Autonomy is Safety: Using 
Supported Decision-Making to 
Facilitate the Safety of People with 
Disabilities 

Ashley Brompton, J.D. 
Program Associate 
Center on Victimization and Safety 
May 14, 2019 



Victimization of People with 
Disabilities 



The Risk: Violence in the Lives of 
People with Disabilities 

• 
People with disabilities are more likely to experience violence. 
• 
Limited research exists, but some people with disabilities 
experience increased risk of domestic and sexual violence than 
people without disabilities. 

What We Know 

• 
According to NPR, people with intellectual and/or 
developmental disabilities are 7 times more likely to 
experience sexual assault than people without 
disabilities 
• 
49% of people with an intellectual disability will 
experience 10 or more sexually abusive incidents in 
their lifetimes (Sobsey & Doe, 1991). 
• 
14% of men with disabilities reported experiencing 
sexual violence at some point in their life time 
compared to 4% of men without disabilities. 

Risk of Violence is Higher for 
Certain People with Disabilities 

• 
People with intellectual or cognitive disabilities 
• 
People with psychiatric disabilities 
• 
People with multiple disabilities 
• 
Women with disabilities 
• 
People of color who have disabilities 

Factors that Contribute to the 
Risk 

• 
Devaluation 
• 
Presumed lack of credibility 
• 
Isolation and segregation 
• 
Increased exposure to potential abusers 
• 
Culture of compliance 
• 
Seen as “easy targets” 
• 
Denied education about healthy relationships and 
healthy sexuality 
• 
Systemic denial of the right to make decisions about 
relationships 
• 
Negative messaging about relationships and sexuality. 

Historic Responses to 
Victimization 



Chat 

How has your agency responded to reports of 
victimization of a person with a disability that you 
serve? 



Historic Responses to Violence 
Against People with Disabilities 

• 
Emphasis on “safety” and “protection” of people 
with disabilities 
• 
Institutionalization 
• 
Mandatory Reporting 
• 
Guardianship 
• 
Our historic responses have not been successful in 
addressing violence against people with disabilities 
and have not made them safer. 

Institutionalization 

• 
The rationale given for institutionalization was a 
desire to care for and protect people with 
disabilities (particularly people with intellectual or 
developmental disabilities and mental health 
disabilities). 
• 
However, people in institutions were (and are) often 
dehumanized, abused, and neglected. 
• 
Research has suggested that 82% of violence 
against adults with developmental disabilities is 
carried out in institutions or group homes. Furey, 
Niesen, and Strauch (1994). 

Abuse in Institutions 

• 
Why? 
• 
Extreme power imbalances between staff and people 
who are living in institutions; 
• 
Little to no oversight or regulation; 
• 
Isolation; 
• 
Attitudes about people with disabilities; 
• 
Policies and procedures that do not value safety, 
confidentiality, boundaries, or education; 
• 
Staff trauma. 

Mandatory Reporting 

• 
Originally designed as a response to abuse and 
assault of people with disabilities who, in the eyes of 
policy makers, could not advocate for themselves. 
• 
If a person cannot protect him or her self, society 
must do it for him or her. 
• 
Break isolation, connect people to needed services. 
• 
However, in some cases, mandatory reporting can 
have unintended consequences which leave a 
person with a disability more vulnerable. 

Mandatory Reporting Unintended 
Consequences 

• 
Legal definition of “vulnerable adult” or “dependent 
adult” is sometimes too broad, covering people who 
have capacity; 
• 
Can undermine the trusting relationship that a person 
with a disability has with their service providers; 
• 
Can take away autonomy and decision-making power 
from the person with the disability; 
• 
May make them less likely to report or reach out for 
services (fear of the unintended consequences); 
• 
Certain types of crimes involve dynamics that make 
straight forward interventions dangerous. 

Guardianship 

• 
First designed to protect adults with disabilities from 
harmful and difficult situations. 
• 
Replaces decision making authority from the person with 
the disability to the guardian. Depending on the type of 
guardianship, the variety of decisions impacted can be 
vast. 
• 
Plenary or full guardianship: financial decisions, medical 
decisions, health and welfare decisions 
• 
Limited guardianship: specific to some types of 
decisions (usually financial and/or medical) 

A New Approach: Maximized 
Autonomy 



Benefits of Autonomy 

Autonomy and self-determination, or making your 
own decisions, helps people with disabilities be: 

• 
Healthier; 
• 
More independent; 
• 
More well-adjusted; and 
• 
More able to recognize abuse (more education and 
support). 

