Supported Decision-Making Service

Supported Decision-Making Service for Persons with Disabilities | Service Model

The Human Rights Center for People with Disabilitis

5. Major insights gained from the pilot

Based on the assessment study, advisory committee discussions and the many discussions held

by the support team – several major insights can be taken away from the pilot:

a. Efficacy of support process:

The major insight gained from the pilot, and confirmed by the

assessment study, is that the supported decision making process is effective. Despite the short

time in which supported decision making services were given, most participants and their

family members indicated there had been a change and that the participants’ awareness and

skills in making decisions about their lives had improved.

b. Guardianship alternative:

The absence of an established legal basis for appointing decision

making supporters, which was the situation at the time the pilot was held, and the decision

to include only participants already or soon to be under guardianship resulted in a unique set

of circumstances wherein most of the participants were under guardianship while receiving

decision making support. There were many disadvantages to this, particularly, the need to have

every action approved by the guardian, and a low ‘glass ceiling’ for support. Members of

the advisory committee were divided on the question of whether to approve decision making

support for persons under guardianship without revoking the guardianship. Bizchut’s position

on this is that these are two contradictory schemes. Decision making support services should be

provided as an alternative to guardianship, rather than as a concomitant service.

c. Choice of goals:

The supported decision making process can be seen as a goal-oriented process,

but does not necessarily have to be conceived in that manner. Where a person has clear goals,

they should, preferably, be laid out as the foundation of the support process. However, it is

important to remember that decision making support is not meant to serve the realization of

dreams, but rather provide assistance with the many decisions every person has to make in the

course of their life. Therefore, the support process could be composed of a great many ‘small’,

daily, changing, goals. So, for instance, support could include help in deciding on a purchase,

acquiring information from a service provider, such as a doctor, planning an expense with

disability benefit money and more.

d. Ongoing services:

There was consensus that the pilot was too short, and that, looking to the

future, decision making support services should not have a time limit, as some persons need

support throughout their lives. Our recommendation is that any extended supported decision

making services pilot continue for at least two years.

e. Universal and adapted services:

There is a strong debate over whether decisionmaking support

should include support for realizing the decision, or whether the two are separate services.

Without stating an opinion on this fundamental issue, it is clear to us, upon pilot completion,

that without support for realizing the decisions, the support process, is, in many ways, partial.

In practical terms, most of the supporters did more than provide support in decision making,

but also supported the realization of the decisions made.

f. Training and practicum:

The supporters’ most meaningful learning occurred during the

practicum and through peer consultations. Training and practicums should be based on practical

experiences and the dilemmas arising from the ground.

g. Unique features affecting support:

Many of the participants’ attributes impacted the support

process, for instance, the level of external support they have (people without any support vs.

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