Support Coordinators & Supported Decision Making: Theory into Practice

Supported decision making is an increasingly important priority of the NDIA. Because the right to make your own decisions, and where necessary to be appropriately supported to do so, is at its heart a human rights issue. It is also the foundation of the principle of “choice and control.” But where do Support Coordinators come into supported decision making? This is exactly one of the questions that the NDIA’s recent Support Coordination Discussion Paper is seeking to answer.

A large proportion of NDIS participants have disabilities that impact on their decision-making capacity. The Independent Advisory Council (IAC) has argued that the NDIS has a clear obligation to provide participants with effective support for decision-making. This is reinforced by the NDIS Act, which says:

“People with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity.” (NDIS Act (Cth) s 4(8).

“People with disability should be involved in decision-making processes that affect them, and where possible, make decisions for themselves.” (NDIS Act (Cth) s 5(a).

In 2019, the NDIA adopted a Supported Decision Making Framework which details, among other things, strategies to strengthen decision making supports.

In reality, the low expectations of the decision-making ability of people with disability which pre-dates the NDIS have perpetuated into the Scheme. Consequently, there has not been any consistency in the implementation of supported decision making processes nor any monitoring of the extent to which a substitute decision maker considers the person’s will and preferences. The allocation and use of nominees for substitute decision making is in direct contradiction to the commitment to supported decision making outlined in the NDIS Act.

Who is who in supported decision making?

Best practice support decision making has defined roles, each with their distinct boundaries. Primarily, it is built on the relationship between the “decision maker” and “supporters”.

• The decision maker- the person making the choices and decisions, who always has the final say. A decision maker may require support for particular decisions at certain times. But there may also be situations where the person does not need any decision making support. The decision maker decides who can support them to make decisions, and the type of support they will provide. Over time, their confidence in decision making may grow, and they will require less support.
• Supporters- most of us have people in our lives who support us to make decisions. These people help us consider things from different angles, weigh the pros and cons and predict the outcomes of different options. Ideally, the decision maker has a network of supporters who may include:

• friends,
• family,
• volunteers,
• community members,
• experts,
• advocates,
• service providers
• any other trusted person.

The role of Support Coordinators

The role of a Support Coordinator is primarily to build the capacity of the decision maker and their supporters. This is sometimes described as a “facilitator” role. Critically, Support Coordinators should never be substitute decision makers.

Support Coordinators often find themselves temporarily playing the part of supporter, but the role of a facilitator is broader than that. Support Coordinators, in the role of facilitators, should be working to build the capacity of the supported decision making network around the decision maker, not just the capacity of the decision maker themselves. The primary objective must be to help people to build supported decision-making arrangements that are sustainable without the involvement of a Support Coordinator. This may include working with the decision maker to build a network of supporters and building the capacity of supporters to fulfil their role.

From my experience, I see the role of the Support Coordinator in supported decision making as encompassing the following:

• Raising expectations that the person can make decisions
• Role modelling good supported decision-making practice
• Connecting decision makers to supporters
• Building people’s capacity as decision makers and supporters
• Facilitating supported decision making

NSW’s Department of Families and Community Services has a booklet that includes a list of some of the roles that the facilitator can play:   

• Explaining the roles of different people in supported decision making.
• Helping supporters distinguish between their role as a supporter and their other roles in a person’s life (such as a friend, family member, support worker, etc).
• Providing training and mentoring as required.
• Modelling good supported decision making practices for supporters. This can include active listening and person-centred thinking, to work out what is important to the decision maker.
• Providing the decision maker and supporters with resources that may be helpful.
• Monitoring the decision making process to ensure that the supporters are not unintentionally making decisions on the person’s behalf or exercising undue influence.
• Ensuring the decision maker’s communication needs are being met and developed.
• Helping the supporter work through ‘ethical dilemmas’, including conflict of interest issues.

Submissions

If you have strong feelings about the role of Support Coordinators in supported decision making, now is a unique opportunity to get your voice heard. As part of their Support Coordination Discussion Paper, the NDIA is asking people to address the following questions:

Building capacity for decision making

1. How can a support coordinator assist a participant to make informed decisions and choices about their disability supports? What are the challenges?
2. How does a support coordinator build a participant’s independence rather than reliance? Should support coordination pricing be determined, at least in part, based on building a participant’s capacity for decision making to become more independent?
3. How can a support coordinator assist a participant in need of advocacy without acting outside the parameters of their role? What are the appropriate parameters of the personal advocacy role and the support coordination role?

You can find our article on the Discussion Paper here and the full Paper and submission details here. Submissions close on 13th September. Until then, DSC will be publishing articles that address the topics and questions in the Discussion Paper. Let us know if there anything particular you would like us to cover!