Supported decision making
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Description
This training is designed for those who work with people with disability and are interested in learning about supported decision making.

The information in this module is general in nature. Every organisation does things differently and has different policies and procedures, so please interpret the content in this module with your organisation in mind and discuss any discrepancies with your line manager.


Duration: Approximately 60 minutes (Note: you can close the training and pick up where you left off at a later date).

Last updated: July 2021

Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors please contact transitionsupport@flinders.edu.au



Training objectives
Lesson 1 of 10
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Training objectives
This module is for people interested in supported decision making (SDM), and how it can impact people in the NDIS. It covers the purpose of supported decision making, core components of SDM, and tips to contribute effectively to SDM.
By the end of this module you will:
Understand the aims and purpose of supported decision making
Understand what is expected of you in helping to support decisions and contributing effectively to decision making
Understand differences between supported decision making and more formalised types of decision making.



Introducing supported decision making
Lesson 2 of 10
Defining supported decision making
Supported decision making (SDM) is a series of formal or informal relationships, practices, arrangements, and agreements designed to assist a person with a disability to make and communicate decisions about their life.
We all use SDM to some extent; for example, many people consult with family and friends before making big decisions. People with intellectual disability or cognitive impairment may require more assistance to make and communicate decisions.
SDM represents a model or tool to support people with disabilities in making and communicating their own decisions and retaining their decision-making capacity by choosing supporters to help them make choices. A person using SDM selects advisors, such as friends, family members, or professionals, to serve as supporters. Supporters agree to help the person understand, consider, and communicate decisions, providing them with the tools to make their own informed decisions.
Supported decision making is about human rights and capacity building
The importance of supported decision making
Supported decision making models have grown from human, civil and disability rights movements, with an increased emphasis on freedom of choice and respect for individual rights and reforms associated with individual funding and person‐centred planning. Consumers and carers have been increasingly included in service design and delivery. SDM is internationally recognised best practice to enable people with a disability to exercise and enjoy their rights.
Previously, it was assumed that if a person had a disability, then they lacked capacity to make decisions for themselves. Such views are being challenged with the growth of disability rights movements, and changes in medical practice and psychology, but unfortunately such views sometimes still prevail.
Australian policy now recognises that all people should be provided with the support to make and implement their own decisions. People with disability have the right to choice and control in their lives. The role of families, carers and other significant persons in this process should be acknowledged and respected.
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Human rights and legislative considerations
Australia is a signatory to the United Nations Convention on the Rights of Persons with Disability (CRPD). Article 3 refers to the basic right to dignity and individual autonomy, including making our own choices. Article 12 recognises that people with disability have the same legal capacity as others in all aspects of life. Article 4 requires nations to replace substitute decision making with supported decision making, to respect a person's will and preference.
Who can benefit from Supported Decision Making?
People who may have impaired decision making capacity
People who have good decision-making capacity

Supported decision‐making is consistent with the ‘social model of disability’, which recognises that disability is a social construct, whereby society places physical, social, and attitudinal barriers on people with disability. Read more about the social model of disability, or watch a short video
The aim of supported decision making
Supported decision making is about supporting people to build up their own capacity. Supporters aim to empower people with disability to exercise choice and control in their lives, to make informed decisions and to ultimately achieve their goals.
Supported decision making can enable people to retain their legal capacity, representing an alternative to enduring documents or formal support as well as enabling people to make arrangements to be implemented in future if required (advance directives).
Supported decision making is an alternative to substituted decision making, where decisions are made on behalf of a person, which takes away people’s rights to make their own decisions and exercise control over their own lives. Environmental factors, such as the availability of someone to provide support and the quality of support relationships, can shape a person’s ability to make a decision.
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SDM is based on the idea of self-determination
Self-determination means that a person directs the plan for their life, deciding what is most important to them, setting goals, and working towards achieving those goals so that they can live the most fulfilling life possible. Supported decision making enables people to retain their legal capacity and protects their autonomy.
Supported decision making:
Enables people to exercise their decision-making ability with support; for example, it can be an alternative to involuntary treatment orders for healthcare decisions.
Enables people to access a range of other rights and supports, like housing, legal, financial and other services.
Extends into people's personal lives to make decisions around who they live with, their supports and services, meaningful employment, and the activities they participate in.
Enables people to have self-determined relationships, to enjoy privacy and dignity, and to fulfil other social and cultural rights.
Each person is dependent on others to varying degrees to achieve their independence. This concept is called relational autonomy. Many people use SDM processes to enhance decision-making across life domains, for example, having informal discussions with someone who has been through similar experiences or who has made a similar decision.
SDM in any health setting is a collaborative approach to support a person in their decision-making.

