Post on 13-Jan-2016
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Balancing Rights & Choice With
Risks & Responsibilities
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Eva Kutas
TODAY’S FACILITATOR
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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.
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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).
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Other Titles Considered
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• Rights versus Risk: Where’s the Balance?
• Cover your Assets – Tools for Balancing Rights and Risks
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• Explain your Decisions to the Newspaper, Board and Parents: A Simple Approach
• Extreme Sports for the DD Provider: Balancing Choice and Risk
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Learn about rights, duties and obligations.
Become familiar with tool to help make decisions.
Practice using the tool through examples.
Agenda:
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Where do rights come from?
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• U.S. / Oregon constitutions
• Laws • statutes • administrative rules
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What rights are common to all
people?
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What rights are common to all people?
Vote Freedom of religion Freedom of speech Own property Bear arms (guns) Have children
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What are the rights of people with
developmental disabilities receiving
services?
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… plus (ORS 430.210):
The same list
individualized written service plan not participate in experimentation without informed consent freedom from abuse and neglect
(and)
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assert grievances no labor without compensation visit with family members, friends, advocates, legal professionals
(ORS 430.210):
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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
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• 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
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• Assure health and safety-from other sources like county contract and conditions with Medicaid funds
• Personal and professional ethics to protect interests of individual
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Balance is key in decision making
Risk and fear = Rights out the door
Rights only = Common sense out the door
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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)
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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 valuesand interests
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The Tool’s 1st leg:
Choice Choice unclear/Inconsistent with known values and interests
Choice clear/Consistent with known valuesand interests
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• 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:
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The Tool’s 2nd leg:
Values
Is choice consistent with values?
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Personal: love, justice, truth, health, religion, family, friends, kindnessAgency: service to others, integration, cost-effective service delivery
Community: safety, cleanliness
Examples of different types of values:
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The Tool’s 3rd leg:
Risks
High Risk
No or Low Risk
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What are risks of choices?
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all risk is not the same
• Probability of harm• Severity and duration of harm
Measuring Risk
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not the movie but a framework for assessing decision-making capacity
The Matrix
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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
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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.
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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.
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Principle #4: If the risk is serious and inconsistent with person’s values and best interest…
The Matrix
careful examination necessary.
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Case study:
Let’s assess an example together using the Matrix
Activity
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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
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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?
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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
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Thank You for Participating!