crisis, we need to examine and explore all possible solutions. One solution I have is to get justice involved individuals as DSPs once they have completed their sentence. According to the Prison Policy Initiative, former incarcerated individuals experience unemployment at a rate of over 27%, which is higher than any time in U.S. history, including the Great Depression (Couloute and Kopf). According to research done by the EBP Society, former incarcerated individuals that are unemployed are more likely to reoffend than those who are employed (Nwoko and Yu). Recidivism rates vary from 31% to 71% across the state, but they are less than 9% for people who were incarcerated previously and found work soon after their release according to research done by Prison to Employment Connection. I believe we can and should find ways to give justice involved individuals a second chance. Maybe it is extremely strict oversight or extended probation until they prove themselves as a DSP, but data shows that former justice involved and incarcerated individuals do not pose an unreasonable risk to the safety of health care staff, patients, or residents according to research by The National Institute of Justice. Even people convicted of violent crimes may be worth considering as research by Prison Policy initiative suggests that they have some of the lowest rates of recidivism. Violence can be a one-time occurrence and should not necessarily block people from every opportunity.

In order to provide some clarity in my thoughts, I would like to introduce my direct supervisor at Solutions for Independence, Director of Operations, Mr. Adrian Boone. Adrian is one of the most passionate advocates for people with disabilities I know. He has been empowering people with disabilities to achieve their goals and dreams in multiple communities in North Carolina for years. He has taught me everything I know about being a Community Inclusion Specialist. I have become a better human and professional since working under him.

Ironically, due to some of the very strict and stringent policies of some provider agencies, I more than likely could not hire my own boss as a DSP because he is a formerly incarcerated individual. You can hear more about his story by viewing the video below.


While incarcerated, Adrian was a part of a vital workforce program called the Inmate Companion Program, or ICP for short. For individuals assigned to this program and work detail, duties included assisting nursing staff with full patient care. Individuals assigned to the ICP work detail were eligible to take the national board exam to become a certified nursing assistant (CNA) upon their release. To be part of this program and work detail, individuals participating had to have 12 months of clear conduct, enroll and pass Durham Tech’s CNA course. In addition to being a part of the ICP, Adrian also earned a certification as a Biomedical Equipment Technician. This is a program offered through the U.S. Department of Labor and was a four-and-a-half-year apprenticeship course. Essentially, this means if my wheelchair or other personal medical equipment ever broke or had issues, Adrian has the knowledge and skill set to diagnose and repair it.

According to a recent press release from The U.S. Administration on Community Living, our country will need more than 1.3 million new DSPs by the year 2030 to support our population. More information can be found here. I’m not saying everyone in prison would be a great DSP, but there are potentially thousands of people looking to turn their lives around, just like Adrian did.

Some recommendations that I have for Employers and Policy Makers are below.

For Employers:

  • Review best practices for conducting criminal background check.
  • Change internal policies to allow for employment of individuals who were formerly incarcerated.
  • Actively recruit formerly incarcerated individuals or individuals currently incarcerated that are about
    to be released to facilitate a pipeline partnership.
  • Avoid blanket bans and disqualifying conviction list; instead use a comprehensive and
    individualized assessment which aligns with what the Equal Employment Opportunity
    Commission (EEOC) advised businesses in 2012.
  • Allow formerly incarcerated individuals to work on a probationary period that is temporarily
    supervised before final determination.
  • Partner with correctional agencies to connect formerly incarcerated individuals who worked in
    hospice or medical units in prison with direct care work post-release. This group of prospective
    workers has already been assessed and entrusted with caring for an elderly and vulnerable
    population and has direct care work experience.

For Policy Makers:

  • Consider developing tax credits for agencies utilizing formerly incarcerated individuals.
  • Increase wages for incarcerated persons.
  • Prisons could expand the number of incarcerated adults with access to such programs, and health care employers could streamline the hiring process for this group.

About the Author:

Bryan Dooley is a Community Inclusion Specialist with Solutions For Independence, a federally funded Center for Independent Living in Winston Salem, NC and Chair of the North Carolina Council on Developmental Disabilities. Bryan raises awareness about this critical time in the developmental disability community by sharing his personal story and how the crisis has adversely affected him and many others.