The Balance between Choice and Control: Risk Management in New Zealand
Intellectual Disability Services
Prepared by Alixe Bonardi | July 2009 with funding from the sponsors
of the Ian Axford (New Zealand) Fellowships in Public Policy
Alixe Bonardi is Assistant Director of the
University of Massachusetts Medical School's Center for Developmental
Disabilities Evaluation and Research. She is a trained occupational
therapist and has spent the past ten years working in disability
policy research and development.
During Alixe's Ian Axford Fellowship exchange to New Zealand she
was based at the Ministry of Health in Wellington, where she researched
approaches to risk management in New Zealand intellectual disability
services.
Abstract
Supports for people with intellectual disability in New Zealand have
undergone great changes in the past 20 years, many of them positive and
driven by a vision for real participation in the community for all New
Zealanders. Movement of a service model from institutional care to a model
that supports community participation, flexibility, and choice has been
steady and in many cases has shown positive change in people's lives.
There is growing concern, however that the pace of progress has slowed,
and that people with intellectual disabilities continue to experience
barriers to living an "ordinary" life in New Zealand.
Studies completed in New Zealand, as well as international studies suggest
that people with intellectual disability experience greater vulnerability
to poor health outcomes, experience higher behavioural support needs,
and are at greater risk of abuse or neglect, compared to the general population.
This report examines how risk management is approached in New Zealand,
in particular in the context of services for people with intellectual
disability. It reviews the development of the philosophy of service provision
to provide necessary background, followed by an analysis of how risk management
is perceived and applied by a number of stakeholders, including people
with intellectual disability and their families. The tensions between
flexibility (choice) and safety (control) are explored both at an individual
and system's level. The report concludes with considerations and recommendations
applicable to the current New Zealand context.
Table
of contents
Acknowledgments
Executive Summary
Introduction
Examining supports for people with intellectual disability in New
Zealand
Risk and risk management in intellectual disability services
Using information to help make the shift: necessary information to
support risk-taking
Supporting risk taking: organisational supports, workforce development
and training
axford2009_bonardi.pdf (911kb)
