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Promoting Independence - Fact Sheet

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Promoting Independence - Fact Sheet

A human being's right to independence is enshrined in many types of legislation, but sadly it can be neglected when a person has a disability.

Promoting independence for people with a brain injury can be a huge lifelong job. Too often service providers foster the expectation that a person can be medically stabilized, learn a few compensatory strategies then live happily ever after. This may occur in some cases with milder brain injuries, but it is rarely the case.


A brief history

For much of the twentieth century people with disabilities were cared for in institutions. During the 1970s, many of these institutions were closed down and people were moved from institutional care back to the "community". While this was long overdue, it is argued that it was substantially motivated by economics; it was much cheaper to provide very basic community supports than run institutions.

This meant that while many people did now live in the community, it was often with little or no support. While the past few decades have seen a growth in support for community living, it is hoped the National Disability Insurance Scheme in Australia will finally provide the kind of support that was needed all along. 


Encouraging independence

Everyone has the right to an autonomous lifestyle ("autonomy" is Greek for self-rule). Ideally we should maximize the ability of everyone to make informed choices according to their own beliefs and preferences. At Synapse, our model of practice is based on:

  • Positive Behaviour Support
  • Client- centred planning
  • Least restrictive alternatives.


Positive Behaviour Support

Positive Behaviour Support is exactly what it sounds like - a supportive, positive approach.
Some key points of positive behaviour support include:

  • Don't try to control other people, but support them
  • There is a reason behind most challenging behaviour
  • Everyone deserves respect regardless of their behaviour
  • Everyone is entitled to quality of life and effective services
  • Positive responses are better than coercion and punishment.


Person-centred planning 

The client is the focal point. While this might sound obvious, it is quite easy to focus on options that are cheaper, or easier for family members or organizations providing support. A good plan results in ongoing listening, learning and further action. It should reflect what is important to the person, their capacities and the support they require, while family members and friends are partners in planning. A plan should result in actions that are about life, not just services and reflect what is possible, not just what is available. 

Least restrictive alternative

Support is provided in the least restrictive, or intrusive, way possible that also encourages choice and freedom. Let's take the case of a person with frequent aggression due to a frontal lobe injury. The most restrictive approach would be prison, followed by chemical restraints through enforced medication. The least restrictive alternative would be positive behaviour support that provides anger management strategies and ongoing support.


Family and carers

Carers and family members play a crucial role in maximizing independence for someone after a brain injury. It is vital that they are involved with setting goals, and how to achieve them. Important questions to ask are where will the person live, how they will be occupied, how they will relate to others, and what is their perception of quality of life?

Promoting independence can lead to opportunities to exercise choice, an enhanced sense of self-esteem, but also an increased likelihood of a person taking risks.

Unfortunately the existing technology to promote self-sufficiency skills in people with brain injury has been borrowed from other areas. We assume it is effective, but more research is needed on life skill development, use of rehabilitation technology and life outcomes as a result of specialized treatments.


The future

Finally, a great deal more work needs to be done to prepare communities to accept individuals with a brain injury. The major area of concern here has to do with accommodating people who behave in ways that are considered "disruptive". Society has changed in many ways to accommodate people with the well known disabilities. Now this needs to occur for those with the invisible disability - Acquired Brain Injury.

References and further information

This fact sheet originally appeared in Bridge Volume 12 - Accommodation. 


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