Presentation on theme: "Supported Decision Making Trial Funded By SA Office Public Advocate & M S McLeod Benevolent Fund - Julia Farr Group DANA CONFERENCE 2012 Cher Nicholson."— Presentation transcript:
1Supported Decision Making Trial Funded By SA Office Public Advocate & M S McLeod Benevolent Fund - Julia Farr Group DANA CONFERENCE Cher Nicholson Co-coordinator of South Australian Supported Decision Making Project
2Outline UN Convention and Supported Decision Making – Background. Capacity Considerations.S.A. Supported Decision Making Trial.Use of Supported Decision Making.Graphs of findings to date.Summary.
3Freedom Positive freedom Negative freedom Opportunity Fulfill ones own goals and potentialCan rely on provision of treatment, rehabilitation and accommodationCan depend on the provision of safe accessible servicesNegative freedomFreedom from unnecessary direction, control, detention, restraint, seclusionSpectrum of interventionPositive freedom – is the opportunity and freedom to fulfill ones ownpotentialNegative freedom – freedom from restraintIn many ways the concern initially was one of unnecessary detention.Not that concern remains. Now it is also one of whether people can get the treatment they want and the treatment they need. It is access to services.Need to consider this when people are in hospital as an unsuitable environment, when discharge is delayed.Adequacy of disability accommodation
4Control vs. Autonomy“At the heart of the jurisdiction in a contradiction. The ideology of freedom is linked to a set of legal tools to restrict freedom through the appointment of substitutes. Guardianship laws use a modern rhetoric of personal rights promoting autonomy, fostering independence, and assisting citizens to participate in social life. And yet the main task of guardianship forums is to strip citizens of rights, entrust proxies with the exercise of legal decision-making, and sometimes authorise incarceration through physical and chemical means. The strange paradox of using coercive forms to achieve emancipator purposes raises practical questions about what could possibly constitute successful intervention in this Alice in Wonderland world? (Carney and Tait, 1997)”Role of OPA – take measures to avoid guardianship.In many respects advocacy
5Article 12 Equal recognition before the law Persons with disabilities have the right to recognition as persons before the law.Persons with disabilities enjoy legal capacity on equal basis with others in all aspects of their lives.Persons with disabilities access the support they may require in exercising their legal capacity.All measures that relate to the exercise of legal capacity are safeguarded to prevent abuse; they respect the rights, will and preferences of the person, are free of conflict of interest and undue influence, are proportional and tailored to the person’s circumstances, apply for the shortest possible time and are subject to regular review by a competent, independent and impartial authority or judicial body.Focus on section 12These items includeenjoying legal capacity on an equal basis with others, andpersons with disabilities will access the support they require to exercise legal capacity.This latter point is one that is leading a move towards supporting people to make their own decisions rather than making them for them.For many people this support may be required to talk throughThe decisions that might need to be madePossible optionsPositives and negatives for each optionReasons why each may be chosenThis may be time consuming. May take a couple of hours and then follow up visits to make sure that the view is consistent. It may seem more time economic to make the decisions for a person.Australia’s Guardianship System mostly compliesThere are not the systems in place to provide formalised supportUN suggests resources can be diverted from Guardianship to Supported Decision MakingGuardians often practice Supported Decision Making but have final “sign off”Approaches linked with individualised funding and Circles of Support
6Timelines And Process for UN CRPD Development of Article 12 2001 -The drafting of UN CRPD commenced when the government of Mexico sponsored a General Assembly (GA) resolution calling for an Ad Hoc Committee (AHC) to be formed to this effect.July 2002 and December Over a period of just 4 years and at 8 meetings of the AHC, the international community discussed, debated and drafted the UN CRPD.January 2004 – The AHC created a Working Group to pull together a draft text and considered amendments by delegates in its sessions.August The main body of the Convention and its Optical Protocol were finalised and December submitted to a Technical Drafting Committee. One of their responsibilities wasto ensure it had the same meaning in the 6 official languages of the UN.13 December UN CRPD and its Optional Protocol were unanimously adopted by the GA, making it “the most rapidly negotiated human rights treaty in the history of international law” (UN Secretary General, Kofi Annan). Another first was that people with disabilities, the key stakeholders, were at the centre of negotiations and drafting of the UN CRPD.30 March 2007 – Once adopted, a Convention is opened for signature and on this first day 81countries signed the UN CRPD –but this did not commit them to implement it. Ratificationthrough a legal process, usually by the Parliament of the signatory country, is required. After 20 countries have done so, a Convention comes into force and the signatories become a State Party to a Convention. Once in force, State Parties must implement it.
