Employee Tip - Least Restrictive Environment

Read the case plan of a Mainstream Living member, and you are bound to encounter the term “Least Restrictive Environment”.  It’s one of those things that is very easy to commit to on paper, but in practice, can be very difficult to define and maintain.  Least restrictive environment does not mean to rigorously control everything a member does.  However, it also does not mean a member can do whatever he or she wants.  The truth is, a least restrictive environment is different for every member we serve.

As staff members, we are often torn between using our authority to push someone towards the right choice, and allowing individuals the freedom to make their own choices and mistakes.  Below are some good questions to ask yourself when you are struggling with whether you should intervene.

Is the member safe?:

One of our main roles as service providers is to ensure the safety of those we serve.  If somebody is placing themselves or others in physical danger, we are obligated to intervene.  For instance, if someone decides to sit down in the middle of a busy street, it is probably best to move them along, perhaps having a discussion about it later.  However, there are some less obvious ways in which members can compromise their own safety.  If a member refuses to buckle their seatbelt before a car trip, you have the authority to say that you are not driving them where they want to go.  If a member refuses to put on sunscreen, you don’t have to take them to the beach.

It is important to note that some members may make unwise choices that do not threaten their safety.  As staff members, we can certain try to talk people out of these choices, but our role gets blurry if a person still wants to make a bad choice.  If skipping work will cause someone to lose their job, we can’t force them to go.  Although it is not a good choice, and we can try to convince them otherwise, we really should not be forcing people to do things like this unless there is a safety concern.

Does the member have a rights restriction in place?:

Sometimes a safety concern is not the only thing to keep in mind however.  Many members have what are called “rights restrictions” written into their plans.  These are clauses that essentially ask service providers to intervene and restrict rights in a given situation.  These are usually agreed upon by the support team to give the member a support they need in an area where they may reject it.  For example, somebody might have diabetes, and have a rights restriction in their plan that prevents them from drinking sugary beverages.  If this is explicitly written in their plan, staff may have the authority to take beverages like this away from a member for health reasons.  Even in these types of situations, staff should still make every effort to persuade a person to make the choice for themselves.  In other words, try to talk the person out of drinking the pop before taking it away from them.  Also, remember that a rights restriction is only valid when it is written in a case plan.  Just because a doctor, or someone else in authority tells you to restrict that person’s rights, it does not mean that you necessarily should, or are legally allowed to do so.  

Am I pushing someone to make the best choice for themselves, or the choice that I would personally make?:

This can be a tricky question for some people, but it is something important to examine.  Even though persuading people is not restricting their rights, it may feel overbearing to the person you serve.  Bear in mind that you do not have the answers to everything in life, and your experience is different from the person you serve.  Just because a vegan or gluten free diet has helped you stay healthy does not mean that it is necessarily right for the member.  As staff, your words have a lot of clout in the decisions that members make.  Be sure to use your authority to help members lead the lives they want to lead, and not the lives you think are best for them.