Duty of care and autonomy: how support workers managed the tension between protecting service users from risk and promoting their independence in a specialist group home

Abstract

There is a tension between the duty of care and the duty to recognise autonomy at the level of service delivery in residential homes. Support workers attempt to manage this tension; however, further work needs to be done by both residential services and policy makers to facilitate the reconciliation of the duty of care with the duty to recognise service users' autonomy in practice.

Providing support for decision making to adults with intellectual disability: Perspectives of family members and workers in disability support services

“…The negative impact of staff with inadequate communication skills, knowledge of the impact of intellectual disability, or awareness of their own values was evident in a number of studies (Antaki et al, 2009;Ferguson et al, 2011;Sowney & Barr, 2007). Such factors were compounded by risk averse organisational management (Hawkins, Redley, & Holland, 2011) or the pressured nature of some environments in which decisions have to be made (Bigby et al, 2011;Sowney & Barr, 2007). In particular, one UK study illustrated the poor outcomes of relying on checklists as a resource for support workers to support decision making when they are inadequately trained in reflective practice and unaware of the influence of their own preferences and values (Dunn et al, 2010).…”

Uncovering Dimensions of Culture in Underperforming Group Homes for People with Severe Intellectual Disability

“…Croft (1999) focused on space, identity, and storytelling and Levinson (2010) on authority and knowledge. Sevetal other studies give an in-depth understanding of staff practices in regard to specific issues, such as risk (Hawkins, Redley, & Holland, 2011 ) and decision making (Dunn, Clare, & Holland, 2010). However, the tight focus on relatively narrow aspects of culture limits the potential value of the studies to outcomes fot service users.…”

The Adaptation of a School‐based Health Promotion Programme for Youth with Intellectual and Developmental Disabilities: A Community‐Engaged Research Process

“…This observation is consistent with the adult literature (Bergstrom & Wihlman ; Hawkins et al . ). Staff perceptions did not reflect evolving perspectives of disability as a social construct or one of many determinants of health (Drum ; Iezzoni & Freedman ; Krahn & Campbell ).…”