7Article 16 Freedom from exploitation, violence and abuse 1. States Parties shall take all appropriate legislative, administrative, social, educational and other measures to protect persons with disabilities, both within and outside the home, from all forms of exploitation, violence and abuse, including their gender-based aspects.2. States Parties shall also take all appropriate measures to prevent all forms of exploitation, violence and abuse by ensuring, inter alia, appropriate forms of gender- and age-sensitive assistance and support for persons with disabilities and their families and caregivers, including through the provision of information and education on how to avoid, recognize and report instances of exploitation, violence and abuse. States Parties shall ensure that protection services are age-, gender- and disability-sensitive.Vulnerable adults.Mainstream mechanismUniversal adult protections for people who are at risk.Prevention protection, avoid recognising and reporting abuse – education, information and effective responses.We need to consider what an effective adult protection system should look like.Should not need to take away a persons decision making to protect them.Elements include joined up local responses and clear local responsibility.
8Article 16 [cont]3. In order to prevent the occurrence of all forms of exploitation, violence and abuse, States Parties shall ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities. 4. States Parties shall take all appropriate measures to promote the physical, cognitive and psychological recovery, rehabilitation and social reintegration of persons with disabilities who become victims of any form of exploitation, violence or abuse, including through the provision of protection services. Such recovery and reintegration shall take place in an environment that fosters the health, welfare, self-respect, dignity and autonomy of the person and takes into account gender- and age-specific needs. 5. States Parties shall put in place effective legislation and policies, including women- and child-focused legislation and policies, to ensure that instances of exploitation, violence and abuse against persons with disabilities are identified, investigated and, where appropriate, prosecuted.Promote recovery after abuse has occurred.Indentification, investigation and prosecution of abuse
9Equality and non-discrimination Article 5 1. States Parties recognize that all persons are equal before and under the law and are entitled without any discrimination to the equal protection and equal benefit of the law. 2. States Parties shall prohibit all discrimination on the basis of disability and guarantee to persons with disabilities equal and effective legal protection against discrimination on all grounds. 3. In order to promote equality and eliminate discrimination, States Parties shall take all appropriate steps to ensure that reasonable accommodation is provided. 4. Specific measures which are necessary to accelerate or achieve de facto equality of persons with disabilities shall not be considered discrimination under the terms of the present Convention.Key element is reasonable accommodation.Can consider how this might apply in decision making
10Autonomous Decision Making: At the top of the stepped model is autonomous decision making. However, autonomous decision making does not necessarily mean individual decision making. Most people will chose to seek advice and support from others when making an important decision. For this reason decision making can be seen as “interdependent” as opposed to independent.Assisted Decision Making. While definitions vary, in assisted decision making a person is regarded as having legal capacity, but requires assistance to collect information to make a decision. This can be communication assistance – for example a person who has had a stroke and may need to communicate with a special device. For people who have an intellectual disability Assisted Decision Making may require information to be presented clearly in plain English with the use of diagrams if needed.Assistance can be provided by anyone including service providers. Providing necessary assistance is a “reasonable accommodation” and is supported by Article 15 of the UN Convention. While a “supported decision maker” may offer assistance too, the presence of a supporter should not stop a service provider from providing assistance.A non-statutory Supported Decision Making agreement: The appointment of a supporter is made by the person needing support. The person must want to have support making decisions, and have a trusting relationship with someone who will be their supporter. The person also must be able to cancel an agreement at any time if they are unhappy with its operation. Agreements can also specify a third person – a “monitor” – who can check to ensure that the agreement is operating as it should.Without a specific law, an agreement acts as a record of the person’s wish to receive support from another. It will not give the supporter any additional standing, and a supported person will not be obliged to use the agreement.This is the type of agreement used in the South Australian Supported Decision Making trial.A statutory Supported Decision Making agreement : This has most of the same features as a non-statutory agreement, but in jurisdictions that have Supported Decision Making laws, this legal recognition has advantages in safeguarding the supported person, and giving a special status to supporters.A legislated form of agreement can create obligations on the supporter to act in the interests of the supported person, and also