North Carolina DSP Training Requirements: 10A NCAC 27G Guide

North Carolina doesn't set a statewide hour count for direct support professionals (DSPs). Instead, its licensing rules for mental health, developmental disabilities and substance use services list the topics staff must be trained in, the skills that have to be shown before someone works with people, and the records a provider must keep. If your agency serves people through the NC Innovations waiver, the waiver's service definitions add their own staff qualifications on top.

This guide walks through the rules most DSPs and managers run into: the personnel and training rule in 10A NCAC 27G .0202, the de-escalation and restrictive-intervention training rules in 10A NCAC 27E, medication administration under 27G .0209, supervision of paraprofessionals under 27G .0204, and the staff qualifications in NC Medicaid Clinical Coverage Policy 8-P.

Before a new hire works with anyone

Under 10A NCAC 27G .0202, every person who provides care or services on a facility's behalf must:

• be at least 18 years old;
• be able to read, write, understand and follow directions;
• meet the education, competency, experience and skill requirements written into the job description; and
• have no substantiated findings of abuse or neglect on the North Carolina Health Care Personnel Registry.

The rule also requires a written job description for each position that lists its minimum qualifications and duties and is signed by both the staff member and the supervisor and kept in the staff file. Every applicant must be asked to disclose any criminal conviction, and the provider weighs the offense against the job they're applying for.

The four required training topics

Section .0202(g) says employee training programs must, at a minimum, cover:

1. General organizational orientation.
2. Client rights and confidentiality, as set out in 10A NCAC 27C, 27D, 27E, 27F and 26B.
3. Training to meet each person's needs as written in their treatment or habilitation plan.
4. Infectious diseases and bloodborne pathogens.

The rule doesn't give a deadline or an hour count for these topics, so your agency's own training policy has to fill in the timing. Because the person-specific item is tied to each person's plan, it's good practice to retrain the staff who carry out a plan whenever that plan changes. For the federal side of bloodborne pathogens training, see our OSHA bloodborne pathogens guide.

Section .0202(f) adds that continuing education must be documented, and .0202(e) requires a file for each employee showing their training, experience and qualifications, including verification of any license, registration or certification.

First aid, seizure management and CPR on every shift

Section .0202(h) requires at least one staff member to be available in the facility at all times when a client is present (with a narrow exception in another rule). That person must be trained in basic first aid, including seizure management, be currently trained in CPR, and be trained in the Heimlich maneuver or another approved technique for relieving airway obstruction, such as those taught by the Red Cross or the American Heart Association.

The rule is written as a staffing requirement, not a requirement for every DSP. But since any shift can end up with a single staff member on duty, many agencies simply require current first aid and CPR for every direct support employee so scheduling never creates a gap.

De-escalation training before services start

10A NCAC 27E .0107 is the rule DSPs often know as "alternatives to restrictive interventions." Before providing services to people with disabilities, staff, including employees, students and volunteers, must show competence by completing training in communication skills and other strategies that prevent situations from becoming dangerous.

The rule sets out how that training has to work:

• It must be competency-based, with measurable learning objectives and testing both in writing and by observing behavior, plus a clear pass/fail standard.
• The content must be approved by the state Division of Mental Health, Developmental Disabilities and Substance Use Services.
• Refresher training is required at least annually.
• Staff must show competence in nine core areas, including understanding the people being served, recognizing and interpreting behavior, the effect of stressors, building positive relationships, supporting the person's involvement in decisions about their life, assessing risk of escalation, de-escalation communication and positive behavioral supports.

Providers must keep records of initial and refresher training for at least three years, showing who took it and whether they passed, when and where, and the instructor's name. The rule also sets qualifications for the instructors themselves.

If a plan includes restrictive interventions

10A NCAC 27E .0108 adds a second layer. Seclusion, physical restraint and isolation time-out may be used only by staff trained and shown competent in them and in their alternatives. Staff who support someone whose plan includes restrictive interventions must finish this training before giving that person direct care, and the 27E .0107 training is a prerequisite. Retraining and a competency check are required at least annually, and the same three-year record rule applies.

Medication administration

Under 10A NCAC 27G .0209(c), medications, including injections, may be given only by licensed persons or by unlicensed persons who have been trained by a registered nurse, pharmacist or other legally qualified person and privileged to prepare and give medications. The rule doesn't name a state curriculum, so keep the trainer's signed record of each DSP's training in the personnel file.

