Assessing Capacity and Decision-Making in Positive Risk-Taking for ABI
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Positive risk-taking in acquired brain injury services is inseparable from capacity and decision-making. ABI can affect insight, judgement and impulse control in ways that fluctuate over time, meaning capacity cannot be assumed or assessed once and filed away. Commissioners and inspectors expect ABI providers to demonstrate proportionate, decision-specific capacity assessment that actively informs risk enablement.
This article explores how capacity and decision-making should be assessed and applied in positive risk-taking. It should be read alongside Positive Risk-Taking & Risk Enablement and Safeguarding, Capacity, Consent & Human Rights.
Why capacity assessment is complex in ABI
ABI-related cognitive impairment may affect memory, reasoning, emotional regulation or insight. Capacity may be present for some decisions but not others, and may change over time.
Commissioner and inspector expectations
Expectation 1: Decision-specific assessment. Inspectors expect capacity to be assessed for each significant risk decision.
Expectation 2: Proportionate response. Commissioners expect providers to support decision-making wherever possible rather than defaulting to restriction.
Operational example 1: Activity-specific capacity assessment
An ABI service introduced short, activity-specific capacity assessments linked directly to risk enablement plans, improving clarity and consistency.
Supporting decision-making before concluding lack of capacity
Providers should evidence how information is adapted and support offered to maximise understanding before determining capacity.
Operational example 2: Supported decision-making tools
A provider used visual aids and simplified scenarios to support decision-making around community access.
Applying best interests without undermining autonomy
Where capacity is lacking, best interest decisions must still reflect the person’s wishes, values and history.
Operational example 3: Best interest decision records
A service recorded how past preferences and current views informed best interest risk decisions, strengthening inspection confidence.
Evidencing lawful and ethical practice
Providers should evidence:
- Decision-specific capacity assessments
- Supported decision-making efforts
- Clear rationale for enabled or restricted risk
Capacity as an enabler, not a barrier
In ABI services, proportionate capacity assessment supports positive risk-taking rather than preventing it when applied correctly.
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