give their role legal recognition so that health services and community agencies can share information directly with supporters.Legislation can also include protections from liability for supporters and other parties assisting a person to make decisions provided that such actions are not in breach of the supporter’s duty to the supported person.A supported person is expected to use the agreement – if they wish to make decisions outside it then a person should cancel the agreement which the person has the power to do. The agreement is a significant document that cannot be ignored.In conducting the South Australian trial, we consider it likely in the future that any widespread use of Supported Decision Making will require statutory recognition.A tribunal appointed Supported Decision Making arrangement: Unlike the agreements already described, a person would not have the option of ending an agreement unilaterally as only the tribunal has the power to do this, and would be required to seek support in making decisions while the agreement is in place.Representational Agreement:. Such agreements are intended primarily to provide Supported Decision Making, and a person appoints their supporters through signing an agreement document as described previously. However, representational agreements also permit the supporter to make a substitute decision if the supported person is unable to make a decision themselves – for example, if the person became unwell and is in hospital. This model, as practiced in British Columbia allows for both supported and substitute decision making.A tribunal appointed Co-decision maker This is an arrangement used in Alberta. If an adult needs support with decisions a co-decision maker can be appointed by a court. The co-decision maker, who is usually a family member or close friend, and the adult, need to agree on major decisions. If there is a disagreement the decision of the adult (not the co-decision maker) takes precedence. If the arrangement is not working it may be followed up by the Public Guardian to determine if another person should be appointed co-decision maker or another form of decision making support is required.
11Bach: Re-Defining Capacity – 2 steps First and foremost, capacity is the ability with assistance as needed, to understand the nature and consequences of a decision within the context of the available range of choices; and to communicate that decision, with assistance as needed.
12Re-Defining Capacity.2. Where a person may not be able to meet these tests even with assistance, capacity can also mean the ability to express one’s intention and to communicate one’s personhood (wishes, vision for the future, needs, strengths, personal attachments and field of care) to a trusted group of others chosen by the individual who, in a fiduciary relationship of trust, confidence and responsibility recognize the individual as a full person, and commit to acting on and representing that person’s agency in accordance with his/her intentions and personhood.This is very significant.How do you operationalise this. There is a risk that a person may be signed up with out checks and balances.
13Capacity Test Presumption of capacity. Still has some form of modified “capacity” consideration.Focus is on the capacity to want support, choose the supporter, and cease the support if this is required.First most important decision is about the agreement – assisted by the facilitator.
14ConsiderationsCapacity versus VulnerabilitySupport versus Assistance
15Other Considerations Examples of other forms of “incapacity” Alternative response to GuardianshipFamily incapacity (e.g. inability to make informal arrangements work due to conflict between family members)Mediation to avoid guardianship hearing and orderService incapacity (e.g. limited ability by others to offer suitable accommodation options or necessary professional care)Advocacy to provide accommodation options professional assessments, care and accommodationService and Community incapacity to assist a person make their own decisionsAssisted and Supported Decision MakingCommunity incapacity to protect vulnerable peopleAdult protection responses: Based on UK- and US-style policies or legislation that offer a prompt practical response that seeks to avoid guardianship.Incapacity of justice system to deter perpetrators of abuse on vulnerable peopleA disability justice strategy to be applied by police, prosecutors and the courts that deters perpetrators.Economic incapacity and social exclusion. People under guardianship more likely to be poor with less access to resourcesPractical social work assistance for people who are poor or disadvantaged and unable to access community resources.
17Models of Guardianship In addition, another factor leading to an increased recognition of the need for orders has been the greater importance placed on the identification and response to restrictive practices now than in the past. This has led to people requiring orders, in particular guardianship with special powers (s32) when they were not on orders but should have been.Parliament’s intentionThe current guardianship system emerged from a review of the former Guardianship Board established under the Mental Health Act This 1989 review identified problems to be solved such as a lack of consideration of alternatives to guardianship, because the Board had assumed that alternatives are explored prior to applications being submitted, which was not always the case. The previous system inappropriately restricted and undervalued the potential role of families and carers.South Australia is considered to have a welfare approach.
