10 minutes
A decision-support review you can run Review your own practice for the places where support has become substitution, and leave with one change.
What you’ll be able to do Complete a decision-support review on one person's recent decisions and produce one change with a named owner and a review point. Compare the responses to this question and explain your choice: What is the most useful next step? Draft Decision-support review for your work, including person and decisions reviewed, who actually determined each outcome, what the record says. Why substitution is hard to see Nobody sets out to decide for people. It happens because helping and deciding look alike from the inside. Explaining an option shades into recommending it. Recommending shades into steering. Steering shades into the person agreeing because that is what the conversation was shaped to produce. Each step feels like support. The result is a record in which the person made choices they were never really offered.
The review works by refusing to take the record's word for it. For each recent decision, you ask who actually determined the outcome, and you compare the answer to what was written down.
The five questions List the person's last four or five significant decisions: where they live, who supports them, how they spend their days, what they spend on, what services they use.
For each, who actually determined the outcome? Not who signed, who determined.
For each, what does the record say? Where the answers to the last two questions differ, that is a finding.
For one finding, what support would have kept the decision with the person?
What will be different about the next decision, who will make sure, and when will you look again?
Decision-support review One page comparing who decided with what the record says, and turning one gap into a change.
Person and decisions reviewed Four or five recent significant decisions
Who actually determined each outcome The person, a family member, a worker, a provider, a team
What the record says Where the record and the answer above differ
Support that would have kept the decision with the person For one decision
One change, one owner, one date Named person; a date to look again
Run it on one person, then change how their next decision is made.
Browse and download only. Staff notes are not typed or saved on this page.
Download this published draft Start with the next decision, not the last four What you can change You control whether a review becomes an audit of the past or a change to the future. The past cannot be re-decided; the next decision can be made differently.
What to watch for Do not let the review become a judgment of the people involved. Substitution is a pattern practice produces, and the useful response is to change the practice.
Your next step Pick one upcoming decision and agree with the team, in advance, how it will be made.
What you are looking for The steered choice
Options presented with one clearly marked as sensible. The person agrees. The record says they chose.
The unoffered option
An alternative that existed and was not mentioned because someone assumed the person would not manage it.
The assumed answer
The person is no longer asked because everyone knows what they will say. Usually a sign they stopped expecting to be asked.
The general reason
A diagnosis or a statement about capacity used to justify deciding for someone across all areas, rather than a specific decision they could not make with support.
Carry this forward Substitution is usually invisible from the inside because it feels like helping.
The review works by comparing who actually decided with what the record says, decision by decision.
One decision area moved from substitution back to support is a better outcome than a complete inventory nobody acts on.
A completed review naming one decision, who actually made it, what the record says, and one change.
Run the review on one person this month and change one thing about how the next decision is made.
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Previous lesson Back to course Participation and course completion in this program do not count toward DHS-required training credits unless management, a director, or DHS leadership expressly approves an exception.
