Adults with developmental disabilities make decisions every day: where to live, which services to use, how to spend money, what health care to receive, and who they want involved in their lives. Some people make these choices independently. Others want help understanding information, comparing options, or communicating a decision.
Supported decision making offers a way to receive that help without automatically transferring decision-making authority to someone else. In Virginia, an adult with an intellectual or developmental disability may also document this arrangement through a Supported Decision-Making Agreement.
This guide explains how supported decision-making works in Virginia, who may create an agreement, how supporters can help, how it differs from guardianship, and what families should consider before moving forward.
This article provides general educational information, not legal advice. Decision-making authority, capacity, guardianship, conservatorship, powers of attorney, health care decisions, and financial arrangements can involve individual legal circumstances. Consult a qualified Virginia attorney or an appropriate disability rights organization when advice is needed.
What Is Supported Decision Making?
Supported decision-making is a process in which an adult receives help from people they trust while remaining the person who makes the final decision. A supporter may help the adult gather information, understand alternatives, consider possible consequences, prepare questions, or communicate a choice.
The supporter does not simply replace the adult’s judgment. The purpose is to make information and choices more accessible so the adult can participate meaningfully and remain in control.
The Virginia Department of Behavioral Health and Developmental Services explains that supported decision-making can help people receive assistance while keeping their rights and their ability to make their own decisions.
Support may include:
- Explaining information in plain language
- Using pictures, examples, or visual comparisons
- Helping the person identify questions
- Arranging visits, meetings, or service tours
- Comparing the benefits and risks of different options
- Helping the adult communicate a decision
- Taking notes and reviewing next steps
- Advocating for others to listen to the adult’s wishes
Everyone uses support when making important decisions. The difference is that a formal agreement can document which help the adult wants, who may provide it, and which areas of life it covers.
What Is a Virginia Supported Decision-Making Agreement?
A Supported Decision-Making Agreement, sometimes shortened to SDMA, is a written arrangement between an adult decision maker and one or more trusted supporters.
Virginia’s Code § 37.2-314.3 describes an agreement that identifies the specific assistance a supporter may provide. That assistance can include helping the adult obtain and understand information, consider responsibilities and consequences, communicate decisions, and advocate for the adult’s wishes to be implemented.
According to current DBHDS guidance, the person creating a Virginia Supported Decision-Making Agreement must:
- Be at least 18 years old
- Have an intellectual or developmental disability
- Not have a legal guardian or conservator
- Choose at least one person who agrees to serve as a supporter
The adult creating the agreement is the Decision Maker. A Supporter is someone the adult trusts to provide the assistance described in the agreement. The adult may choose different supporters for different subjects. An optional Facilitator may help everyone understand the agreement and follow their responsibilities.
DBHDS states that the Decision Maker may change or cancel the agreement. The adult continues to make the final decisions and retains their legal rights.
Supported Decision-Making vs. Guardianship
Supported decision-making and guardianship should not be treated as interchangeable.
| Question | Supported Decision-Making | Guardianship |
|---|---|---|
| Who makes the decision? | The adult makes the final decision with assistance from chosen supporters. | A court-appointed guardian may receive authority to make some or many decisions, depending on the court order. |
| How is it created? | The adult voluntarily identifies the support they want and the people they trust. | Guardianship is established through a court process. |
| What happens to the adult’s rights? | The adult retains their legal rights and decision-making authority. | The court order may limit the adult’s authority in specified areas. |
| Can the adult change the arrangement? | The Decision Maker may update or cancel the agreement. | Changing or ending guardianship generally requires legal action and court review. |
Virginia describes supported decision-making as a less restrictive option. That does not mean it is appropriate for every situation, and it does not mean a family should alter an existing legal arrangement without professional advice.
If an adult already has a guardian or conservator, or if the family is considering, changing, or seeking to end guardianship, consult a qualified attorney or the resources listed by DBHDS. The Virginia Judicial System’s plain-language guide to decision-making options can also help families understand the different tools available.
What Decisions Can Supporters Help With?
An agreement should reflect the individual rather than use the same categories for everyone. One adult may want help only with medical appointments. Another may want different supporters for health care, housing, finances, transportation, education, employment, or services.
