Choices and Risk

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What is choice, and what are choice opportunities?

We make many types of choices. Some choices are about important parts of our lives. For example, you choose the work that you do and how to spend the money that you earn. You choose where to live and with whom. You choose your friends. You choose to get married and have a family, or not. Other choices are less important. You can choose whether to sleep 10 minutes longer than usual tomorrow. You can choose whether to watch TV rather than read a book.

By making choices, we cause our lives to go one way rather than another. If you accept a job in a bookstore, that will be the job that you do, at least for a time. If you choose to stay home today and read, you will spend the day reading rather than going out. Of course, you can change your mind. In that case, you make a different choice.

A choice opportunity is a situation where someone can choose between two or more options—for example, between two activities that a person might do that day, or between different clothes that he or she might wear. Each of us has choice opportunities all day, every day. If you are offered a job working in a bookstore, you have an opportunity to accept it, or not accept. At the grocery store, you have an opportunity to choose to buy tomatoes, or not.

Why is choice important?

Choice is important for two reasons. First, each of us wants to decide what our own lives will be like. We do this through making choices. Our lives belong to us, and we want and need to make our own choices, as much as possible. Second, each of us usually knows best what we want. Others are not likely to make the choices for us that we would make for ourselves.

Why is choice especially important for people with developmental disabilities?

Choice is important to people with developmental disabilities for the same two reasons. Individuals with developmental disabilities want to decide what their own lives will be like, as much as possible. And they usually know best what they prefer.

Most of us don’t think a lot about choices. We take them for granted. But studies show that people with developmental disabilities make very few choices in their lives. As a direct support professional (DSP), it’s your responsibility to help people make choices in their daily lives and to give them more choice opportunities.

How can you make sure people with developmental disabilities have choices?

Think about the choices you made this morning. You decided whether to get out of bed or sleep longer. You decided what to eat for breakfast and what to wear for the day. You may also have decided what to do after work, where to do it, and with whom. Making everyday choices is part of what makes our lives fun.

The people you support as a DSP have the right to make choices like these about their lives. The Lanterman Developmental Disabilities Act (Lanterman Act) says people with developmental disabilities have the right to make choices that include how to spend their time each day and what to do for fun.

You can help by making sure they have as many choice opportunities as possible in their daily lives. For more information, go to Community Conversations with People with Developmental Disabilities.

Other choices are about major life decisions—for example, where to live, who to live with, and what job to do. The Lanterman Act says that people with developmental disabilities have right to make these decisions as well. We need to honor major life choices that people with developmental disabilities make.

You can support someone’s everyday and major life choices through person-centered planning. In person-centered planning, a team meets with an individual to talk about what’s important to him or her. The team can include family members, caregivers, and a regional center service coordinator. They help find ways to carry out the person’s everyday and major life choices.

How can you help individuals that you support to understand their choices?

To make good choices in your life, you need to understand what it means to pick one thing over something else and what the consequences of that choice may be. For example, if you choose to spend money going to the movies, you might not have enough money to go out to dinner later in the week.

As a DSP, you need to help the individuals that you support to understand the choices they make and what the results may be. Not all people with developmental disabilities have the same skills for understanding their choices. For example, some can answer questions like, “What do you want to do this afternoon?” But if a person does not understand language, you need to use other ways to offer choice opportunities.

You may need to try many different ways to help someone understand a choice opportunity. Here are some examples.

1. You might begin by asking the person, “What would you like to do?” during his or her free time.
2. If the person does not seem to understand, you might then ask, “Would you like to look at a magazine or listen to your radio?”
3. If the person still does not understand, you might ask the same question while showing them an index card with a picture of a magazine and another index card with a picture of a radio.
4. If the pictures don’t work, you might actually show the person a magazine and a radio, and gesture to the person to point to what they want.
5. For people who do not have the skills to say or point to something they want, you must provide a choice opportunity in an even easier way. For example, you can offer the person a magazine and then watch to see how they respond to the magazine, to see if they like it.

You may also need to help someone understand the consequences of their decisions. For example, someone that you support may want to eat fast food more often than is good for them. You may need to help them understand what will happen to them over time if they do this. Or, someone that you support may want to buy something that will leave them little money for other things that they want. You can help them to understand when they cannot have everything that they want. You can help them to think about what they want most.

No matter what you try, it is important to give people with developmental disabilities time to answer. Some of us take longer than others to think things through!

What is risk?

