Celebrating DSPs: A Conversation with NADSP’s Joe Macbeth

Welcome to the "Could This Happen in Your Program?" podcast, where we find collaborative solutions to protecting NY’s most vulnerable populations.  The Justice Center is proud to celebrate Direct Support Professional Recognition Week, which is happening from September 7 – 13.

This week is a chance to shine a light on the committed direct support workforce at the heart of care for individuals with disabilities.   

On today’s episode, we are honored to be joined by Joe Macbeth, President and CEO of the National Alliance for Direct Support Professionals. He joins us for a special conversation about the evolving role of direct support professionals and the shared responsibility we have to equip DSPs with the necessary tools to safeguard those in their care.   

Transcript

Erin Hogan (00:04):

Hello, and welcome to the “Could This Happen in Your Program?” podcast where we find collaborative solutions for protecting New York's most vulnerable populations. On today's episode, we are honored to be joined by Joe Macbeth, president and CEO of the National Alliance for Direct Support Professionals. He joins us for a special conversation about the evolving role of the direct support professional and the shared responsibility we have to equip DSPs with the necessary tools to safeguard those in care.

Okay. Well, welcome, Joe. Thank you for joining us again. For our viewers and listeners, we're speaking with Joe Macbeth, president and CEO of the National Alliance for Direct Support Professionals, or N-A-D-S-P. How are you today? Thank you for joining.

Joe Macbeth (00:46):

I’m good. Thanks for having me.

Erin Hogan (00:47):

Yeah, so we'll dive right into it, into your history, your background. I know from speaking with you that you started as a direct support professional. Can you speak to that a bit?

Joe Macbeth (01:00):

I did. It was a long time ago. It was in 1983, just out of college, fresh out of college. And I was looking for a job so I could move out of my parents' house. And I looked in the newspaper, and I saw an advertisement for a resident instructor, and I had no idea what a resident instructor was. It was in the Times Union classified advertisement section of the paper. And I circled it, and I went down, and I filled out this application, and it was basically for a direct support professional job with a local agency. And to my surprise, they hired me on the spot. See, this was 1983, before we had the criminal background checks in the Justice Center and everything like that. They hired me on the spot. I got two days of training, and then I was to report to this group home in Schenectady. And I'll never forget that day, I'll never forget that moment of walking into this home for 12 people and not being prepared, thinking to myself, I'm putting these people at risk and putting myself at risk. And even today, 40-something years later, I think direct support professionals still have that anxiety because nobody's prepared to be a direct support professional on their first day of the job, which is why a lot of direct support professionals leave within the first three months of employment because it's not really what they thought it would be. There are a lot of issues with those early days of employment. However, for those of us who stick around,

(02:37):

We stay, and we stay for a long time. I had no intention of making this my career, and I have no regrets, but I learned a lot as a direct support professional. I was 22 years old, I didn't know how to cook. I didn't know how to manage a household. I didn't know any of the things that were required of me at that time. And boy did I learn quickly. And then you start to develop relationships with people, and then you're hooked. And the deeper the relationships that you are able to establish, professional relationships, as a direct support professional, the better direct support professional you are. And I did it for, boy, a good eight or 10 years. And, of course, you move around, you get promotions and things like that. But I think in my role today as the president and CEO of the National Alliance for Direct Support Professionals, it sure does give me some credibility that I did the work and I enjoyed the work but I also was attentive enough to take notes on what needs to change about the work

Erin Hogan (03:46):

And you know the demands too of A DSP

Joe Macbeth (03:49):

And the demands are significant.

Erin Hogan (03:51):

So, tell us a little bit about the origins behind N-A-D-S-P.

Joe Macbeth (03:56):

So N-A-D-S-P, it's a very interesting creation. We are part of the Kennedy Family Legacy of disability issues. In 1996, John F. Kennedy Jr. was the chair of President Clinton's committee for people with intellectual disabilities. And each term, that committee is requested to submit a report to the president, and the committee decides on the topic of that report. In 1996, the topic of the report was the direct support workforce crisis. And as we know, a crisis doesn't last 40 years.

(04:41):

A crisis is sudden, a crisis is temporary, a crisis is unexpected. But this paper actually called for the creation of a national alliance to further the education and training of the nation's direct care workforce. First time that was mentioned in a government-sponsored paper. So, from that paper, a lot of those early advocates that were part of AAIDD and the University of Minnesota and the City University of New York is where John Kennedy Jr. was affiliated with. They created this little grassroots organization. And then John passed away in 99, and they lost a lot of momentum at that point because when a Kennedy sends letters to national organizations for support and funding and partnership, it gets their attention, especially him. But after he passed, we were housed at the University of Minnesota's Institute on Community Integration where we created the NADSP competency areas, the NADSP’s Code of Ethics, which is very close to the Justice Center's Code of Conduct, and a lot of other, the first iteration of our credentialing program.