18Forms of incapacity and response to Guardianship What is least restrictive?The Guardianship and Administration Act requires that decisions be the least restrictive of aperson’s rights and personal autonomy as is consistent with proper care and protection. However, ‘least restrictive’ is not defined. It is likely that what is seen as least restrictive willvary according to the eye of the beholder.For example, in the area of mental health, what is seen as least restrictive can vary between policy makers, clinicians and consumers (Clisby and Starr, 2007). It is reasonable to apply this conclusion about what is seen as least restrictive to guardianship as well as mental health practice. Whether or not a limited or full guardianship order is seen as least restrictive may also be a matter of perception.This is why one of the three principles in the Mental Capacity Act 2005(UK) is so potentially useful. In the context of making a guardianship appointment, it defines what is least restrictive. It states:A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.Annual Report 2010–2011 | Guardianship and Administration Act 1993
19A Definition of Decision Making THE PROCESS OF EXAMINING YOUR POSSIBILITIES AND OPTIONS, COMPARING THEM AND CHOOSING A COURSE OF ACTION..
20DO YOU KNOW HOW MANY DECISIONS AN AVERAGE PERSON MAKES PER DAY? There are so many decisions to make - about 35,000 for an average adult each day [Approximately 200 are about food!].Some of these are logically thought out but most are made at an instinctual level, using a sense of emotion or vaguely defined likes and dislikes.
22Decision MakingThe thought process of selecting a logical choice from the available options.When trying to make a good decision, a person must weight the positives and negatives of each option, and consider all the alternatives. For effective decision making, a person must be able to forecast the outcome of each option as well, and based on all these items, determine which option is the best for that particular situation.Decision Making
23Steps in Decision Making Collins 2004 believes there is 3 stepsin decisions:1. Benefits of decision.2. Risks of decisions.3. Strategies to + benefits or – risks.He also talks about reseasonableness and balance of risks – benefits.
24Process of Decision Making The process of decision making is one of the most complex mechanisms of human thinking, as various factors and courses of action intervene in it, with different results. Orasanu and Connolly (1993) define it as a series of cognitive operations performed consciously, which include the elements from the environment in a specific time and place. Narayan and Corcoran-Perry (1997) consider decision making as the interaction between a problem that needs to be solved and a person who wishes to solve it within a specific environment.
26Factors in Decision Making Several factors influence decision making. These factors, including past experience (Juliusson, Karlsson, & Gӓrling, 2005), cognitive biases (Stanovich & West, 2008), age and individual differences (Bruin, Parker, & Fischoff, 2007), belief in personal relevance (Acevedo, & Krueger, 2004), and an escalation of commitment, influence what choices people make. Understanding the factors that influence decision making process is important to understanding what decisions are made. That is, the factors that influence the process may impact the outcomes.
28Summary of Decision Making Information – including risks and benefits.Values – importance of various pieces of information.Decision making context – broader aspect of a person’s life – life-style impact.Preferences for each of the options – can be related to a range of factors including age, knowledge, culture.Human beings are not rationsalInformation: This includes the risks, and benefits of making a decision. Information must be accessible and comprehensible.Values: This reflects the importance of particular pieces of information to each person – for example the benefits of a decision compared to the risks.Decision making context: These are the influences on decision making from the broader aspects of a person’s life and level of functioning. Context can include the lifestyle impact of a decision, as well as barriers to a decision –for example a person may not chose a particular form of accommodation if they believe it is not available.Preferences for each of the options: This is the relative liking of one option compared to another. This just may not depend on information, and values, but be a preference associated with a persons gender, income, overall knowledge and ethnicity (Wills and Holmes-Rovner, 2006) amongst other factors.28
29Supported Decision Making Recognition of individual variation in how decisions are made.Understanding of risk.Different support needs.The significance of impulsivity and time.Recognise the risk with the long term gains.Communication of risk information.
30Aims of the Projectto develop effective ways of enabling people to make supported decisions within an appropriate safeguarding frameworkto identify, facilitate and provide the range and forms of support that can make a differenceto inform the principles for and a clear policy framework for supported decision makingto develop practice guidelines for supported decision makingto prioritise the voice of people living with disability about the optimal ways to provide support with decision makingto promote awareness and strategies to assist agencies and service providers to work within a supported decision making framework with people living with disability so they can exercise their legal rights and capacity.
31SA Supported Decision Making Trial Supported PersonSupporterMonitor20 people alternatives to guardianship20 people early intervention + further approval for 10 (Health Ethics)People who have a disability
32The Supported Person: PARTICIPANT A supported person will need to be able to:To express a wish to receive support.To form a trusting relationship with another person (s) (supporter or monitor).To indicate what decisions they may need support for.To indicate who they wish to receive support from for which decision.To express a wish to end support if that time comes.To be aware that they are making the final decision and not their supporter.