Risk is the chance that something bad might happen when you make a choice. For example, you can choose to wash your hands before eating. You can also choose not to wash your hands. If you eat without washing your hands first, you will have a greater chance of getting sick. If you wash your hands before eating, your risk of getting sick will be smaller.

What are the different levels of risk?

Some risks are much worse than others. If you eat without washing your hands, you may get sick. If you choose to cross the street without looking both ways, you might get hit by a car and be injured very badly.

It’s important to remember that nearly everything we do each day has some level of risk. For example:

• While taking a shower, you could fall and hit your head.
• If you walk to the store, you could trip over a piece of sidewalk that is uneven.
• If you are eating a piece of hard candy, you could break a tooth.
• If you try to pet a normally friendly dog, he could suddenly bite you.

Levels of risk can change depending on the time of day. For example, a neighborhood may be safe during the day but dangerous at night. Street traffic may be very busy at some times of the day. The risk of walking to the store might change from low to very high at those times.

Risk can also differ from one person to another because they have different skills and experience. Some people are quick enough to grab a bar in the shower and prevent a fall, while others are not. Someone who can grab the bar quickly has a smaller risk of falling.

To lower the risk of harm in an activity, people should be:

• Careful when they know that there is some risk in the activity.
• Cautious when they know that there is a high level of risk.
• Very cautious or unwilling to do the activity if they know the risk is very high.

Individuals with developmental disabilities may not be able to tell a low-risk situation or activity from a high-risk one. They will need your support to learn the difference and to make good choices.

Teaching Someone About Risk James did not like going to places he’d never been before. His DSP made him more comfortable with a new place by showing him pictures and videos and talking to him about it. He came to think that the risk of going to this new place was not high after all, and he felt less afraid.

Once again, any activity can involve risk. Even an everyday activity like eating breakfast can be high-risk for someone who eats too quickly or doesn’t chew and, therefore, may choke. As a DSP, it is your responsibility to know the risks in an activity and take steps to make them as small as possible.

Why is risk an especially important issue for people with developmental disabilities?

We all decide what risks to accept in our lives. People with developmental disabilities need the same opportunity. Protecting an individual from any risk whatsoever keeps them safe but also limits their chance to live a full life.

Still, it is best to make a choice knowing the risks of choosing one path over another. That’s why it’s important that individuals with developmental disabilities have people around them who respect their informed choices but recognize when they do not understand the risks that they face.

As a DSP, your challenge is to help individuals get more experience making choices while limiting the amount of serious harm that can happen to them.

Balancing Risk and Choice A young woman wanted to go out walking without staff, but she couldn’t see well enough to see the white lines of the crosswalk near her home. Rather than tell her that she would have to go with staff, her support team talked about their concerns with her at a team meeting. The team worked together with the young woman and came up with a plan. She would not go out alone, but would not have to go out with staff either. She could go out with a housemate, friend, or family member who could help her if she needed it.

What are the responsibilities of the DSP in risk management?

As a DSP, you’re responsible for managing risk among the individuals you support in the following ways:

A. Prevent serious incidents.

Your first priority is to prevent injury or harm to the people you support and to protect them from abuse, neglect, and exploitation.

B. Make sure their living space is safe.

For example, if you see a rake left where someone could trip over it, put it away. If water on the floor might cause someone to slip, wipe it up.

C. Share information about risks.

Sharing information is the key to identifying risks and preventing harm. Everyone — the person, their family, and all members of the planning team — may have important information about potential risks (for example, food allergies). It’s your responsibility to talk to all these people about risks and to tell an individual’s planning team about choices you know can result in harm.

D. Report special incidents when they happen.

If you see or hear about an incident, it’s important to report it right away.

E. Report new risks.

If you learn of a new possible risk in someone’s life, tell the planning team so it can be included in a risk assessment.

In your role as DSP, you work day-to-day, hour-to-hour, and minute-to-minute with people with developmental disabilities. You see things first - including possible risks for accidents and injuries. This means you can do the most to help the people you support make safe choices. Remember: prevention is the number one priority!

Additional Resources

Choice and Risk Self-Assessment Tool
Designed to help Direct Support Professionals: (1) look at ways that they can support individuals in making choices and taking risks; and (2) work on ways to improve services and supports if needed.
(include link to Tool)

Direct Support Professional Training – Year 2 Teacher and Student Resource Guides. California Department of Development Services. Making Choices and Risk Management in Daily Living. Includes articles and activities on both topics.

Risk Management Training Manual. The California Department of Developmental Services and the Columbus Organization (2004). Designed for Regional Centers and Service Providers.