And then we started to get too big. So, the University of Minnesota invited us to leave their comfortable nest, invited

Erin Hogan (06:06):

You to leave,

Joe Macbeth (06:06):

Invited us to leave, and they were looking for a part-time executive director. And I was on their board at the time. They did a national search. Nobody applied for the position because it really wasn't established. It was an idea. And I was working for NYAC, or which is now the New York Alliance for Inclusion and Innovation.

And my executive director, Ann Hardiman allowed me to work part-time at NYSRA and take a part-time position at N-A-D-S-P. That was in 2011. And here we are almost 15 years later, and we have 13 full-time employees at the N-A-D-S-P.

Erin Hogan (06:50):

Excellent.

Joe Macbeth (06:50):

Yeah.

Erin Hogan (06:51):

Amazing. I want to talk a little bit about the role of the direct support professional. I think it's really evolved over time from being more of just what I think most would view as a caregiver to really a skilled position that requires, to your point, a lot of different skill sets. You talk about the demands, what the job looks like today,

Joe Macbeth (07:17):

It's a complex job. And we, as a system, as a field, have not given the direct support workforce its due credit. The work, as you mentioned, is often misperceived as an entry-level caregiving position that just anybody can do, and nothing can be further from the truth. It is a job that requires a high level of judgment, a high level of professional ethics, sound decision making and judgment. And also the ability to build those relationships with not only the people that you support, but their families, your coworkers, the community. And you see direct support professionals--the direct support professional's office is the community. That's where they work, that's where they do their work. And it is different every day. And it's dependent on the person that you support, their own individual support needs or preferences, or goals or outcomes that are required. So, you have to have a high level of flexibility, as well. But, the role and the expectations have evolved over the 40 years that I've been doing this work, where direct support professionals are now being seen more and more as a co-professional to those other disciplines like social workers, psychologists, nurses, and dieticians. They're part of the interdisciplinary team, and their input is valuable. And we need to, as a system and as my organization, try to get direct support professionals to understand their role in this vast disability complex. And it's not an easy thing to do because I think we are still entrenched in some old ways of thinking.

Joe Macbeth (09:22):

And one of the things that I try to do is to get direct support professionals to see that, without them, and, you know this at the Justice Center, the system's going to collapse.

Erin Hogan (09:34):

Exactly.

Joe Macbeth (09:34):

The system will be less safe for people with disabilities. And DSPs are often the front lines of helping people protect themselves from bad things. So all of that is, and you can't, I've been doing this a long time. I can't describe what a direct support professional does in an elevator. And if anybody, you don't have that pitch, I don't have that pitch because I can go on for a day about what direct support professionals do. The reality is, and I hope we get to this later, they are still relatively anonymous, not only in our communities, but by the federal government.

Erin Hogan (10:14):

And yeah, I mean, you said it well, that the Justice Center knows this very well. I mean, we're still a new agency in the grand scheme of New York State, but we've been around a while, and we learned early on in the Justice Center that the DSP is our friend. They're also a source of intelligence that we need to learn from the service sector, what they need to grow, what they need to keep people safer, and so that we can help aid in their development as well. And so I think we've had this kind of codependent relationship for a while that our relationship with the DSP has also evolved quite a bit.

Joe Macbeth (11:00):

It has evolved immensely. I remember the early days of the Justice Center and the anxiety and the trepidation in the system and the misinformation, quite frankly, and the myths and the legends around what the Justice Center is going to do, which is why I wanted to get involved with the Justice Center because nothing is more important to a direct support professional than the safety of the people that they support. And to see the Justice Center as an opportunity to build a relationship, a symbiotic relationship where you support us, we support you, and we both support the people with disabilities.

Erin Hogan (11:47):

Because let's be honest, if they don't trust us, no one's going to make a report, right? We're not going to know about allegations to then follow up on. So I think we've done leaps and bounds working with you, making that relationship stronger and a better environment.

Joe Macbeth (12:05):

Yeah, it was necessary. It was. I mean, the code of conduct awards,

Erin Hogan (12:11):

Finding, celebrate the good,

Joe Macbeth (12:12):

Celebrate the good. And that came out of interesting that came out of focus groups that we did in those early days and rooms with DSPs, who we promised that their identity would be anonymous, share with us, what's going on? What's going on out there? And they were all saying, find us doing something good, share that.

The bad guys get all the attention. And by the way, the bad guys are a small fraction of this workforce, and they need to be removed. But in the focus groups, it was loud and clear, turn it to a positive. And I think that you have,

Erin Hogan (12:53):

Yeah, yeah. Well, we appreciate that. So tell us a little bit about training programs that exist to help elevate the role of the DSP and give them a path to a path forward to success.

