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
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.
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
- Positive responses are better than coercion and
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.
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.
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.
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