Although this article was first presented as a new concept in 1994 the principles are still relevant to this day.
The model proposed that:
- Maximum self-determination is the desired goal for persons with a brain injury despite the cognitive and behavioural deficits that may interfere with the options available and the process of informed choice
- Community integration requires the development of programs and interventions that are both practical and innovative
Click the plus symbol beside each principle to learn more about it:
- Brains, pre-injury characteristics, coping behaviours and injuries all differ, we are all unique
- Personalized programs that are uniquely responsive to a persons needs, should be the norm
- Group activities are good for learning social skills and coping strategies, for support from others and for having fun but should not be used in the absence of individual activity
- Due to cognitive changes and learning difficulties the ability to generalize will always be an issue after brain injury i.e. being able to apply a skill or behaviour learned in one setting to another
- Skills should be taught in the environment where they will be used
- Environments can be enabling or handicapping. Both of the following examples are handicapping: A flight of stairs to the washroom for a person who uses a wheelchair; eating a meal in a noisy, cramped busy cafeteria for a person with attention difficulty
- Modifying the environment and providing adaptive equipment can transform a handicap into an ability
- Identify strengths in addition to deficits both for the individual and the environment in which they live
- Community integration includes: control over ones’ home environment, integration into a social support network, and meaningful activity
- Aim for active participation in a broad range of community activities
- Provide supports to make the persons preferred living situation work and where possible limit moving the person from one place to another
- Provide supported employment by placing the person in a work site, providing a job coach, then training how to do the job, on the job
- After a brain injury the persons support network tends to shrink
- Think of ways to build a social network e.g.“circle of friends” concept
- A combination of natural supports (unpaid) and minimal support by paid helpers is likely to be the best long term solution
- Examine each and every intervention to determine whether potential harm outweighs the benefits e.g. medications, institutional care, overzealous involvement
- Care must be taken not to create dependency by allowing maximum freedom and risk
- There is ignorance in the general population about brain injury
- There is fragmentation of service responsibility and no single authority responsible for all programs that address the needs of persons with brain injury
- The most important assistance needed to accomplish community integration is coordination of the services that are available and advocacy for those that are not
- At all times think about the language and labels that are used
- Provide multiple options and opportunities to ensure true choice and enhance self respect
- Services must be planned for the life of the person, or until they are no longer needed
- Family members and the person involved should be well informed about, and fully involved in, the long term consequences of using up treatment resources