Involving People With ABI in Planning When Insight, Memory or Cognition Are Impaired
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Involving people with acquired brain injury in person-centred planning is a core expectation, but it presents distinct challenges when insight, memory or cognition are impaired. ABI services must balance involvement, safety and decision-making support while avoiding tokenistic consultation. Commissioners and inspectors increasingly scrutinise how providers enable genuine involvement rather than relying on substituted decision-making by default.
This article explores how ABI services can meaningfully involve individuals in planning despite cognitive impairment. It should be read alongside Person-Centred Planning & Strengths-Based Support and Involving Family & Advocates.
Why involvement is complex in ABI services
ABI can affect memory, insight, emotional regulation and processing speed. These changes may fluctuate, meaning involvement must be flexible rather than assumed absent.
Commissioner and inspector expectations
Two expectations are consistently applied:
Expectation 1: Supported involvement. Inspectors expect providers to evidence how involvement is enabled, not just recorded.
Expectation 2: Proportionate decision-making. Commissioners expect capacity and involvement to be assessed decision by decision.
Operational example 1: Structured planning sessions
An ABI service introduced shorter, focused planning sessions using visual prompts, improving engagement for individuals with reduced concentration.
Using supported decision-making approaches
Supported decision-making may include repetition, simplified language, visual aids and trusted supporters.
Operational example 2: Decision-specific support tools
A provider developed decision-specific tools to support involvement in areas such as daily routines and activity planning.
Balancing involvement and safety
Involvement does not mean unmanaged risk. Plans should clearly document how views were considered and balanced.
Operational example 3: Recorded decision pathways
A service documented how individual preferences were explored and how final decisions were reached, strengthening inspection confidence.
Evidencing meaningful involvement
Providers should evidence:
- How information was adapted
- How views were sought and revisited
- How decisions were supported and reviewed
Involvement as an ongoing process
In ABI services, involvement evolves over time. Providers that revisit involvement regularly demonstrate person-centred maturity and safer practice.
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