All disabled people have the right to live independently and be included in the community, with access to support services that respect their autonomy and self-determination. This page centers disabled people's expertise to help social workers provide genuinely person-centered, rights-based services that go beyond minimum compliance.
Social workers often hold significant power over disabled people's lives—decisions about housing, benefits, services, and even liberty. This power can be used to support self-determination or to impose paternalistic control.
Too often, disabled people experience social work as something done to them rather than with them. Services get designed around professional convenience. Risk aversion overrides dignity. "Best interests" determinations replace asking what people actually want.
Social workers who center client autonomy and presume competence can transform this relationship from control to genuine support.
Person-centered planning places disabled people as experts on their own lives. The person directs the planning process—setting goals, choosing supports, and making decisions. Professionals facilitate rather than lead.
Federal guidelines now emphasize: "When done thoughtfully, person-centered planning creates a space of empowerment—a level playing field—that allows for consideration of personal preferences as well as health and safety needs, without unnecessarily restricting freedoms."
Client-directed goal setting: Goals originate from the individual, not professionals. Ask what matters to them, not what you think should matter.
Self-selected circles of support: The person chooses who participates in planning—family, friends, professionals they trust, advocates. Don't impose your preferred team.
Pre-planning control: The person decides when to meet, where to meet, who facilitates, and how the meeting runs. Accommodate communication and scheduling needs.
Strengths-based focus: Center capacities, interests, and dreams—not deficits and limitations.
Regular follow-up: Plans aren't static. Check in regularly and allow modification at any time as preferences change.
- Talking about clients instead of to them
- Having professionals dominate conversations
- Scheduling for staff convenience rather than client preference
- Focusing on what services are available rather than what the person wants
- Creating plans that sit in files rather than driving action
- Failing to revisit plans as circumstances and preferences change
Person-centered planning applies to everyone, including people who don't communicate through speech:
- Use their communication system (AAC, sign language, communication boards)
- Observe preferences through behavior and response
- Include people who know them well and can interpret preferences
- Never assume someone has nothing to communicate because you can't access their communication
Social workers face constant tension between protecting clients and respecting autonomy. Too often, "protection" wins—and disabled people lose control of their lives.
Vermont self-advocate Max Barrows captures this: "Life is about learning from the mistakes that you make. I appreciate and we appreciate protection from people, but please don't protect us too much or at all from living our lives."
Bengt Nirje stated: "To be allowed to be human means to be allowed to fail."
Robert Perske's 1972 article introduced "the dignity of risk"—the right to take risks that others take for granted. Overprotection creates its own harms:
- Loss of autonomy and agency
- Reduced opportunities to learn and grow
- Dependence created by never having to make decisions
- Depression and disengagement from life
- "Secondary disabilities from disuse"
Research shows environments supporting positive risk correlate with higher self-determination scores, while overprotection reduces them.
Your role is ensuring clients have complete information, not overriding their choices.
When a client's choice worries you:
- Ensure they have accurate information about risks and alternatives
- Explore their reasoning—they may have considerations you haven't thought of
- Ask if there are supports that would make the choice safer while preserving autonomy
- Document the informed decision
- Support the decision even if you'd choose differently
What you should not do:
- Override the decision because you know better
- Refuse to support choices you disagree with
- Manipulate through selective information sharing
- Infantilize by treating adult decisions as evidence of incapacity
Warning signs you're being paternalistic:
- You've decided what's "realistic" for a client
- You're protecting a client from disappointment
- You're making decisions "in their best interest" without their input
- You find yourself saying "but they don't understand..."
- You're more worried about liability than the client's wishes
- You'd support this choice if a non-disabled person made it
Supported decision-making (SDM) provides an alternative to guardianship. Individuals identify areas where they need assistance, select trusted supporters, and retain final decision-making authority. Supporters help gather information, understand options, and communicate decisions—but the person makes the decision.
The UN CRPD Article 12 emphasizes "will and preferences" over "best interests"—supported decision-making over substitute decision-making.
| Guardianship |
Supported Decision-Making |
| Court removes decision-making rights |
Person retains all rights |
| Guardian makes decisions for person |
Person makes own decisions with support |
| Based on "best interests" |
Based on person's will and preferences |
| Difficult to modify or remove |
Flexible, changeable |
| One guardian decides everything |
Different supporters for different decisions |
SDM is now recognized in 21+ US states and many other countries. Implementation includes:
- Supported Decision-Making Agreements (written or verbal agreements about who provides support and for what decisions)
- Training for supporters on providing support without taking over
- Recognition by third parties (banks, doctors, landlords) that SDM is valid
Before pursuing guardianship, explore:
- What specific decisions need support?
