Balancing tensions between human rights principles and systemic requirements: service providers’ experiences with supported decision-making for persons with intellectual disabilities

Persons with intellectual disabilities have the right to and need for supported decision-making to realize their self-determination. However, there is a significant gap in the research on service providers’ experiences and the factors that impact supported decision-making in the context of persons with intellectual disabilities living in municipal housing in Norway. The study involved six focus group interviews with 32 service providers from 6 municipal housing in 4 municipalities. The analysis takes an abductive approach. As analytical lenses, it utilizes Lipsky’s theory of street-level bureaucracy, which focuses on the role of service providers, and Nussbaum’s capabilities approach, which emphasizes the importance of individual capabilities. Study findings indicate that service providers have a crucial role in supported decision-making. Findings also provide insight into key factors in supported decision-making processes, including the importance of relationships, discretion, oral communication/reports, written/electronic documentation and in-depth knowledge about the person. The study also highlights how organizational structures in municipal housing can significantly hamper the supported decision-making processes and realization of self-determination. Furthermore, findings reveal a tension between providing for social participation and supported decision-making facilitated autonomy.