33The Supporter (s)Respect and value the supported person’s autonomy and dignity.Know the supported person’s goals, values and preferences.Respect the individual decision making style of the supported person and recognise when and how support may be offered.Manage a conflict of interest – understand the risk of substitute decision making
34The Supporter (s) [cont] To form a trusting relationship with the supported person.Be willing in the role of supporter, to fulfil their duty to the supported person, and not use this role as a way of advancing their own interests or any other person’s interests.To be able to spend as much time as is required to support a person make each decision.
35TRY TO SUPPORT AND NOT RESCUE Rescuing is only short term whereas a supporter sees longer term resultsTHE SUPPORTER:ListensRespectsReflectsExploresAssistsEmpowers
36TRY TO SUPPORT AND NOT RESCUE Rescuing is only short term whereas a supporter sees longer term resultsTHE RESCUER:Gives AdviceControlsKnows BestDisempowersJumps to ConclusionsDoesn’t ListenTalks A Lot
37Monitor:To be aware of all decisions made and how support is provided.To provide assistance to the supported person and supporter in undertaking the supported decision making process.To act as a resource for the other parties when a matter is difficult to resolve.To take necessary action if the monitor believes that the supported decision making agreement has broken down.
38Agreements The document itself - deliberate wording. Consent. People have specifically added what they wanted to make decisions about.They added what kind of support they specifically wanted and how they wanted it delivered.You might prompt the supported person by letting them know how participants have used their agreements to date.
39Types of decision Accommodation Lifestyle Health [Trial did not include financial decisions or any decisions regarding assets. Participants were asked to be specific in their decision making to allow for measurable out comes. Administration Orders remained in place]Decisions relate to a specific course of action. All decisions can be seen as actionsNot counselling or therapy.Not mentorship.Has an advocacy componentExclusions:Illegal behaviourMarriage, voting or religion
40Trial Inclusion People themselves make the decision. Duty of care – whether to endorse it.Question re people at risk.Looking at Dignity of Risk and moving. away from a safe place and the balance with reasonableness risk – benefits.Safeguards with supporters/monitors being in place.
42Participants’ Reasons for wanting SDM End informal arrangements.To take back control of one’s life.Provide for decision support.Improve the quality of support.Alternative to guardianship.Family & friends felt that supported person had a framework to work for them in the future.Services would recognize their decision with choosing a supporter/s.
43Practice Considerations What Information to provide to Agencies: -When, where and how much.Agency response to SDM.Rights & responsibility basis.Not crisis or problem solving driven.Selling the risk - dignity of risk.New model acting in expressed wish not best interest.
44Practice models Strength based - Narrative systems theory. SRV theory. Gather Model.Person Centred.
45Narrative – Strength Based Works as re-enforces positives and builds on existing knowledge. “I can do it” approach.Re-enforces the alternative story.Engages with existing story of participants’ life to notice exceptions.Works with future hopes and expectations.Builds relationships.
46Person centredSDM is rights based so is ideally suited to a person centred approach.Possible tensions:1. Family.2. Guardianship.3. Agencies.4. Other Networks.5 Duty of care / OH&S issues.
48Opportunities for Improvement or Success may be limited Results may not fit with our expectations.There are many challenges of working with vulnerable and or disabled people.These people are more likely to be frustrated and disappointed.All parties view of success may be different.Participant, Supporter(s), Monitor & Project
49Trial Governance Non-statutory agreements – oversight. Based at Office of Public Advocate.Project Control Group ( 4 consumers, 1 carer, 2 advocate/guardians, 2 academics, 2 lawyers, 1 advocate leader).Development of practice guidelines.Future base in the non-government sector.Ethics committee.
50SDM Trial Model Project Control Group Principal Researchers Community ConsultationSDM Project Coordinator / VolunteerSupporter / MonitorParticipant / Supported Person
51Data to date from the SA Trial 26 Agreements in place out of a total of 52 possible candidates
66How people wanted support delivered I want my supporters to assist me to make my decisions by:Providing information in a way I can understand.Discussing the good things and bad things that could happen.Expressing my wishes to other people.
67Specific AdditionsI want my supporters to assist me to make my decisions by:Listening to me first and try and understand (Home with family).Remind me to look forward and think of the future (Home with family).Support with specific information re Court (Sharing house temp).Support with responsibilities / advice (Sharing house temp).Sometimes helping me to communicate (Residential).