A supporter, like all providers of capacity building services, should assist people to move toward being independent service users, exercising choice and control and engaging in the life that they choose.



A deeper dive into SDM
Lesson 3 of 10
Decision making capacity
Decision making capacity is required for people over 18 years to make legal documents and consent to medical treatment. Impaired decision-making capacity means that you are unable to manage parts of the decision-making process. People with impaired decision-making capacity may not be able to:
- understand some or all of the information relevant to a decision
- understand the consequences of a decision
- remember relevant information
- use this information to make their decision
- communicate their decision to others.
A person may be able to make one decision, and not another. Decision making capacity should be assessed in relation to each particular decision. A person may still have the capacity to make a particular decision, even if they are not able to understand all information, can only remember information for a short period of time, make a decision that results in a negative outcome, or if their capacity fluctuates between full decision-making capacity and impaired capacity.
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Dignity of risk
The goal of decision-making strategies cannot be to eliminate all risk. Rather it might be to maximise the person's decision-making potential and autonomy while keeping risk to an acceptable level. There are complex arguments about ‘dignity of risk’ and the rights of people with disabilities to take their own risks in decision making. From a recovery-oriented practice perspective, dignity of risk means a version of positive risk-taking that ‘involves optimising informed choice and decision-making, even where this involves a degree of perceived risk’.
There are risks involved in all decisions we make. Everyone has the right to take risks and make mistakes, including people with disability. Supporters to a person with a disability must respect the person’s right to take risks, even if there is the potential to make mistakes. As part of providing support, supporters can point out potential risks, and assist the person to explore how they could avoid or handle predictable risks. It is important to recognise that existing mechanisms designed to keep people safe, including consumer mechanisms which limit involvement in decision making, have the potential to be, of themselves, risky. To read more about dignity of risk, visit: http://www.hardhack.com.au/disability-services/dignity-of-risk.
Supported decision making and the NDIS
Living an ordinary life means making small decisions (e.g. what to eat) and large decisions (e.g. where to live). Supporting people to make their own decisions is an important part of supporting them to live an ordinary life.
The NDIS aims to empower and enable people by placing them at the centre of decision making about their lives, with more choice and control over the supports they receive. The NDIS philosophy of choice and control for all participants should be central to providing decision making support. It is an expectation that participants “will 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). This means participants will need to make more decisions. The complexity of participants’ decisions will increase as they take more responsibility in their lives and the outcomes of the decisions they make.
SDM is not disability specific. The universal model for decision support suggests a role for all in creating inclusion by recognising and supporting decisions when and wherever this support is needed. This fits well within an NDIS framework. SDM activities could include awareness raising, information and online resources, training for decision makers, and supporters and linkages to support the establishment of SDM relationships.
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The NDIS Act
The NDIS Act puts Australia's obligations under the Convention on the Rights of Persons with Disabilities into practice. These principles include:
a) People with disability should be supported to exercise choice, including in relation to taking reasonable risks, in pursuit of their goals and the planning and delivery of their supports (Section 4(4))
b) 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 life, to the full extent of their capacity (Section 4(8))
c) People with disability should be involved in decision making processes that affect them, and where possible make decisions for themselves (Section 5(a))
In the NDIS, people must make a multitude of complex choices and decisions which require significant cognitive, relational and emotional work.
Around 60% of adult NDIS participants have a disability that may affect the way they think. Sometimes they need help to make decisions.
Using SDM, people with psychosocial disability, intellectual or cognitive disability and acquired brain injury are provided with the support they need to make a decision, ensuring they can truly exercise choice and control.
Without SDM, people with impaired decision-making capacity may be unable to participate in the NDIS on an equal basis with others.
Click on the flip cards below to learn more about components of the NDIS where supported decision making is important.
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Planning
Back of card
Planning is an important component of the NDIS where supported decision making is required, as there are many decisions to be made by people with respect to their plans.
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Goal setting
Back of card
Goal setting is another important component of the NDIS where supported decision making is required, as people need to make decisions with respect to deciding on and articulating their goals.
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Support required
Back of card
In 2021, NDIS changes will result in more choice and control for consumers. Supported decision making will become even more crucial, so that people can fully exercise their rights and make decisions about the supports they require.
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Who provides support?
Back of card
People decide who provides the supports they require, for example, exercising more flexibility in choosing a supplier. Supported decision making is important to this process.

