How To Write an NDIS Dignity of Risk Policy

Independence and Informed Choice is one of the five standards under Rights and Responsibilities in the NDIS Core Module. The outcome requires that each participant is supported to make informed choices, exercise control and maximise their independence relating to the supports provided. Specifically, providers must ensure the following:

• Active decision-making and individual choice is supported, including the timely provision of information in a form the participant is most likely to understand
• Each participant's right to the dignity of risk in decision-making is supported, and when needed, each participant is supported to make informed choices about the benefits and risks of the options under consideration
• Each participant's autonomy is respected, including their right to intimacy and sexual expression
• Each participant has sufficient time to consider and review their options and seek advice if required, at any stage of support provision
• Each participant's right to access an advocate of their choosing is supported, as is their right to have the advocate present

This article explores what these indicators mean in practice and what your policy and procedure should include.

Dignity of risk in practice

The NDIS Practice Standards define dignity of risk as "the right of the individual to choose to take some risk in engaging in life experiences."

So what does this look like? A participant should be free to choose to do something that involves risk, and your role is to make sure they understand what those risks are, not to prevent the choice. A participant might choose to go out alone when the risk assessment says otherwise, decline medication, or refuse a support they're funded for. Your role is to support them to understand the risks and then respect the decision they make.

Your policy should address what a worker should do when a participant makes a choice the worker is uncomfortable with, including who they can talk to, how the decision and conversation are recorded, and when a concern should be escalated. It should also address how dignity of risk and duty of care interact, and when a duty of care concern applies.

Supporting informed choice

Dignity of risk is linked in the standard with informed choice: the participant is supported to understand the benefits and risks of the options available to them, before they make a decision.

This means providing information that's relevant to the decision, in a way the person can understand, and giving them enough time to think about it properly. The fourth indicator is specific about timing: each participant should have sufficient time to consider and review their options and seek advice at any stage, including assessment, planning, provision, review and exit.

Think about what this looks like for you:

• How information about options and risks is provided, and in what form
• Whether the person has time to think, ask questions, and talk to people they trust before deciding
• How you and your workers confirm that someone has understood the information, without assuming
• How you handle situations where a decision needs to be made quickly
• What happens when a participant changes their mind

Record the conversation, what information was provided, what the person decided, and that the decision was theirs. If a participant makes a choice that involves risk, the record should show what they were told about the risk, that they understood it, and that the decision was respected.

Intimacy and sexual expression

The third indicator says each participant's autonomy is respected, including their right to intimacy and sexual expression. Your policy should assert that participants have the right to intimate and sexual relationships, and outline what that actually means for how workers provide support.

What to cover:

• Privacy during visits from partners, including overnight stays, and how workers manage their presence in the home during these times
• How workers respond if a participant asks for support related to sexual health, such as accessing contraception, STI testing, or sexual health services
• How workers respond to sexual expression that's part of a person's everyday life, without treating it as a problem or something to report (unless there's a safeguarding concern)
• The boundary between supporting someone's right to sexual expression and situations where safeguarding obligations apply, including where consent is in question or where there's a power imbalance
• How workers support a participant's right to a relationship practically, for example by providing transport to see a partner or helping them communicate with someone

For SIL providers, this includes how co-tenants' rights are balanced. A participant's right to have a partner stay overnight exists alongside another participant's right to feel safe and comfortable in their home. Your policy should address how these situations are discussed with the people affected and how decisions are made.

Where a participant has a decision-maker appointed under guardianship or administration, your policy should set out how decisions about relationships and sexual expression are handled, including the limits of a guardian's authority in this area. State and territory guardianship legislation varies on this, so if you operate across jurisdictions, make sure your policy reflects that.

Include this in your induction and supervision, particularly for workers providing personal care, where supporting someone's physical needs while respecting their bodily autonomy should have clear guidance.

Advocacy

The fifth indicator requires that each participant's right to access an advocate of their choosing is supported, including their right to have the advocate present.

This obligation also appears in the Violence, Abuse, Neglect, Exploitation and Discrimination standard, which covers advocacy in the context of allegations. Under this standard, advocacy access is broader: a participant can access an advocate at any time, including during planning meetings, service agreement discussions, or conversations about their supports.

Double check that your policy doesn't limit advocacy to complaints or incidents.

Training

Your worker induction and ongoing training should cover:

• What dignity of risk means in practice, with examples relevant to the supports you deliver
• How to have a conversation about risk with a participant, including how to provide information without being directive
• When and how to record a dignity of risk decision
• When to escalate, and to whom
• How to separate a personal view about what's safe from a professional obligation to respect the participant's choice
• How dignity of risk and duty of care interact
• Intimacy and sexual expression, including practical scenarios relevant to your supports

What to put in place

• A policy covering all five indicators under Independence and Informed Choice (note: this doesn't need to be it's own policy necessarily, as long as each of the areas above is covered somewhere)
• Practical guidance for workers on supporting dignity of risk decisions, including how to document the conversation and the decision
• A process for providing information to participants about their options, in a form they can understand, with enough time to consider them
• Guidance on intimacy and sexual expression, covering the areas above
• Training that covers dignity of risk, informed choice and intimacy as part of induction, and revisits these in supervision
• A cross-reference to your advocacy arrangements

Paperbark's Certification Toolkit helps you build your independence and informed choice policy and procedure directly from your answers about how your service operates and supports participants day to day.