Supported Decision-Making in Practice

Supported decision-making (SDM) is emerging as an approach to provide decision making assistance for adults with disabilities and other functional challenges without imposing any long-term legal limitations on their rights or personal liberties. This promising practice has the potential to enhance, advance, and transform the current approach to daily support for people if it is successfully integrated into routine practices. In simplest terms, we are talking about supporting children and adults with disabilities to experience the natural process of maturation—learning how to make better decisions over time through real-life experiences. Increasing opportunities for people with disabilities to participate in decision making follows the typical process of growth and development and has the potential to result in reduced reliance on more restrictive approaches for support over time. The ideas behind supported decision-making are not entirely new. They build on a long tradition of research and implementation around person-centered planning and the concept of self determination. Person-centered practices, self determination, and support for individual choice have been seen as best practice for decades in the field of disabilities. Yet, the reality is that these practices are used for only a small percentage of the people with disabilities receiving formal support. Figuring out how to use these principles for all people and making this an integral part of day-today support interactions remains a challenge. The person-centered support model blends with an supported decision-making approach because it is built on respect and uses the person’s expressed will and preferences to guide action. Support teams are directed to learn about each person’s unique characteristics and desires and use this knowledge to design individualized interactions and activities. The goal of true ‘‘support’’ is to nurture gifts and talents and assist the person to develop as a person—not just teach ‘‘skills.’’ Working with the person, assistance is provided to explore and experience options related to a given choice. For example, if the choice is related to where to live, support starts with seeking to understand what experience the person already has and the preferences he or she expresses. Additional activities are then planned to help the person learn about other various living options that are available and assess which option is preferred. For some people, this process is relatively easy. What they want and desire is consistent with what other people typically want and does not conflict with established community norms. For others, the goals and activities they want to pursue challenge our beliefs about right and wrong, health and safety, and what is possible for people with different disabilities. In these instances, it is common to see support for individual preference diminish as the attention of ‘‘supporters’’ shifts to thoughts about redirection and protection. Our desire to help can limit our capacity to see consequences we may not be able to control. It may be difficult, if not impossible, to stop a person who is determined to pursue a relationship, activity, or life path that others can clearly see is not healthy or leading to positive outcomes. The application of simple logic does not stop people— with or without disabilities—from smoking, overeating, biting fingernails, or drinking too much, for example. There are multiple theories about why people behave this way, and not all strategies work well with all people. In these situations, sometimes our best option is to maintain a positive relationship with the person so we are available to assist when (and if) the person is ready to change or pursue a different path. Although health and safety are important elements in and for life, most people accept that some risk is inherent in the daily living process. Crossing the street, riding in a car, or coming in contact with large numbers of people all contain potential threats to our personal health and safety. We can mitigate these threats with our personal choices and behavior, but we cannot eliminate all possibility of harm. The same is true for people with disabilities. Addressing this mental ‘‘roadblock’’ is essential for advancing practice in