One Approach: Supported Decision 
Making Basics 

• 
Supported decision making is a decision making 
process where a person with a disability retains his 
or her decision making abilities by using supporters 
to help them make choices. 
• 
The person with the disability makes their own 
decisions. 

Supporters Help People… 

• 
Understand options, responsibilities, and 
consequences of decisions; 
• 
Obtain and understand the information they need 
that is relevant to those decisions; 
• 
Communicate their decisions. 

SDM Supports the Concept of 
Dignity of Risk 

“To deny the right to make choices in an effort to protect 
the person with disabilities from risk is to diminish their 
human dignity.” 

-Robert Perske, a long-time advocate for people with 
intellectual disabilities 

Dignity of Risk: 

• 
Acknowledges that life comes with inherent, and often 
times positive, risks 
• 
Encourages individuals who support people with 
disabilities to balance the urge to ”protect” them with 
autonomy 
• 
Respects and individual's right to take reasonable risks 

Principles 

1. Adults have the right to make their own decisions. 
2. Adults have a right to make decisions you (or 
others) may disagree with. 
3. People should be offered support in order to make 
their own decisions before decisions are made on 
their behalf. 
4. It is not one size fits all – different solutions and 
supports work for different people and 
circumstances. 

Team Work! 

Supported decision making is nearly always done in a 
team, which can include: 

• 
Parents 
• 
Friends 
• 
Support staff 
• 
Advocates 
This ensures that the person is getting a wide variety 
of perspectives and protects against abuse or 
manipulation. 



Provides People with Information 

• 
Supporters provide people with disabilities with the 
information that they need to make decisions, help 
them weigh the information, and make an informed 
decision. 

Allows for Agreement and Clarity in 
Relationships 

Supported decision-making allows the person to make 
clear, affirmative decisions about the roles that others 
will play in the person’s life. The person can: 

• 
Articulate roles and responsibilities for various 
support staff; 
• 
Clarify boundaries; 
• 
Affirmatively consent and outline the consent giving 
(or withdrawing) process. 

Example 

Maria is a thirty year old woman with autism. She lives 
independently in her own apartment with part time 
aides that provide her with services. Her parents live 
nearby and she sees them regularly. Recently, at work, 
she met Steve, who doesn’t have a disability. He liked 
her and asked her on a date. She wasn’t sure if she 
wanted to go on a date with Steve, and wasn’t sure 
how to respond. So she asks her parents and her aides 
and her parents. What should their responses be? 



Responses 

Traditional Responses: 

• 
”Maria can’t date, she isn’t capable of being in a 
relationship.” 
• 
”What if Steve is a bad man who is preying on 
Maria? We can’t let her go out with this strange 
man.” 
• 
“What would Steve want with a woman like Maria?” 

Supported Decision-Making 
Response 

Parents and aides who are acting as Supporters would: 

• 
Ask Maria about Steve 
• 
Ask Maria what a date is and help her understand 
what typically happens on a date 
• 
Help Maria understand what is not normal for a date 
• 
Talk to Maria about what a relationship is 
• 
Help Maria develop boundaries and expectations 
• 
Talk to Maria about her choice – she gets to decide 
whether she wants to go on a date with Steve 

Autonomy = Safety 

• 
Autonomy empowers people like Maria to live fuller, 
safer lives that are self-directed 
• 
Encourages people to evaluate all options and 
possible consequences 
• 
Gives tools to people with disabilities to promote 
safe decision making 
• 
Allows for ”checks” on the role of supporters 

Supported Decision Making 
Resources 

National Resource Center for Supported Decision 
Making 

Support My Decision Project, Disability Rights Maine 

The Right to Make Choices: New Resource on 
Supported Decision-Making 



Questions 

Ashley Brompton, J.D. 
Program Associate 
Center on Victimization and Safety 
Vera Institute of Justice 

www.endabusepwd.org 

(646) 992-1131 



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