Areas of support may include:
- Choosing a home or roommate
- Comparing Adult Day Support or Community Engagement programs
- Understanding medical information and preparing questions
- Reviewing a budget, bill, or purchase
- Considering employment, volunteering, or educational options
- Planning transportation
- Understanding service plans and provider choices
- Communicating preferences during meetings
- Deciding who may receive private information
The agreement should be specific. Saying “help with health care” is less useful than explaining whether the supporter may help schedule appointments, prepare questions, review written information, attend a meeting, or assist the adult in communicating a final decision.
A Practical Example: Choosing a Disability Service
Imagine that an adult is comparing two daytime programs. Without meaningful support, the person may receive a long packet, attend a fast-moving tour, and then be asked to make an immediate choice.
Supported decision-making could make the process more accessible:
- The adult identifies what matters most, such as friendships, music, cooking, volunteering, quiet space, or community outings.
- A supporter helps turn those preferences into questions for each provider.
- The supporter arranges tours and requests information in an accessible format.
- After each visit, the supporter reviews what the adult liked, disliked, and wants to understand better.
- The adult compares the options and makes the final decision.
- The supporter helps communicate that decision to the family, Support Coordinator, or provider.
The supporter makes the process easier to understand. The supporter does not choose the program simply because it is more convenient for someone else.
How to Create a Supported Decision-Making Agreement in Virginia
DBHDS provides a Virginia agreement template, instructions, examples, recorded trainings, frequently asked questions, and Discovery Tools. Families can use these resources to structure the conversation before completing an agreement.
1. Start with the Decision Maker’s goals
Ask which decisions feel comfortable, which feel difficult, and what type of help would be useful. The adult may want support for only one subject or several areas of life.
2. Identify trusted supporters
A supporter should listen, respect the adult’s communication, explain options honestly, protect private information, and avoid using the role for personal benefit. The closest relative is not automatically the best supporter for every subject.
3. Define the support clearly
Describe when help is wanted and what the supporter may do. Also identify what the supporter should not do. Clear boundaries reduce confusion and help other people understand the arrangement.
4. Discuss privacy and information sharing
A Supported Decision-Making Agreement does not automatically give every supporter unrestricted access to medical, educational, financial, or service records. Ask what separate releases, permissions, or legal documents may be necessary.
5. Use the official tools
Visit the DBHDS Supported Decision-Making resource page for the current Virginia template and instructions. The page also includes tools for identifying when support is wanted, what kind of support would help, and who the adult may want to choose.
6. Share the completed agreement appropriately
Ask the Decision Maker who should receive a copy. Relevant people may include supporters, health professionals, a Support Coordinator, or a disability service provider, depending on the agreement and the adult’s wishes.
7. Review the agreement over time
Needs, relationships, services, and preferences can change. Review whether the support remains useful, whether boundaries are being respected, and whether the Decision Maker wants to update or cancel any part of the arrangement.
Safeguards Every Family Should Discuss
A good agreement promotes autonomy while recognizing the possibility of pressure, conflicts of interest, privacy violations, abuse, or exploitation.
Useful safeguards include:
- Speaking directly to the adult rather than only to the supporter
- Confirming that participation is voluntary
- Choosing supporters who respect disagreement
- Using different supporters for different areas when appropriate
- Explaining every realistic option, including the option to wait
- Documenting boundaries for private information
- Checking whether a supporter has a financial or personal conflict
- Making information accessible to the Decision Maker
- Reviewing the agreement regularly
- Knowing where to report suspected abuse or exploitation
A supporter should never threaten, punish, deceive, isolate, or pressure the adult into a preferred outcome. Help should strengthen the person’s voice, not make it disappear.
When Should a Family Seek Legal Advice?
Professional legal guidance is especially important when:
- The adult already has a guardian or conservator
- Someone disputes the adult’s legal capacity
- The family is considering a power of attorney or advance directive
- There are significant financial assets or complicated benefits questions
- Family members disagree about authority or the adult’s wishes
- There is concern about coercion, abuse, neglect, or exploitation
- A guardianship or conservatorship may need to be reviewed, limited, or ended
DBHDS lists Virginia disability rights and legal resources on its supported decision-making page. Using an official template does not replace individualized legal advice when the circumstances are complex.