Explore these benefits and outcomes of SDM below:
Promotes personal recovery
Enhances wellbeing
Aligns with choice and control
Person-centred
Builds capacity
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Promotes personal recovery
Linked to a recovery perspective, or the concept of personal recovery, is the ability for people with disability to engage in supported decision making. Being supported to make key decisions and to exercise agency can positively impact a person’s recovery journey. SDM promotes personal recovery by providing people with the tools and supports required to actively make decisions in their lives.

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Enhances wellbeing
Making decisions is important to personal wellbeing. Supported decision making can develop and enhance the overall physical and psychological wellbeing of people with disability, which could have positive health outcomes and improve quality of life.
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Aligns with choice and control
SDM aligns with choice and control by providing people with the tools and supports required to maintain choices and to have and retain control over their daily life.
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Aligns with a person-centred approach
SDM aligns with a person-centred approach. When supporting people with disability with their decision making, supporters put people first, actively considering their hopes, views, and wishes, and supporting them to achieve their goals.
Important to a person-centred approach is the notion of co-production. Co-production involves consumers and others working in equal partnership to design, deliver and evaluate agreed objectives.

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Builds capacity
SDM builds capacity. There is a growing emphasis on strength‐based assessments for capacity, where capacity is related to the level of support available to a person to make the decision, rather than to the level of a person’s cognitive capacity or functional ability.
The right to make one’s own decisions is closely linked to quality of life, health and well-being. Making decisions can lead to increased self-determination, autonomy, confidence, improved decision-making skills, strengthened support networks and better community engagement. Using people’s direct lived experience is empowering, strengthens autonomy and dignity, and can facilitate SDM.



SDM in action
Lesson 4 of 10
Types of decisions
Different decisions have different consequences for a person's life.
- Life changing decisions are decisions made at important life stages, and tend to have an impact on life milestones
- Lifestyle related decisions are related to how people live and what they like to do, such as what to do in their spare time
- Everyday decisions are the decisions people make throughout the day, like what to wear.
Image of person standing in front of a blue house door and next to that is a red house door

Choice and decisions
Choices are opportunities or options presented to a person. A decision is the final selection. Choice reflects a person's capacity, while a decision reflects the final result. A decision implies there has been a selection from more than one option.
Assessing decision-making ability
There are various ways that professionals assess a person’s decision-making ability. Assessment tools can be used to determine the person’s capacity to make decisions, such as consenting to treatment or medication and can be used by courts and tribunals to determine a person’s ability to make lifestyle and financial decisions.
Providers should exercise caution when using assessment tools. When selecting or developing assessment tools, providers should look at strengths-based approaches that identify a person’s abilities, as well as areas of improvement. Remember, whatever tool is used, the results only relate to that point in time, and for that specific decision, which is why tools should not be used only at one point in time and relied upon for years. There are other ways to assess decision-making ability, including conversations with the person and their family and carers.
What can SDM look like?
A person may want different types of support with different decisions. For example, they may want a higher level of support in making medical decisions than they do for housing decisions. A person’s decision-making ability is decision specific. The ability to make decisions can also change over time, as a person gains life experience.

Steps involved in SDM
The decision maker decides what kind of help they would like in making certain decisions.
Click to see different types of potential help.
click Start