The same rule covers daily medication practice DSPs should know:

• Medications are given only on the written order of a person authorized to prescribe.
• The Medication Administration Record (MAR) must be kept current, and each dose recorded right after it's given, with the person's name, the drug and strength, instructions, date and time, and the name or initials of the person who gave it.
• Medication errors and significant adverse reactions must be reported immediately to a physician or pharmacist, and a refusal must be charted.

Supervision of paraprofessionals

Direct support staff without a professional credential generally work as paraprofessionals under North Carolina's rules. 10A NCAC 27G .0204 says paraprofessionals must be supervised by an associate professional or a qualified professional, must show the knowledge, skills and abilities the population served requires, and must have an individualized supervision plan that starts when they're hired.

NC Innovations waiver staff qualifications

For agencies providing NC Innovations services, Clinical Coverage Policy 8-P lists qualifications for agency staff who work with beneficiaries. In the policy version we reviewed (amended May 1, 2022), staff providing Community Living and Supports must:

• be at least 18;
• have a valid driver's license, a safe driving record and acceptable auto insurance if they transport people;
• have a criminal background check that shows no health and safety risk to the beneficiary;
• not be listed on the North Carolina Health Care Abuse Registry (the policy's term);
• be qualified in CPR and first aid;
• be qualified in alternatives to restrictive interventions;
• be qualified in the customized needs of the person as described in their Individual Support Plan (ISP);
• have a high school diploma or equivalency (GED); and
• be supervised by a qualified professional if they're paraprofessionals.

The policy also lists professional competency areas for support professionals, including communication, person-centered practices, evaluation and observation, crisis prevention and intervention, professionalism and ethics, health and wellness, community inclusion, cultural humility, and education and self-development. Other services list their own qualifications, so check the definition for each service your agency bills, and confirm the current policy version with your LME/MCO.

Why the paperwork matters

LME/MCO monitoring reviews look for exactly these items. In its April 17, 2026 network bulletin, Trillium Health Resources reported its post-payment review trends for October through December 2025:

Each of these traces back to the rules above, and each is fixed by keeping a complete, current file for every staff member.

A quick checklist for each DSP file

• Signed job description
• Criminal conviction disclosure
• Health Care Personnel Registry check, done before services start
• Proof of diploma or GED (for Innovations services)
• Organizational orientation, client rights and confidentiality, and bloodborne pathogens training
• Training on each person's habilitation plan or ISP (good practice: refresh it when a plan changes)
• Division-approved de-escalation training before services, with an annual refresher and pass/fail record
• Restrictive-intervention training, if any person they support has it in their plan
• First aid (including seizure management) and current CPR
• Medication administration training record signed by the RN, pharmacist or other qualified trainer, if they give medications
• Individualized supervision plan
• Documented continuing education

How TES helps North Carolina providers

Our North Carolina DSP compliance pathway is built around 10A NCAC 27G .0202(g) and 27E .0107. It tracks the four required training topics for each hire, and it tracks items your agency or an approved trainer must deliver, such as Division-approved de-escalation training, hands-on first aid and CPR, and medication administration training, as external evidence with a place to store the certificate or signed record. Courses mapped in the pathway or useful alongside it include:

• Communication Foundations for Direct Support Professionals
• Fundamental Rights for Direct Support Professionals
• Person Centered Planning for Direct Support Professionals
• Infection Control: Universal Precautions and Basic Safety

Online courses build knowledge, but they don't replace the Division-approved de-escalation curriculum, the hands-on parts of first aid and CPR, or medication training from an RN or pharmacist.

Training & eTracking Solutions has trained more than 200,000 professionals since 2010, and our catalog includes 400+ courses and programs. As an NADSP Accredited Education provider, our courses count toward the DSP-I and DSP-II credentials. For a one-page version of these rules, see our North Carolina DSP requirements page and North Carolina training audit checklist. To keep every file current without spreadsheets, read how to track employee training in a care agency, or contact us to set up the pathway for your team.

This article summarizes 10A NCAC 27G .0202, .0204 and .0209 and 10A NCAC 27E .0107 and .0108 as published by the North Carolina Office of Administrative Hearings, and NC Medicaid Clinical Coverage Policy 8-P (amended May 1, 2022). It is not legal advice. Your LME/MCO, service definitions and licensing surveyors may add requirements, and rules change, so check the current text before making compliance decisions.