1 Balancing Rights & Choice With Risks & Responsibilities

2 Eva Kutas TODAY’S FACILITATOR

3 Required Copyright Notice This presentation includes the creative works of others which is being used by permission, license or under a claim of fair use (17 U.S.C. 107). This presentation was prepared under the Fair Use Guidelines for multi-media presentations, and further use of distribution of it is not permitted.

4 DISCLAIMER This presentation is NOT LEGAL ADVICE, and you should consult your agency’s attorney for legal advice (DOJ attorney, private attorney, city attorney, or county counsel).

5 Other Titles Considered

6 Rights versus Risk: Where’s the Balance? Cover your Assets – Tools for Balancing Rights and Risks

7 Explain your Decisions to the Newspaper, Board and Parents: A Simple Approach Extreme Sports for the DD Provider: Balancing Choice and Risk

8 Learn about rights, duties and obligations. Become familiar with tool to help make decisions. Practice using the tool through examples. Agenda:

9 Where do rights come from?

10 U.S. / Oregon constitutions Laws statutes administrative rules

11 What rights are common to all people?

12 What rights are common to all people? Vote Freedom of religion Freedom of speech Own property Bear arms (guns) Have children

13 What are the rights of people with developmental disabilities receiving services?

14 … plus (ORS ): The same list individualized written service plan not participate in experimentation without informed consent freedom from abuse and neglect (and)

15 assert grievances no labor without compensation visit with family members, friends, advocates, legal professionals (ORS ):

16 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

17 A humane service environment with protection from harm and reasonable privacy Consider grievances in a fair, timely and impartial manner Duties and Obligations of Guardians, Providers, County and State

18 Assure health and safety-from other sources like county contract and conditions with Medicaid funds Personal and professional ethics to protect interests of individual

19 Balance is key in decision making Risk and fear = Rights out the door Rights only = Common sense out the door

20 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)

21 High Risk No or Low Risk Low Scrutiny High Scrutiny Moderate Scrutiny Choice unclear/ Inconsistent with known values and interests Choice clear/ Consistent with known values and interests

22 The Tool’s 1 st leg: Choice Choice unclear/ Inconsistent with known values and interests Choice clear/ Consistent with known values and interests

23 Healthy eating or overeating Living in environment with dirty dishes or exposed wiring or backed up toilet Trading sex for “Stuff” Having people over to visit or staying for a week Drinking or using drugs Examples of different types of choices:

24 The Tool’s 2 nd leg: Values Is choice consistent with values?

25 Personal: love, justice, truth, health, religion, family, friends, kindness Agency: service to others, integration, cost-effective service delivery Community: safety, cleanliness Examples of different types of values:

26 The Tool’s 3 rd leg: Risks High RiskNo or Low Risk

27 What are risks of choices?

28  all risk is not the same Probability of harm Severity and duration of harm Measuring Risk

29  not the movie but a framework for assessing decision-making capacity The Matrix

30 Principle #1: If the client’s choice is clear, consistent with their values and has little or no risk of harm… The Matrix  From everyday examples Provider responsibility for looking at decision is minimal

31 Principle #2: If the client’s choice is less clear, inconsistent with their values little or no risk of harm… The Matrix Provider responsibility is still minimal and informal process ok, but look to see if it is a voluntary decision.

32 Principle #3: If the risk is greater… The Matrix Provider should look at decision and make sure it is voluntary and informed (person understands it). Formal conversation, e.g. team meeting.

33 Principle #4: If the risk is serious and inconsistent with person’s values and best interest… The Matrix careful examination necessary.

34 Case study: Let’s assess an example together using the Matrix Activity

35 What type of choice is being made here? Consider: Is it clear and consistent with their known values and interests? Is it unclear and inconsistent with their known values and interests? Choice

36 1.Evaluate and identify the risk. Our Task: 2.If the risk is imminent and potential for harm is serious, what interventions do you recommend? 3.If the risk is serious but not imminent, what interventions do you recommend? 4.Does the situation call for an informal or formal process?

37 Challenges / Impediments and Other Considerations Skittish board of directors Fear of bad publicity or liability Nervous case manager Fear of it being called “abuse” and being reported

38 Thank You for Participating!