Step 1
Help gathering information needed to make a decision
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Click to Step 2
Help understanding information
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Click to Step 3
Assisting with evaluating available options
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Click to Step 4
Giving information about others who have made the decision before
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Click to Step 5
Understanding the consequences of different decisions
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Click to Step 6
Weighing up pros and cons or predicting outcomes of a particular decision
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Click to Step 7
Role playing to help understand available choices
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Click to Step 8
Advocating for extra time to think about choices and make decisions
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Click to Step 9
Communicating a decision to others
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Click to Step 10
Helping to make sure decisions are carried out
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Who can provide supported decision making?
Supported decision making can be both formal or informal, depending on the person's needs and preferences. SDM covers a wide spectrum of decision-making models from informal support involving natural support networks, to formally appointed decision makers and representatives.
At the centre of SDM is the decision maker, who chooses people to help them make decisions at different times and to varying degrees. These people are supporters. See below for a list of potential supporters:
Family
Friends
Neighbours
Service providers
Advocates
Other professionals
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Range of SDM approaches
Supported decision making models may be informal, formalised through agreements, or provided for by legislation. Two types of supported decision making models are outlined below: circles of support and the stepped model.
Circles of Support
‘Circles of support’ is one of the more collective or collaborative models of supported decision‐making. A circle of support is a group of people like family and friends, who meet regularly with a person with a disability to help them formulate and realize their goals. This model is focused on creating a natural support network for people with disability. The role of the circle of support is to “collectively represent the person’s wishes and best interests, identify and weigh up the available range of choices, implement decisions and review the impact of decisions, both positive and negative, on the person and others”.
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The stepped model
Previously, decision‐making was often conceived as being binary in nature; either fully autonomous or, if this was not possible, requiring substitute decision‐making by another person.
The stepped model presents the range of decision‐making options as a continuum, progressing from more to less autonomous decision making by the person depending on the degree of third-party intervention in the arrangement.
This model is suited to the NDIS, with families and carers of participants supporting them to be as involved in their decision making as possible.



Tools for SDM
Lesson 5 of 10
Assessing how a person communicates
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Some people with disability can clearly verbalise their wishes, preferences and decisions. Others may use sign language, body movements, or technology to communicate. Supporters need to understand each person’s own communication methods and styles. It can take time getting to know a person's likes and dislikes, and how they express themselves in different situations. However, this is key to enabling people to gain experience and skills in decision making.
Some indicators that a person may be having difficulty making a decision include:
Being unable to understand what decision is needed
Avoidance of decision making
Frequently changing their mind
Being unable to choose between available options
Making a snap decision without considering all options, or the advantages and disadvantages of each option
Making a decision or acting in ways that exposes themselves or others to risk
Questions and prompts to assist supporters
What decision needs to be made?
Clearly identifying the decision to be made is necessary. Decision aids, like questions and prompts, can be used with a person.
Click on start

Step 1
Has the person’s right to make their own decisions been considered?
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Click on Step 2
Is the decision complex or straightforward?
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Click on Step 3
Has the necessary support been provided to enable the person to make their own decision?
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Click on Step 4
Has the person’s will and preference driven the decision-making process?
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Click on Step 5
Are safeguards in place so that the decision has not been unduly influenced by others?
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Click on Step 6
Who needs to be involved in the decision? Should others be involved?
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Click on Step 7
What part of the person’s life is affected by the decision?
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Click on Step 8
What are the risks and benefits associated with the possible options?
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Click on Step 9
Are strategies such as monitoring of arrangements, accountability and regular reviews in place to prevent abuse of power?
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Click on Step 10
What is likely to happen if a decision isn’t made?
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Click on Step 11
Remember, decisions which are not straightforward may be broken down into smaller components.
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Summary

There are various steps and prompts to consider in implementing supported decision making. Explore these below:
Gathering, understanding, and considering relevant information
Support the person to gather, understand and consider relevant information, so they can benefit from knowing the facts relevant to a particular decision. Present information in a way the person understands, in line with their individual strengths and needs.

Questions to ask may include:
• Do you have all the facts?
• What information might be helpful?
• Where can you find this information?

Determining available options
Using the facts, support the person to work out the options available for the decision. Set out different options so they are easy for the person to see and understand. Explain what is involved in making things happen for each option.

Consider:
• What are some ways to go about it?
• What has and has not worked in the past?
• What has to be done to make this happen?

Identifying and weighing up pros and cons
identify and weigh up the pros and cons of each option.

Consider:
• Will it work immediately or take time?
• Will it affect other people?

Prioritising different options
By assisting a person to identify their priorities, it’s more likely the decision will be followed through. Encourage the person to list or consider things which are important in relation to a decision.

For example:
• What are the top three priorities?
• What are the bottom three priorities?
• What would be the best outcome for the current situation?

Explaining potential consequences of options
Some people with disability may find it difficult to predict outcomes and consequences and will benefit from support to evaluate these. Outline the consequences of each option, including positive and negative outcomes.

Consider:
• What might happen if you decide to go ahead with the decision?
• What do you have to do if you go ahead with the decision to be made?
• What steps would you have to take if you chose to make this decision?

