Worth the Risk

A Toolkit for Teams on Balancing Risks and Supports to Maximize Quality of Life



A critical component of serving individuals with developmental disabilities is ensuring their health and safety while maximizing their independence and self-reliance. Teams are challenged to identify supports that protect individuals from risk in the least restrictive manner appropriate to their needs. But there are no easy answers or clear guidelines. In an attempt to minimize risk and decrease the potential for bad outcomes, teams often make decisions to increase staffing levels—even though more staffing does not always lead to better outcomes.

These challenging decisions have been made even more complicated by unprecedented workforce shortages that limit the availability of staff to provide supervision and support. As stakeholders in Ohio’s developmental disabilities system, our organizations have compiled the following resources to support teams in creating plans that promote health and safety without being unnecessarily restrictive or overstaffed. We believe that decisions using these resources will result in more individual satisfaction, improved quality of life, and better deployment of staffing and technology resources.

This toolkit is intended to help identify issues to consider when making decisions, rather than determine a specific path forward for every individual. We recognize that no guidelines or resources can be expected to provide an answer for every situation or circumstance. These resources are for all members of an individual’s team—the individual, SSA or QIDP, provider, guardian, family members, and other supporters.

There are several steps that teams follow to make decisions. This toolkit provides resources and guidance for:

–  Identifying risks

–  Matching identified risks to needed supports

–  Evaluating options, including technology

–  Addressing specific challenges

–  Documenting the decision-making process

We believe that these resources will give teams confidence in the decisions they are making to balance each individual’s health and safety with maximizing their independence and minimizing restrictiveness.

Identifying Risks

The first step in addressing risks is understanding specific and unique risks, and how these risks impact the individual and people around them. It is important to clearly identify risks—but it is also important to understand that everyone experiences risks. Addressing risks includes realistically evaluating the harm related to each risk.

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Matching Risks to Supports

Team members are often faced with the difficult task of solving a risk issue with few clear solutions. Not all risks should be handled the same way—and increased supervision cannot always protect an individual from harm. Supervision levels or services can become rigid categories instead of being tailored to the person’s needs. A step-by-step approach helps to match the risks to the right supports.

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Evaluating Technology Options

Technology options for supporting individuals with developmental disabilities have rapidly expanded, and teams are expected to consider “Technology First.” But teams may be hesitant to use technology, unsure about the available options, or unclear on how to balance the risks and benefits of each option. Being equipped with knowledge and understanding that in-person staffing is not necessary in every situation can empower teams to make the appropriate decision for each individual.

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Addressing Specific Challenges

Service Refusals

Service refusal by individuals manifests in several ways, such as when an individual:
– Is not physically at the specific service location when services are scheduled to be provided
– Refuses to engage in services as DSP attempts to provide them by:

o Not letting the staff enter (won’t open door)
o Refusing to leave with DSP to engage in activity (attend appointments, run errands, go to work)

– Damages or refuses to use equipment or applications installed in the home for use as remote supports

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Documenting the Decision-Making Process

It is always important to document the team’s decisions—but it is especially important to document the decision-making process when there are no clear answers and the team is making the best decision it can with the information available. Documentation will include the Ohio ISP, but also meeting minutes and case notes. Good documentation always includes the 5 Ws and 1 H

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Approaching supports in this way means that all team members—and all system partners—must be more comfortable thinking about risk and how to balance it with safety and quality of life. We will need to not assign blame if a decision is not immediately successful, but rather work as a true team to determine what went wrong so improvements to the support strategy can be made. Most importantly, we need to be checking in with the person who is receiving the services every step of the way to ensure the supports they receive are keeping them safe, but not making them miserable!

Concerns about the health and safety of the person being served must remain a primary consideration, but they should not be the only consideration. Our system is evolving as we continue to grow in person-centered planning while dealing with the challenges of the current workforce crisis. These have highlighted the need for us to look at things differently as a system. It is time to prioritize helping people stay healthy and safe by employing less invasive and often less restrictive support strategies.

Our organizations are committed to supporting each other, our members, and other partners in the DD system to continue to build a team culture that meets the needs of the individuals we serve while helping them grow their skills and independence.