Decisions Decisions Decisions! Staff and Clients in Acquired Brain Injury Outreach Contexts

Staff who work in front line, direct contact support§positions with community based clients with acquired§brain injuries (ABI) hold unique responsibilities,§and face unique challenges in their work due to the§combination of three key factors: autonomous work§environments, socially sanctioned power status over§clients, and the decision making deficits of clients§with ABI. These factors further contribute challenges§to staff in the presently complex and ambiguous§outreach context, where the embedded ideologies of§the medical model of treatment remain in tension with§the purported ideologies of the social model of§disability and client self determination that drive§outreach services. This work documents decision§making strategies used by interview participants,§examines the factors that influence their decision§space when in the field with clients, and explores§the role staff awareness of professional and personal§values plays in making decisions in the best of§interest of the client. Staff awareness is shown to§be a critical, yet oft neglected factor in§consideration of staff ethical decision making in ABI§outreach. Implications for best practices in the§field are discussed.