Making the decision and following it through
Once the decision has been made, ensure the person has appropriate support to implement it within a reasonable timeframe. Consider what supports the person will need to be able to participate in the actions that flow from the decision. Check in with the person as the decision is being implemented to make sure their expectations are being met and that they are feeling emotionally supported and confident.

You could ask:
• How are you feeling about getting started?
• Do you want some help to do this?
• Is this going well for you?

Checking in to see how the decision went in practice
Keep in mind that supporting a person to build experience in decision making will broaden their understanding of what is possible. It will also help them practice their skills.

Consider:
• How did that go? What did you like about it? What didn’t you like about it?
• Would you do it the same way next time? Would you do something differently?
Keeping the big picture in mind
Small decisions can have a big impact on a person’s life. Having a good understanding of what the person’s overall goals are is important so that decisions can be made in line with these goals. Sometimes people may choose to ignore longer term goals – this should be an active choice based on knowledge and understanding that the decision might lead away from the bigger outcome. Some people may need support to remember what their longer-term goals are.

You may ask:
• Remember setting yourself (goal)? Will this decision help you reach that goal?
• Do you still want (goal)? Would doing this make it harder to reach your (goal)?

Final considerations
Keep the following considerations in mind throughout the supported decision making process:
How can I encourage the person to make their own decision about this?
Can I prompt the person with questions to support them to make a decision?
Can I work out a way that the person can try some of the options?
What possibilities are there for the person to have more control in their life?
What ideas might be relevant to support this person to see more possibilities?
Am I interfering with the person's ability to make their own decisions?
Can I use silences to encourage the person to think more for themselves?
Does the person need more positive feedback and encouragement to develop confidence in decision-making?



Barriers and enablers to SDM
Lesson 6 of 10
What can impact engagement with SDM?
If a person has low self-confidence, they may not feel comfortable or able to engage with SDM. Fostering people’s confidence is key. Supporters, professionals, and clinicians are responsible for improving their way of practising, to strengthen people's capacity to make decisions, whilst reducing practices viewed as coercive or manipulative.
Personal preferences
Some people with disabilities may not be accustomed to making their own decisions or receiving support to make more autonomous decisions, which can be a barrier to fully engaging with SDM. Helping people to realise their decision-making potential is important.
Anxiety or fear
Some people with disabilities may have anxieties or fear around making their own decisions, especially with respect to medical or treatment decisions. People who have experienced chronic disempowerment may find it difficult to know, or speak up about, what they want or feel.
Providing people with the support they need can help to lessen their anxiety or fear around making such decisions.
Cultural perceptions of disability
It is important to acknowledge that different communities (e.g. Aboriginal and Torres Strait Islander, and culturally and linguistically diverse) can understand and approach disability and decision making differently. This can impact whether they need supports outside the family or community. It is important to provide the chance for all participants to explore supported decision making in a culturally sensitive way.
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Enabling SDM: Skills and competencies of effective supporters
Click on the tiles below to discover some of the broader skills or competencies which make someone a good supporter

Front of card
Adaptable
Back of card
Supporters are flexible, know how to respond to changes and are always ready to try new approaches.

Front of card
Builds partnerships
Back of card
Supporters are collaborative. They build effective relationships with providers, mainstream services, family, friends and the community.

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Builds trust
Back of card
Supporters know how to build rapport and they treat people with respect, dignity and fairness.

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Develops others
Back of card
Supporters help participants - and their broader network - to build their independence and skills.

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Creative
Back of card
Supporters think outside the box. They can think of new solutions to tricky problems and thrive on innovation.

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A learning mindset
Back of card
Supporters take advantage of opportunities to upskill and learn. They keep themselves up to date on relevant information.

Front of card
Person-centred
Back of card
Supporters have a person-centred approach. They focus on people's strengths, skills and wishes, and encourage them to achieve their goals.



SDM - an example
Lesson 7 of 10
Scenario: Finding community supports
Below is a brief example of supported decision making in practice, centring on a person finding appropriate community supports.

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Click on information point one
What is the decision?
A person with psychosocial disability has expressed feelings of loneliness and is considering finding community supports.
Their decision is around what kind of support to look into, whether to explore individual or group support options, and making arrangements to join in.

