TODAY’S FACILITATORS Eva Kutas Office of Investigations and Training Lois Gibson Albertina Kerr Ione Johnson Bethesda Lutheran Ginger Jones Shangri La
Rights versus Risk: Where’s the Balance? • Cover your Assets – Tools for Balancing Rights and Risks
Explain your Decisions to the Newspaper, Board and Parents: A Simple Approach • Extreme Sports for the DD Provider: Balancing Choice and Risk
Agenda: • Learn about rights, duties and obligations. • Become familiar with tool to help make decisions. • Practice using the tool through examples.
U.S. / Oregon constitutions • Laws • statutes • administrative rules
What rights are common to all people? • Vote • Freedom of religion • Freedom of speech • Own property • Bear arms (guns) • Have children
What are the rights of people with developmental disabilities receiving services?
The same list … plus (ORS 430.210): • individualized written service plan • not participate in experimentation without informed consent • freedom from abuse and neglect (and)
(ORS 430.210): • assert grievances • no labor without compensation • visit with family members, friends, advocates, legal professionals
Duties and Obligations • Provide a reasonable explanation of service considerations • Provide services in way that is least restrictive and providing for greatest degree of independence
Duties and Obligations of Guardians, Providers, County and State • A humane service environment with protection from harm and reasonable privacy • Consider grievances in a fair, timely and impartial manner
Assure health and safety with other sources like county contract and conditions with Medicaid funds • Personal and professional ethics to protect interests of individual
Balance is key in decision making Risk and fear = Rights out the door Rights only = Common sense out the door
Balancing Rights and Risks (A Decision-making Tool) • Use by provider, ISP team • Helps to document and explain decision to others (family, staff, managers, board, county)
High Scrutiny Choice unclear/Inconsistent with known values and interests Moderate Scrutiny Choice clear/Consistent with known valuesand interests Low Scrutiny High Risk No or Low Risk
The Tool’s 1st leg: Choice Choice unclear/Inconsistent with known values and interests Choice clear/Consistent with known valuesand interests
Examples of different types of choices: • Healthy eating or overeating • Living in environment with dirty dishes or exposed wiring, backed up toilet, • and mice/rats • Having people over to visit or staying for a week
The Tool’s 2nd leg: Values Is choice consistent with values?
Examples of different types of values: Personal: love, justice, truth, health, religion, family, friends, kindness Agency: service to others, integration, cost-effective service delivery Community: safety, cleanliness
The Tool’s 3rd leg: Risks No or Low Risk High Risk
Measuring Risk • all risk is not the same • Probability of harm • Severity and duration of harm
The Matrix • not the movie but a framework for decision-making
The Matrix Principle #1: If the client’s choice is clear, consistent with their values and has little or no risk of harm… Provider responsibility for looking at decision is minimal • From everyday examples
The Matrix Principle #2: If the client’s choice is less clear, inconsistent with their values little or no risk of harm… Provider responsibility is still minimal and informal process ok, but look to see if it is a voluntary decision.
The Matrix Principle #3: If the risk is greater… Provider should look at decision and make sure it is voluntary and informed (person understands it). Formal conversation, e.g. team meeting.
The Matrix Principle #4: If the risk is serious and inconsistent with person’s values and best interest… careful examination necessary.
Group Activity Case studies: Work in small groups to assess using the Matrix
Consider: What type of choice is being made here? Is it clear and consistent with their known values and interests? Is it unclear and inconsistent with their known values and interests? Choice
Small Group Tasks: Evaluate and identify the risk. If the risk is imminent and potential for harm is serious, what interventions do you recommend? If the risk is serious but not imminent, what interventions do you recommend? Does the situation call for an informal or formal process?
Challenges / Impediments and Other Considerations • Fear of bad publicity or liability • Skittish board of directors • Nervous case manager • Fear of it being called “abuse” and being reported