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Supported Decision Making

All children need support to develop the skills needed to be more independent and make decisions for themselves.

Introduction

All parents make decisions about their children’s life when they are young. As children get older, however, they may have more opinions about their life and may want to make decisions for themselves independently.

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All children need support to develop the skills needed to be more independent and make decisions for themselves. This includes children with intellectual disability and autism spectrum disorder.  Some children will grow into adults who can make many decisions independently and some children will continue to need support to make decisions as they age. That is OK. Everybody needs help making decisions sometimes.

Supported decision making is an important way for parents and carers to foster their child’s developing independence safely.  It is a process that helps to build their skills in decision making and develop confidence to make their own choices.

Supported decision making follows three key principles.

  1. Everyone has the right to make decisions that affect their lives and have those decisions respected
  2. Everyone  should have access to appropriate support to make decisions that affect their lives
  3. Decisions, arrangements and interventions for people  who require decision making support must respect their wishes

By providing decision making support in line with these principles and involving your child in making decisions about things like their bodies, health and relationships from a young age, you are helping them to build the skills they will need to make independent decisions an adult.

Supporting your child to make choices throughout their daily lives is a great way to practice decision making skills. It will help them to develop independence and learn from positive and negative consequences of decisions. For example, you could offer 2-3 options for which outfit they can wear, what movie they can watch or what snack they can eat. If your child chooses the same thing every time, that’s OK!

Having too many choices can be overwhelming for some people, so by providing a shortlist of choices, you can support your child to choose what they think is best. Supporting your child to practice this type of smaller decision making from a young age will prepare them for making bigger decisions as they grow older.

As your child grows older and goes through puberty, they will need to make bigger decisions about their life. Teenagers may be faced with more complex choices like which activities they want to be involved in, who they want to be friends with or whether they want to make changes to their appearance. They may also start expressing their gender and sexual identity in new and different ways. (link to Supporting gender and sexual identity)

While this might be scary or confronting for parents and carers, it’s important to communicate with your teenager about the choices they want to make and provide information in an accessible manner so they can make informed decisions. If a choice they want to make crosses a line of safety, it’s important to communicate to your teen about why a certain decision is not a good choice rather than just saying ‘no’.

Your teenager may also want to make decisions about their healthcare as they get older. Supporting decision making in a healthcare context is important as service providers (such as doctors, support services or the National Disability Insurance Agency) will involve your child in more and more of their care as they get closer to 18 years old. Even if your child is still developing their capacity to make decisions about their support and healthcare, it is important to involve them in the decision making process so they can more confidently understand their support and health care needs and manage these needs either on their own or with support.

 

Adult choices can seem confronting to parents and carers, particularly if you have a child with higher support needs. Adult choices might include things like:

  • identifying their life goals, particularly relevant for NDIS plans
  • moving out of home
  • dating, having sex or finding a partner
  • spending their own money
  • choosing a service provider
  • going to a bar or club for a drink
  • deciding to have a baby
  • making decisions around healthcare and medication

You can prepare your teenager to make informed decisions about more complex matters by providing clear easy read information, pictures and resources. We also recommend speaking to health care and service providers before appointments to ensure that accessible information is readily available for appointments and ensuring that service providers speak directly to your teenager about their care.

As your teenager grows into a young adult, you will also need to be aware of the laws of consent and confidentiality in each state. Depending on where you live, these laws will affect the information shared with you as a support person in regards to your teenager’s healthcare and support services.

The age at which a young person has automatic confidentiality rights is:

  • 14 years and over in the Northern Territory
  • 16 and over in New South Wales and South Australia
  • 18 and over everywhere else in Australia

This means that a doctor or other health professional is required by law to keep what your teenager says private, even from you.

If your teenager does not have the capacity to make decisions independently, it is important to check in with your state or territory’s administrative tribunal or public guardian before your teenager reaches the age for automatic confidentiality rights. They can assist you to develop a plan to ensure your teenager’s ongoing support. If your teenager does not have the capacity to consent, it is still important that they are given the opportunity to learn as much as possible about the decisions being made on their behalf.

Conversation Starters

We’re going to the GP for a check-up today. It’s important to check in with the doctor to make sure you’re healthy. Have you got any questions you want to ask the doctor today?
I’m putting the grocery list together. What dinner should we have on Monday? The choices are spaghetti bolognese or stir fry.
You decided to not take a jumper to school today, did you feel cold? How did being cold make you feel? What can you do next time so you don’t feel cold?

Strategies for you to try

Build your child’s decision-making skills by giving them opportunities in their everyday life to make small decisions. This can be as simple as choosing to wear a red or blue t-shirt or what they would like to have for breakfast. Gradually offer your child choices that increase in complexity as they become more comfortable with decision making. This will help them to feel more comfortable saying ‘yes’ or ‘no’ to things they do or do not want to do

Involve your child in their healthcare. You can do this by asking health professionals to address your child directly during appointments and asking your child for their approval or input on different things throughout the appointment. For example, ‘Do you think that sounds good?’ or ‘Do you want a red or blue bandage?’ This gives your child confidence in dealing with health professionals and allows them to be an active participant in their health care

Ask your health care providers and support organisations for accessible information and encourage your child to ask questions. Your child should learn about their disability, health conditions and support needs so that they can make informed decisions as they get older

Contact an advocacy agency if you would like extra advice and information on supporting your child’s decision making in a health setting

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Introduction to puberty for girls
Supported Decision Making

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