Supported Decision-Making in Day and Residential Services
Choice should remain visible after an adult enters a program or residential service. A person-centered provider should learn how the individual communicates, present meaningful options, respect preferences, and connect daily support to goals that matter to the person.
For example, supported decision-making may help an adult:
- Choose preferred activities and community destinations
- Participate in developing a daily routine
- Express preferences about meals, clothing, recreation, and personal space
- Prepare for an Individual Support Plan meeting
- Compare housing or service options
- Communicate concerns or request a change
Smiles Like Yours describes its Adult Day Support as a program where adults with developmental disabilities build friendships, practice life skills, participate in activities, and connect with the community. Its Group Home Services include person-centered care plans, daily living support, health management, and community involvement.
Smiles Like Yours does not provide legal advice or create legal Supported Decision-Making Agreements. Families can, however, ask any prospective provider how the adult will participate in decisions, how communication preferences will be documented, and how recognized supporters will be included when the adult wants their involvement.
Questions to Ask a Disability Service Provider
- How do you include the adult in service planning and everyday choices?
- How do staff learn the person’s preferred communication method?
- Can the adult decline an activity or request another option?
- How are preferences, goals, and concerns documented?
- How do you distinguish the adult’s wishes from a supporter’s opinion?
- How do you handle disagreements between the adult and family members?
- What privacy or release forms are needed before sharing information?
- How can a chosen supporter participate in planning meetings?
- How do staff recognize and report possible coercion or exploitation?
- How can the adult request a change in services, schedule, or living arrangements?
These questions can be useful during a program tour, referral conversation, residential visit, or Individual Support Plan meeting.
Frequently Asked Questions
Is supported decision-making the same as guardianship?
No. In supported decision-making, the adult receives assistance but makes the final decisions and keeps their legal rights. Guardianship is created by a court and may give another person authority to make decisions in areas identified by the court.
Does a supporter make decisions for the adult?
No. A supporter may help the adult understand information, consider options, communicate choices, and advocate for those choices. The Decision Maker remains the person making the final decision.
Who can create a Virginia Supported Decision-Making Agreement?
Current DBHDS guidance states that the Decision Maker must be at least 18, have an intellectual or developmental disability, and not have a legal guardian or conservator. Always check the current official instructions before completing an agreement.
Can an adult change or cancel the agreement?
Yes. DBHDS explains that the Decision Maker can change or cancel the agreement. The official instructions should be followed so the change is clearly communicated.
Does an agreement give supporters access to private records?
Not automatically. Separate permissions or releases may be needed for health, education, financial, or service information. Clarify privacy and information-sharing requirements with the relevant organization or a qualified professional.
Does a family need an attorney?
Virginia provides a template and instructions that families can review. An attorney is particularly important when there is an existing guardianship, a dispute about legal authority, complex finances, possible exploitation, or uncertainty about how an agreement interacts with another legal document.
Can supported decision-making be used when choosing a day program or home?
Yes. An agreement may identify support for housing, services, health care, finances, transportation, or other decisions. The adult determines which areas are included and what help is wanted.
Support the Person, Not Just the Decision
Supported decision making begins with a simple principle: needing help does not erase a person’s right to have preferences, ask questions, communicate concerns, and participate in decisions about their own life.
For some Virginia adults with developmental disabilities, a formal Supported Decision-Making Agreement can document how trusted people will provide that help. For others, different tools may be more appropriate. The right approach depends on the individual, their circumstances, and current Virginia requirements.
Families should begin with the adult’s voice, use the official DBHDS resources, and obtain legal guidance when needed. When exploring disability services, they should also look for providers that make choice, dignity, communication, and person-centered planning visible in everyday practice.
If your family is considering Adult Day Support, Community Engagement, Supported Living, or Group Home Services in Central Virginia, review the Smiles Like Yours services or schedule a conversation with the SLY team.
This article is for general educational purposes only and is not legal, medical, financial, guardianship, capacity, eligibility, or case-specific advice. Laws, forms, guidance, services, and program availability can change. Confirm current requirements with Virginia DBHDS, the Virginia Judicial System, a qualified attorney, the individual’s Support Coordinator, and the relevant service provider.
