Managing Risk Without Over-Restriction in Acquired Brain Injury Services
Risk management in acquired brain injury services requires a careful balance between protection and autonomy. Overly restrictive approaches may reduce immediate risk but can undermine independence, confidence and rights. Commissioners and inspectors increasingly expect providers to demonstrate proportionate, individualised risk management rather than blanket controls.
This article explores proportionate risk management in ABI services. It should be read alongside Safeguarding, Capacity, Risk & Vulnerability and Positive Risk-Taking & Risk Enablement.
Why over-restriction is a safeguarding risk
Excessive restriction can reduce skill retention and increase dependency.
Commissioner and inspector expectations
Expectation 1: Least restrictive practice. Inspectors expect risk controls to be justified and proportionate.
Expectation 2: Individualised risk planning. Commissioners expect risk management to reflect personal circumstances.
Operational example 1: Removing unnecessary controls
A provider reduced supervision levels where risks were no longer present.
Using risk enablement frameworks
Risk enablement focuses on managing risk rather than avoiding it.
Operational example 2: Risk enablement plans
Providers documented how risks would be managed while supporting independence.
Reviewing restrictions over time
Restrictions should be reviewed regularly and removed when no longer needed.
Operational example 3: Restrictive practice audits
Services audited restrictive practices to ensure ongoing necessity.
Evidencing proportionate risk management
Providers should evidence:
- Individual risk enablement plans
- Regular review of restrictions
- Decision-making linked to MCA principles
Why proportionate risk management matters
Balanced risk management protects both safety and rights.