Date of Award

Spring 5-15-2026

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Genevieve Pinto Zipp, PT, EdD, FNAP

Committee Member

Dawn Apgar, PhD, LSW, ACSW

Committee Member

Deborah DeLuca, JD, MS

Committee Member

Peggy Swarbrick, PhD, FAOTA

Keywords

direct support professionals, intellectual and developmental disabilities, trauma-informed care, turnover, Theory of Planned Behavior, affective-relational embeddedness

Abstract

The relationship between Direct Support Professionals’ (DSPs’) attitudes toward trauma-informed care (TIC) and their turnover intention has remained empirically untested, despite DSPs’ exposure to primary and secondary trauma. An estimated 8.38 million Americans with intellectual and developmental disabilities (IDD) depend on this workforce, yet 2024 turnover rates reach 53.7%. This convergent mixed methods study examined TIC attitudes, turnover intention, and their relationship among 109 DSPs in IDD provider agencies in New Jersey. Grounded in the Theory of Planned Behavior (TPB), the cross-sectional design used the ARTIC-10, TIS-6, and two open-ended items. DSPs with more favorable TIC attitudes were significantly less likely to intend to leave (Spearman’s ρ = −.241, p = .006) — the first empirical evidence linking TIC attitudes to workforce stability in IDD. Most strikingly, intrinsic fulfillment (43.0%) and emotional bonds with the individuals served (39.5%) emerged as the dominant retention drivers, surpassing compensation (22.1%) and directly challenging the prevailing pay-centric retention narrative. This study is the first known application of TPB to the DSP/IDD workforce and contributes a novel construct — affective-relational embeddedness — giving IDD organizations, human resources leaders, and Medicaid policymakers grounds for prioritizing trauma-informed culture and relational support over compensation in DSP retention strategy.

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