Joe Macbeth (13:10):

Well, training is training. There are a lot of good training programs out there. In my opinion, good training is focused on the competency areas, the validated portable competency sets that are researched and proven to be valid. And there are other soft skill types of trainings that are out there. But training is not a one-and-done thing. Training is like a doctor's practice or a lawyer's practice. Training is throughout your career, lifelong learning in direct support. The competency-based training is important because it covers all of those different roles. And, we as an organization review training curricula, we accredit it, and that training curriculum is approved to be used towards our national credential called the EBA Academy. Now, the EBA Academy, I'm really proud of it. There are a few states that are using it in a very big way, including New York, and it's funded through like O-P-W-D-D in New York State, ODP in Pennsylvania. But DSPs who go through it, it's a fairly rigorous process, and they should earn something when they achieve our three levels of certification. And through some funding post-COVID, with ARPA, we're able to provide bonuses for DSPs, which is great. You get a thousand dollars for each level, fantastic. But what I know about DSPs is that the thousand dollars will be spent the next day immediately. Immediately. What we're trying to do is trying to get state government to buy into a preferred provider status. When an organization certifies a certain percentage of their direct support professionals, they get a higher rate

(15:16):

From the state and Medicaid, and they would pass some of that money through to their DSPs who earn certification not as a bonus, but in their hourly wages. And that money is forever. That money doesn't go away. And it's also an incentive that if I receive these three levels of certification, I can make a dollar, $2, $3 more an hour. But the government has to have the will and the funding to do that. And I understand that's a heavy lift, but we've been talking about the direct support workforce crisis for 40 years. I think it's time to try something different. I think it's time to invest in this workforce and stop talking about how important they are and how valuable they are. They need money. They need a livable wage and a career ladder program that is based on competencies. The review and the demonstration of their skills that lead to certification by an objective third party is what every other profession does. So I think it's going to happen. It probably won't happen during my career. I think this is a generational issue, but it will happen, and we have the foundation for it to happen.

Erin Hogan (16:39):

You touched on funding. I do want to mention, I think it's kind of the elephant in the room with some of the Medicaid cuts that New York certainly isn't immune to the rest of the country is experiencing or gearing up to experience. How does that impact the DSP community, who I would assume not only those they care for are impacted by these cuts, but also them themselves probably rely on a lot of Medicaid funding?

Joe Macbeth (17:08):

Absolutely.

Erin Hogan (17:10):

So it's duly affected, in my view,

Joe Macbeth (17:14):

Duly affected and dual tragedies in my opinion. I mean, Medicaid cuts of this magnitude, you're talking almost a trillion dollars in Medicaid cuts. No matter how it's couched, it's going to hurt people. It will certainly affect waiting lists for people with disabilities who are looking, and families who are looking for services like respite and childcare for disabled kids. But also the burden of going in and determining your eligibility for Medicaid every six months, which is just kind of a scheme to get people off of the Medicaid rolls.

Erin Hogan (17:55):

The goal is to weed out fraud and abuse. But really, when it comes down to it, it's weeding out the people who maybe don't have access, the ability to make those decisions.

Joe Macbeth (18:05):

Cerebral palsy is not going to go away. Intellectual disabilities aren't going to go away. You're going to have that, that is a lifelong disability, so that should be waived, but DSPs will be affected. There may not be opportunities to find positions that accommodate your shift that you're accustomed to. Working transportation is always an issue for DSPs. But, yeah, I think there are a lot of direct support professionals who rely on SNAP benefits. Child healthcare programs for their own children are dependent on Medicaid, and they're going to be squeezed. And when something like this happens in a system, and I know it's more than just IDD, it's aging, it's mental health, it's substance abuse disorders, the lowest wage earners get hurt the most. And we've seen that cycle time and time again. And I just think that it will be a tragedy to watch this unfold, and DSPs will absolutely be affected.

Erin Hogan (19:18):

Well, moving on to a more positive topic this week is DSP Recognition Week. And what would you say to the DSPs out there that might be listening to this, any vote of positivity for their work or advice coming from a former DSP?

Joe Macbeth (19:38):

Ah, well, the first thing I would say is, thank you. And your work does not go unnoticed. And what you do every day, most people in our society cannot do.

The work that you do is challenging but rewarding at the same time. And I think there are a lot of people out here that are really fighting hard for your professional recognition, for raising your wages so that you don't have to work two or three jobs or rely on a lot of overtime. And I can't thank you enough. Occasionally, I will help a friend or two who has disabilities, and I can tell you my 63-year-old body isn't what it used to be when you're doing a lot of physical work and helping people transfer out of wheelchairs and whatnot. So the job also takes its toll on your physical body. So take care of yourself and be good to yourself and take your time and reflect on how you've impacted people's lives in so many positive ways. And I have this love-hate relationship with DSP Week because a lot of DSPs work for organizations that don't celebrate DSP Week or it's foreign to them. And we see that on our Facebook page, where there are 30,000 people who are being recognized, some are not. And I always say, well, direct support professionals, you need more than a week. You need a lot more than a week, but take this week and make the most of it.