- What supports would enable self-determination?
- Have less restrictive options been tried?
- Would power of attorney or healthcare proxy suffice for specific needs?
- Is supported decision-making appropriate?
National Resource Center for Supported Decision-Making: supporteddecisions.org
The Arc's SDM toolkits and state-specific resources
The 1999 Supreme Court Olmstead v. L.C. decision established that "unjustified segregation of persons with disabilities constitutes discrimination." Justice Ginsburg wrote:
"Institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life."
- People have the right to receive services in the most integrated setting appropriate to their needs
- States must make reasonable modifications to policies to avoid discrimination
- A comprehensive, effectively working plan for community placement can satisfy Olmstead (but only if it actually works)
Advocate for:
- Community-based alternatives to nursing facilities and institutions
- Transition planning for people in institutions who want to leave
- Money Follows the Person and similar transition programs
- Home and community-based waiver services
- Challenge waitlists for community services as potential Olmstead violations
Watch for systems that:
- Default to institutional placement when community options exist
- Have long waitlists for community services but immediate access to institutional care
- Fail to inform people about community alternatives
- Make institutional placement easier than community services
- Describe institutions as "appropriate" without exploring preferences
ADAPT: adapt.org
National Council on Independent Living: ncil.org
Olmstead Rights: olmsteadrights.org
Disabled people experience abuse at significantly higher rates than non-disabled people:
- Physical abuse
- Sexual abuse
- Emotional and psychological abuse
- Financial exploitation
- Neglect
- Institutional abuse
Abuse is perpetrated by family members, caregivers, staff in residential settings, romantic partners, and others.
Physical signs:
- Unexplained injuries, especially injuries consistent with restraint
- Injuries in various stages of healing
- Signs of overmedication or sedation
- Pressure sores
- Malnutrition or dehydration
- Poor hygiene
Behavioral signs:
- Sudden behavioral changes
- Fear of specific people or places
- Withdrawal or depression
- Flinching or cowering
- Self-protective behaviors
Environmental signs:
- Missing personal possessions or funds
- Caregiver isolates person from others
- Caregiver prevents private conversations
- Unusual financial transactions
- Inadequate living conditions despite available resources
Institutional signs:
- High staff turnover
- Lack of personalization in resident spaces
- Residents appear overly sedated
- Limited community access
- Inadequate staffing
Social workers are mandatory reporters in all states. Requirements vary but generally:
- Report when you have "reasonable cause to believe" abuse occurred
- Report typically within 24-48 hours
- Reports go to Adult Protective Services, licensing agencies, and/or law enforcement depending on setting and state
- Inform clients of reporting obligations at intake
- When possible, include clients in the reporting process
- Ensure clients have access to private communication opportunities
- Know your state-specific reporting requirements
- Document observations and reports carefully
Cultural humility recognizes that you cannot fully understand another person's cultural experience. It requires ongoing self-reflection about your own biases and power, openness to learning from clients, and recognition that they are experts on their own cultural identities.
Disabled clients hold multiple identities:
- Race and ethnicity
- Gender and sexual orientation
- Immigration status
- Religion and spirituality
- Socioeconomic class
- Geographic location
These identities intersect with disability to create unique experiences. A Black disabled woman's experience differs from a white disabled man's—and differs from both Black non-disabled women and white disabled women.