Information point two
What are the indicators that the person may need support?
The person may believe that there may be no community supports which are suited to them, or which will accept them without judgement.  They may not know where to begin researching community supports and how they will go about joining in if they find an appropriate support.  They may be fearful around taking this step.

What support could be provided?
A supporter could openly discuss what kinds of support the person wishes to gain from their involvement in a community group or service.
If a person expresses that they do not know where to begin their research, a supporter could show the person how to begin this process online or in person, to weigh up different options with respect to available supports.
A supporter could facilitate a meeting with the people in charge of running the community supports, to discuss the focus, aim and nature of the particular support provided.
A supporter could facilitate a discussion with someone else who attends this particular community support, to gain a lived experience perspective.
A supporter could provide practical information around logistical support for attendance, such as getting public or private transport to the support, and to set reminders to remember to attend relevant meetings and events.
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Formalised decision-making models
Lesson 8 of 10
Comparing SDM to other decision-making models
Supported decision making is an alternative model to substitute decision making. A substitute decision maker can be appointed under an Advance Care Directive. Legal guardians have court authorised power to make decisions on behalf of a person. These decisions may not always be in the person’s best interests or in line with their wishes.
In contrast to substitute decision making, supported decision making usually involves the person retaining their legal decision-making power, although a third party may provide assistance or support to make or communicate the decision. Sometimes this arrangement is authorised by law, but it can also be an informal arrangement. Importantly, it means that a person retains their autonomy and agency to make decisions.
Mechanisms have been introduced in both formal (e.g. advance care directives) and informal models of supported decision making to lessen concerns about people being subject to manipulation, coercion, exploitation, and abuse as part of supported decision-making arrangements. Click here to watch a short video on SDM and other decision-making models.
Formal decision-making models and systems include:
Attorneys
Advanced directives
Guardianship orders
Guardians
NDIS plan nominees
NDIS correspondence nominees
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Click on the tiles below for more information

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Attorneys
Back of card
Attorneys can empower people to make financial and personal decisions. Regulated by state and territory laws, decisions have the same legal force as if they were made by the person who appointed them. A representative can only make an NDIS-related decision on behalf of a participant where the decision falls within the scope of their legal authority.

Front of card
Advance care directives
Back of card
Advance care directives (ACDs) are legal documents made by people over 18, who are able to make their own decisions. ACDs capture people's wishes and instructions about their future, healthcare, accommodation, personal affairs, and end of life decisions. One or more substitute decision makers can be appointed.

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Guardianship orders
Back of card
Guardianship orders are legal documents and can be enacted for people with mental incapacity. One or more guardians can be appointed to work together or separately to make specific decisions. Guardianship orders may be made if there is no one to help informally, if informal arrangements are not working, and if there is no ACD in place.

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Guardians
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Guardians can be family members or professionals. They are formally appointed to make decisions for a person, in line with the person’s rights and preferences. When someone has a formal guardian, their decision-making ability has been taken away.

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NDIS plan nominee
Back of card
A plan nominee can be appointed to act on behalf of a participant over 18 to prepare, review and replace their plan and manage funding. A plan nominee can only act if the participant is not capable of doing or being supported to do something. A plan nominee could be a family member or a supporter of the participant and/or a substitute decision-maker. Nominees have a duty to build a person's decision-making capacity.

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NDIS correspondence nominee
Back of card
A correspondence nominee can conduct NDIS related correspondence on behalf of a participant. The NDIA appoints a nominee if requested by a participant, when all other decision-making options are exhausted.

SDM under guardianship
For a person under guardianship, it may be possible to try out supported decision making to see if it works for them. While there is a guardianship in place, the guardian retains the legal authority to make decisions on behalf of the person in the areas that have been designated by the court. It is important that the guardian fully understands the principles and values of autonomy that are embedded in SDM and is prepared to support the person to make decisions.
If the guardian is not a supporter, the person and their supporters should discuss how they will approach SDM and communications with the guardian. Consider what it may be like to work with third parties like health care providers when using SDM while under a guardianship. Even if the person is making their own decisions with support, the guardianship remains in place and health professionals may look to the guardian for the decision. If the eventual goal is to remove or end the guardianship, trying SDM while under guardianship may make removing the guardianship easier.
The way guardians and trustees work with the NDIA is inconsistent, as each state and territory has different laws and rules.
Incorporating SDM into the formal decision-making process means the person can be aware of the decisions being made and can make their wishes known.



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