This talk video is an introduction to Step 3.
In Step 3, the person and their supporters think as widely as possible about the decision, all the possible options to be explored, and the consequences of different options.
Everyone has preferences. Preferences, or what a person wants to do, stem from their own values or cultural norms, knowledge and available information. Preferences are also influenced by past experiences and the consequences of previous decisions. Considering all of these things, it shouldn’t be surprising that a person’s preferences will change from time to time.
Trying Different Ways
Understanding a person’s preference for the decision may not be an easy or straightforward task. However, you will be well-prepared for this step if you have been thorough at Step 1, Knowing the Person.
Understanding how the person expresses their preference, and what their preferences are at this point in time for this decision, may take time, creativity and persistence. You must develop multiple strategies to determine this information. If one way does not work, you must try another way.
For some people, preferences have to be interpreted by supporters based on their knowledge of the person, or acquired from the perspectives of others who know the person well or in different contexts.
Preferences are communicated by people in many ways, including through:
- words
- signs
- gestures
- expressions, including facial expressions like staring at an item of interest
- behaviour
- actions or lack of actions
Finding Ways to Understand Preferences
The Principles and Strategies are intertwined with each Step in the support for decision making Framework.
Applying the principles and using the strategies will help you to understand the person’s preferences for the decision. You will learn more about the Strategies in later modules, but they are introduced here.
Things you can do to understand preferences include:
You will need to consider different ways to create opportunities for exploration and new experiences. And remember, that a person’s preferences can change over time. What they liked a few years ago might not be their preference now.
- Active listening and finding different ways to listen: communication is not always verbal, and observation is important to determine the person’s preferences. What hobbies does the person have? What do they like to collect? What pictures do they display in their bedroom? How do they react in different types of settings? Do they seem to prefer noisy lively places rather than quiet places?
- Exploring and experiencing different options, including creating new experiences: when making decisions, we use our previous experiences to guide and inform us. For example, if we enjoyed Thai food at a friend’s place for dinner, then we might want to try Thai food again on another occasion. However if we had not had Thai food before then we do not really know whether or not we will like it. It is harder to make decisions without having had direct experience. Many people with cognitive disability may not have had the opportunity to explore and experience different options. For smaller, every day decisions, sampling new experiences is easy. You can provide a selection of clothes to wear for the day, for example, and see which the person likes best. For more complex decisions, such as where to live, it may be difficult for the person to imagine what it would be like to live in a group home if they have only ever lived in a large, secure unit.
You will need to consider different ways to create opportunities for exploration and new experiences. And remember, that a person’s preferences can change over time. What they liked a few years ago might not be their preference now.
Ways to think about understanding a person's preferences include:
- Keeping internal voices and judgements “still”: this allows the person’s preference to be heard. Supporters should avoid imposing their own preference onto others. Try to suspend your own judgements and preferences so that you can hear what the person prefers.
- Unconditional positive regard: means maintaining a commitment to the person throughout the decision making process. You should maintain this approach, even if the person’s decision is in contrast to your own beliefs and values. Taking time to reflect during the process of effective decision making will enable you to consider whether your views are getting in the way.
- Devoting time and focus: determining someone’s preference can take extended periods of time as well as uninterrupted focus on the person being supported. Doing this effectively may require you to prioritise competing demands so that you are devoting the necessary amount of time.
- Thinking about risk and taking risks: if activities involving risk were avoided, we would lead a very dull life. As a supporter, you will need to help the person you support to unpack and understand the potential risks embedded in the decisions they are thinking about. You will need to work with the person to make choices and be involved in activities that may involve some risk while minimising potential harm to themselves or others.
- Continuously seeking feedback: it is important that, on an ongoing basis, you reflect and review your own practice. This includes seeking feedback from others who know the person you are supporting. If you are part of a network or circle of supporters around an individual, you should take the time to reflect on the functioning of the group as a whole, and whether any particular aspect of the group’s interaction is negatively impacting on the support being provided. Is everyone in the group able to openly express their opinion?
You should check back, again and again, to ensure you understand the person’s preferences and that it is actually reflected in all parts of the person’s decision.
What to do when You Find it Difficult to Determine Preferences
Determining a person’s preferences can be challenging. It can be particularly difficult when the person has a more profound cognitive disability and finds it hard to clearly articulate or express their preferences through their actions. For example, a person with severe intellectual disability does not use language or symbols to express their preferences. On the other hand, a person with brain injury may display a tendency to ‘live in the moment’ due to their short term memory loss. This will mean that their will and preferences may differ from moment to moment, not always reflecting what they truly want.
You may need to think more about a person’s ‘will’ when their preferences are difficult to work out. As discussed in Module 1 a person’s ‘will’ is more enduring than in the moment preferences. A person’s will represents the underlying directions they want to pursue in their life. So, when you are unsure about preferences you might need to think about what you know more generally about the type of life the person prefers – are they striving for independence? Do they consistently enjoy being in situations where there is lots of social interaction?
Thinking about rights will also help when a person’s will and preferences are not clear. Which decision will least interfere or restrict a person’s rights? For example, will their right to full participation in the community be restricted more by living in a large facility away from the town compared to living with fewer people or own their own close to local community facilities and their friends?
You might ask yourself these questions in the following order. If you cannot answer one, then move onto the next:
- What are the person’s preferences? Do you know the person well enough to answer this? What is important to this person? Why do they want this choice?
- What is the person’s will? This reflects the person’s longer term intentions.
- What are the person’s rights? What is the least restrictive option for this person that will allow them the most choice and control while minimising harm? What would optimise their quality of life?
It is important to remember that people with intellectual disability may have had narrow life experiences, so acting on a least restrictive alternative can open up new experiences for them.
What does a good option look like for the person you support – from their perspective not your own? As a supporter, your purpose is to support the person to explore all the possible options and help them to determine which they prefer.
This video shows an example of understanding the person's will and preferences for the decision.
Watch the video and then answer the questions. Write in the downloadable workbook located in the Resources section.
- What are the different strategies that Carol's parents use to determine whether she would like to try yoga classes?
- When providing support for decision making, why would it be important to create opportunities for people with cognitive disabilities to have different experiences?
- Would you say that Carol's parents know her? Explain your observation.
This video shows an example of understanding the person's will and preferences for the decision.
Watch the video and then answer the questions. Write in the downloadable workbook located in the Resources section.
- Penny is Jerry’s support worker. What are her reasons for organising Jerry’s trip to Bali?
- Explain whether Jerry’s preferences were taken into account in organising his trip to Bali?
- What approaches can Penny use in future to support Jerry to make decisions about where he would like to holiday?
Select the button below to learn about Step 4 Refining the decision & taking account of constraints.