Adapting Person-Centred Planning for Complex and High-Risk ABI Presentations
Acquired brain injury (ABI) services often support individuals with complex and high-risk presentations, including severe cognitive impairment, behavioural challenges and fluctuating capacity. In these contexts, person-centred planning must go beyond standard approaches to ensure that support remains safe, effective and aligned with the individual’s needs and preferences. Commissioners and inspectors expect providers to demonstrate how planning is adapted to manage complexity without losing its person-centred focus. For broader context, this article should be read alongside Person-Centred Planning & Strengths-Based Support and ABI Service Models & Pathways.
Providers that fail to adapt planning for complexity risk increased incidents, inconsistent support and poor outcomes. Effective services use structured, flexible approaches that integrate risk management, behavioural support and ongoing review.
Understanding complexity in ABI services
Complex ABI presentations may include a combination of cognitive impairment, communication difficulties, behavioural challenges and co-existing health conditions. These factors interact and can change over time.
Planning must therefore be dynamic, detailed and responsive.
Commissioner and inspector expectations
Commissioner expectation: Safe and effective management of complexity. Commissioners expect providers to demonstrate how complex needs are understood, planned for and managed.
Regulator expectation (CQC): Person-centred care in complex contexts. Inspectors expect providers to maintain person-centred approaches even where risk and complexity are high.
Developing detailed and dynamic plans
Plans for complex individuals must include detailed information on needs, risks and support approaches. They must also be regularly reviewed and updated.
Operational example 1: Multi-layered planning frameworks
An ABI provider developed multi-layered plans that included detailed sections on behaviour, risk, communication and health needs. Each section was linked to specific support approaches.
Plans were reviewed frequently, ensuring they remained current and effective. This improved both safety and quality of care.
Integrating behavioural and risk management
Complex presentations often involve significant behavioural and risk considerations. Planning must integrate these elements clearly.
Operational example 2: Behavioural and risk integration
A service integrated behavioural support plans and risk assessments directly into person-centred plans. Staff had clear guidance on how to respond to different scenarios.
This reduced variability in practice and improved outcomes.
Supporting staff in managing complexity
Staff supporting complex individuals require high levels of skill and confidence. Providers must ensure that staff are trained and supported appropriately.
Operational example 3: Specialist training and support
An ABI provider introduced specialist training programmes focused on complex presentations, including behavioural management and risk decision-making.
Supervision sessions reinforced learning and supported reflective practice. This improved staff confidence and consistency.
Balancing risk and quality of life
Complex cases often involve significant risk. Providers must demonstrate how they balance safety with quality of life and autonomy.
This includes:
- Proportionate risk assessments
- Clear documentation of decision-making
- Regular review of restrictions
Balancing these factors is essential for person-centred care.
Governance and oversight
Providers must monitor complex cases through robust governance systems. This ensures that risks are managed and support remains effective.
This can include:
- Regular case reviews
- Analysis of incidents and outcomes
- Oversight from senior management
Governance processes must be clearly defined and consistently applied.
Evidencing effective support for complexity
To meet expectations, providers must demonstrate how they manage complex needs through person-centred planning. This includes:
- Detailed and current plans
- Evidence of consistent application
- Records of review and adaptation
Strong evidence supports inspection outcomes and commissioning confidence.
Adapting planning as a mark of quality
In ABI services, the ability to adapt person-centred planning for complex and high-risk presentations is a key indicator of quality. Providers that achieve this demonstrate advanced practice, improved outcomes and strong compliance with regulatory and commissioning expectations.