68Which decisions I trust them to help me make decisions about: - Where I live.Who I spend time with.What to do with work/study/activities.My health.
69Specific Additions (Cont. 1) Alcohol use (Aged care facility)Travel (Aged care facility)Spending time with the family (Aged care facility)Parenting of daughter (Independent living private house)Parenting of son (Private house sharing temp)Court proceedings (Private house sharing temp)
70Specific Additions (Cont. 2) Choosing my friends (Residential setting)My health including all medical procedures (Residential setting)Choice of diet (Residential setting)Managing my personal care. (Residential setting)Managing medication including never having flu injections (Residential setting)Support with decisions around access with children (Lives alone private)Funeral arrangements (Lives alone private)
71Feedback of people receiving support All said the written information was helpful, however only a few went back to read it afterwards and very few read it again with help. When relevant, the pictograms were also useful.All found the interview process comfortable.All found the interviewer listened understood and treated them with respect and dignity.Instructions were clear.All were given the opportunity to speak by themselves.All said the written information was helpful, however only three of the nine went back to read it afterwards, and one read it again with help. When relevant the pictograms were also useful (this was only applicable to one of the people who had completed an agreements, although other people in the referred group had been able to make use of the pictograms). (The topic of literacy has been raised earlier, and the facilitator is also considering developing a CD audio version of the information.)All found the interview process comfortableAll found the interviewer listened understood and treated them with respect and dignityInstructions were clearAll were given the opportunity to speak by themselves.
72Feedback of supporters Most people had not heard of supported decision making prior to the project.Roles were clearly defined.Clarification and questions were dealt with to their satisfaction.All parties were satisfied with the outcome of their interview and were treated with respect and dignity.One responded said while she felt definitely respected she went onto say “As a friend of somebody, it was strange to be drawn into an official role. Both with Police Checks and a formal role. It was very odd”.All found the written information helpful. 8 of the 12 people had not heard of supported decision making prior to the project.Roles were clearly defined. Six participants said that roles were explained in a way that was easy to understand. One said no. Comments included “yes definitely” to “It took me a little while to understand it.”Clarification and questions were dealt with to their satisfaction. One of the supporters who lived interstate who only received information by phone and regretted not being able to receive information face to face.In terms of wanting to spend more time on some matters, five were satisfied with the time spent, and one person wanted more time. Comments included “sufficient time”, “self explanatory” “I would have liked to spent more time on family involvement.”Supporters felt understood and listened to. Information was generally considered easy to understand. Comments were positive – “Very very easy” “straightforward”. One respondent wondered whether other family members understood the information.”All parties were satisfied with the outcome of their interview. Questions were answered, roles were clearly explained, and people felt they could follow up afterwards.People reported that they were treated with respect and dignity. One responded said while she felt definitely respected she went onto say “As a friend of somebody it was strange to be drawn into an official role. Both with Police Checks and a formal role. It was very odd.”All appreciated the time and care taken with the process
73SDM in GuardianshipWhen a person is under guardianship, the final accountability for making a decision rests with the appointed guardian.A supported decision making arrangement can be used to help a person formulate their expressed wish.Running SDM along side a short term Guardianship Order may make a way for the Order to be revoked.
74Conclusions from the SA Trial (1) The Supported Decision Making Trial is effectively providing information about supported decision making, what it is, and how it might work.This information has enabled people with a disability, and their potential supporters and monitors to decide whether or not to proceed with an agreement.The facilitator role is to assist with this initial personal decision making by participants, and then be a resource to assist and coach participants in their support role.The Supported Decision Making trial is effectively providing information about supported decision making, what it is, and how it might work.This information has enabled people with a disability, and their potential supporters and monitors to decide whether to proceed with an agreement.The facilitator role is to assist with this initial personal decision making by participants, and then be a resource to assist and coach participants in their support roleThe commencement of a supported decision making agreement can have a positive impact on a person’s life. A “strengths based” approach can build confidence in decision making.The agreements when established have been used for a range of health care, accommodation and life style decisions.
75Conclusions from the SA Trial (2) The commencement of a supported decision making agreement can have a positive impact on a person’s life. A “strengths based” approach can build confidence in decision making.The agreements when established have been used for a range of health care, accommodation and life style decisions.Many Agreements have been established for over twelve months.Several Participants have requested aid in revoking their Administration Order using the SDM framework.Many tentatively start SDM with small decisions but quickly progress to those that are life-changing.