Engendering a Feeling of Safety as an Ethical Imperative in Preventing Emotional Distress and Behaviours that Challenge Services

Safety is a common organizational value, generally understood as the obligation to ensure the physical safety of service recipients, staff, and visitors. Missing from this definition is the service recipient’s right to feel safe. Cultural safety theory recognizes the inherent imbalance between a service provider and recipient and recommends shifting the power to the recipient to decide whether they feel safe with the service. This chapter focuses on people with intellectual and developmental disabilities, with or without co-existing autism (IDD/ASD), especially those engaging in behaviours that challenge services. We offer an ethical argument for engendering a feeling of safety in the lives of people with IDD/ASD and discuss the neurobiology underpinning human feelings and responses to safety, danger, and life threat; the latter responses to danger and life threat being similar to emotional distress and behaviours that challenge services observed in people with IDD/ASD. In these contexts, we highlight the importance of practices such as co-regulation and advocate that organizations broaden their understanding of “patient safety” to include recipients’ Inside-Out perspectives and their felt sense of being safe.