Balancing Safety and Independence Through Risk Enablement in ABI Support
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Acquired brain injury services are often characterised by tension between safety and independence. Individuals may wish to take risks that carry genuine potential for harm, while providers retain safeguarding responsibilities. Commissioners and inspectors expect ABI services to evidence how safety and autonomy are balanced through structured risk enablement.
This article explores how ABI providers can balance safety and independence effectively. It should be read alongside Person-Centred Planning & Strengths-Based Support and Positive Risk-Taking & Risk Enablement.
Why safety and independence conflict in ABI
ABI-related changes to insight, impulse control and judgement can increase risk while also increasing frustration with restriction.
Commissioner and inspector expectations
Expectation 1: Least restrictive practice. Inspectors expect providers to avoid unnecessary restriction.
Expectation 2: Safeguarding accountability. Commissioners expect clear safeguards where risks are enabled.
Operational example 1: Graduated access to activities
An ABI service introduced graduated access to community activities, reducing supervision over time as confidence and competence improved.
Using risk assessments dynamically
Risk assessments should evolve as abilities, insight and circumstances change.
Operational example 2: Dynamic risk reviews
A provider reviewed risks monthly during recovery phases, preventing outdated restrictions.
Supporting staff confidence
Staff require clear guidance and leadership support to enable risk safely.
Operational example 3: Escalation frameworks
A service implemented escalation pathways, allowing staff to seek support when risks increased unexpectedly.
Evidencing balanced practice
Providers should evidence:
- Risk enablement linked to outcomes
- Clear mitigation strategies
- Documented review and oversight
Safety and independence as complementary goals
In ABI services, safety and independence are not opposites. When balanced effectively, they support recovery and quality of life.
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