Different cultures may have different:
- Understandings of disability (medical, spiritual, social)
- Expectations for family caregiving roles
- Concepts of independence and interdependence
- Comfort with formal services
- Trust in social service systems
- Language for discussing disability
- Don't assume your cultural lens is universal
- Ask clients about their preferences rather than assuming based on cultural background
- Provide interpretation services (not family members)
- Examine your own biases about disability in different cultural contexts
- Connect clients with culturally-specific resources when available and wanted
- Recognize that immigrant and refugee communities may have specific barriers and needs
SSI (Supplemental Security Income):
- For people with limited income who haven't worked enough for SSDI
- Approximately $943/month (2024 rate)
- $2,000 individual asset limit
- Comes with Medicaid in most states
SSDI (Social Security Disability Insurance):
- Based on work history
- Benefits based on earnings record
- Medicare after 24-month waiting period
- No asset limit but income limits
Medicaid Waivers (HCBS):
- Home and Community-Based Services as alternative to institutional care
- Covers personal care, respite, supported employment, day services
- Each state designs its own waivers with different eligibility and services
Medicare:
- For SSDI recipients (after 24 months) and people 65+
- Covers medical care but limited long-term supports
Social workers should:
- Help clients understand eligibility and application processes
- Assist with applications and appeals
- Advocate for appropriate service levels
- Know local resources and how to access them
- Stay current on policy changes that affect clients
Help clients understand they can work while receiving benefits:
- PASS (Plan to Achieve Self-Support): Set aside money for work goals without affecting SSI
- IRWE (Impairment-Related Work Expenses): Deduct disability-related work costs
- Ticket to Work: Employment support without immediate benefit review
- Trial Work Period: Test ability to work without losing SSDI
ABLE Accounts: Tax-advantaged savings up to $100,000+ without affecting SSI/Medicaid
Special Needs Trusts: Hold assets for supplemental needs without affecting benefits
Families often know clients well and provide significant support. Engage them as partners while:
- Centering the client's preferences
- Recognizing family members have their own perspectives that may differ from clients'
- Not allowing families to speak for clients who can speak for themselves
- Addressing family concerns without overriding client autonomy
¶ When Family and Client Disagree
Your client is the disabled person, not the family. When there's conflict:
- Center the client's preferences
- Help families understand self-determination
- Explore whether conflict stems from genuine concern or desire for control
- Support family adjustment to client autonomy
- Recognize clients may need support to advocate within family systems
Not all families are supportive. Watch for:
- Family members who isolate clients
- Financial exploitation by family
- Physical or emotional abuse
- Family members who undermine independence
- Excessive control justified as "protection"
Be prepared to help clients access services that reduce family dependence, safety plan around family abuse, and report abuse when present.
Social work with disabled clients can involve:
- Systemic barriers that feel insurmountable
- Limited resources that don't meet needs
- Emotional intensity of supporting people through crises
- Moral distress when systems fail clients
- Vicarious trauma from hearing about abuse and hardship
- Set boundaries around work hours and emotional availability
- Access your own supervision and support
- Process difficult cases with colleagues (while respecting confidentiality)
- Take actual breaks and use leave time
- Maintain life outside work
- Recognize what you can and cannot control
Individual self-care doesn't fix systemic problems. Also:
- Advocate for manageable caseloads
- Push for systemic changes that reduce harm
- Connect with advocacy organizations
- Recognize that you cannot single-handedly fix broken systems
- Celebrate small wins
¶ Professional Standards
Key principles relevant to disability practice:
- Self-determination of clients
- Informed consent
- Competence (including cultural competence)
- Dignity and worth of the person
- Importance of human relationships
- Social justice
¶ Disability-Specific Standards
NASW has standards for practice with people with disabilities that emphasize:
- Viewing disability through a social model
- Self-determination and empowerment
- Advocacy for systemic change
- Cultural competence including disability culture
- Accessible services
Seek out:
- Training on specific disability types and their implications for practice
- Disability rights law updates
- Person-centered planning approaches
- Supported decision-making
- Training developed and delivered by disabled people
| Instead of... |
Try... |
| "I know what's best for you" |
"What matters most to you?" |
| Making decisions for clients |
Supporting client decision-making |
| Protecting clients from risk |
Honoring the dignity of risk |
| Pursuing guardianship first |
Exploring supported decision-making |
| Speaking for clients |
Helping clients speak for themselves |
| Planning services around what's available |
Planning around what clients want |
| Allowing families to override client preferences |
Centering the client |
| Defaulting to institutional care |
Fighting for community options |
- Unjustified institutional segregation is discrimination
- People have right to most integrated setting appropriate
- States must have comprehensive community placement plans
¶ ADA and Section 504
- Prohibit discrimination in services
- Require reasonable modifications
- Require effective communication
- Community-based services must be in integrated settings
- Must ensure individual rights and autonomy
- Must allow choice and self-determination
- Vary by state
- Increasingly recognizing supported decision-making alternatives
- Require least restrictive option
This page centers disabled people's expertise and is informed by disabled-led organizing globally. For questions or to suggest additions, see How to Contribute.