Erin Hogan (21:25):

Well, you do also have a national conference that, again, when this airs, you'll be right in the middle of. So what are you most excited about for the conference?

Joe Macbeth (21:34):

Well, we do a conference every other year. It's hard for us to get direct support professionals away from their work. They're busy people at work. It's hard for organizations and employers to free up DSPs to travel to a three-day conference. And we beg and we push and we guilt to get DSPs in the rooms with us. It's magic. We will have 500 direct support professionals from all over the United States, including Alaska, who are coming to join us to celebrate, to learn, to network.

We've got a couple of awards that we're giving out. A New Yorker, BJ Stasio is receiving our Dave Hansberger humanitarian Award. He's a Buffalo guy. The conference is in Buffalo. Really excited about that. And there's a lot of great learning sessions, but it's more than a conference when 500 direct support professionals get into a room. There's just a whole lot of love. And I know that sounds a little corny, but you couldn't speak in front of a nicer audience, a more forgiving audience. And then once we get them talking, one of the things that I really want to do, I encourage people to get away from your table. If you're sitting next to your coworkers from the same organization, get away from them. Go sit with people you don't know because the best thing about conferences is networking. And we really want DSPs to network. And we thank the Justice Center for your sponsorship and your presence at this event. I know Governor Hochul has been really, really positive about this conference in general, that we're in her hometown as well, and the work that O-P-W-D-D has done to support us throughout this whole conference planning. It's not easy.

Erin Hogan (23:29):

No,

Joe Macbeth (23:30):

It's It's not easy. It's

Erin Hogan (23:30):

A lot of work.

Joe Macbeth (23:31):

It is.

Erin Hogan (23:32):

But to your point, great opportunities for these DSPs to network, learn from other states, assuming what challenges are being faced in different regions of the country. Some much-needed educational opportunities. I know. I think we're presenting our professional boundaries

Joe Macbeth (23:48):

To you. You are. That's a great session. Yeah,

Erin Hogan (23:51):

We just did a, of course, did a podcast episode on professional boundaries. So yeah,

Joe Macbeth (23:57):

See, that is a great example of a session that has no state boundaries. You folks are going to be doing the session, but every direct support professional in that room will understand the need for professional boundaries.

Erin Hogan (24:12):

Exactly. And it's such an interesting topic after I got to dig into it a little bit and something that you would assume, oh yeah, I know the line that can't be crossed. But it's hard to your point, you develop such great relationships, especially with the people you care for and your colleagues. I think people always leave with a nugget of information they didn't know.

Joe Macbeth (24:37):

And I can go on. I mean, as a direct support professional, we talk about professional boundaries, and that's why that session is so important. But it's hard not to develop a caring relationship that you truly do care about the people that you support and DSPs. 

Erin Hogan (24:55):

And you wouldn't to discourage that.

Joe Macbeth (24:56):

No, you don't. But there needs to be lines because I've seen some really shady things happen because of the lack of boundaries. And I've, in my tenure, have terminated DSPs for not following those boundaries, sadly.

Erin Hogan (25:19):

Okay. I mean, I think we're approaching the end of our discussion, but is there anything you would leave our listeners with or any one piece of advice you'd give to DSPs, maybe listening in?

Joe Macbeth (25:32):

One piece of advice for DSPs.

Erin Hogan (25:34):

I know you don't have an elevator pitch, but maybe one piece of advice.

Joe Macbeth (25:41):

My advice is cherish your coworkers. Work within the context of your team, and communicate well with each other. Document, document, document everything. Be flexible in your role. Smile. Be an open gatekeeper where people will come to you. Establish relationships with your community for those DSPs that we're helping people find employment. DSPs are usually the best go-getters to help people connect with potential employment. And that's what we talk about, open gatekeeping, and just be open. I think DSPs, we need to give them opportunity to really do their jobs. And I know that there are always issues around following protocol and procedures, and all of that's really important. But a job of a direct support professional can literally change the course of a person's life, and do it, never go rogue, but do it always within the context of your team. I think that's the most important thing I can tell people.

Erin Hogan (26:57):

That's great. I think great advice and great advice all throughout. So thank you so much. You've been a great guest. Once again, we've been speaking with Joe Macbeth, president and CEO of the National Alliance for Direct Support Professionals. Their recognition week. We are right in the middle of it as this airs, as well as their annual conference or biannual conference. So yeah, we wish you the best of luck with that.

Joe Macbeth (27:18):

Thanks, Erin.

Erin Hogan (27:18):

Thank you. It was great having you.