Dignity of Risk
Ruth Estes, Ph.D.
Krista Davis, RRP
ResCare Premier, MO, ON
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Ms. Davis is a Registered Rehabilitation Professional (RRP) with the Canadian Association of Rehabilitation Professionals (CARP) and holds college credentials in the field of Health Sciences – Multidisciplinary Rehabilitation. She began her career in the field of acquired brain injury as a volunteer. She co-founded the Timmins and District Brain Injury Association in Northern Ontario, Canada and served as First Vice President. Ms. Davis is certified as a Clinical Instructor and Examiner by the American Academy for the Certification of Brain Injury Specialist. Ms. Davis is currently the Executive Program Director of Anagram Premier, Niagara-on-the-Lake, Ontario.

Ruth Estes, Ph.D., received her doctoral training in Clinical Psychology at the University of Health Sciences/The Chicago Medical School where she specialized in medical psychology/behavioral medicine. Dr. Estes is on the Board of Directors of the Brain Injury Association of Missouri and is the Chair of the Program and Service Development Committee of that organization. She also serves as a surveyor for CARF—The Rehabilitation Accreditation Commission. Dr. Estes is the Director of Training, Research, Accreditation, and Compliance for Rescare Premier.

Dignity of Risk
Maximum participation cannot be attained without taking risks.

Dignity
The quality or state of being worthy of esteem or respect

Risk
The possibility of suffering harm or loss; danger; a factor, element, or course involving uncertain danger

Dignity of Risk
Dignity derived from being able to try things that involve uncertainty or a possibility of harm

Challenges of Risk Taking for Rehabilitation Professionals, Families, and Caregivers
Differentiating restrictions that are necessary from those based on fears
• Overcoming fears, letting go
• Challenging what you “know”
• Learning to embrace risk as a necessary part of rehabilitation

Challenge What You “Know”
Avoid making assumptions about what an individual can or cannot do
Gain empirical evidence of what the individual can do, in this situation, at this time

Steps in Risk Taking
• Identify barriers to desired outcome:
• Clearly define desired outcome ~Limited awareness of functional impact of deficits
• Challenge overly cautious perspectives ~Limitations resulting from injury
• Collaborate with all persons affected by the risk taking ~Pre-injury issues
• Evaluate risk associated with goals ~Gaps in resources
• Environmental factors
• Identify supports
• Work up to the risk--build confidence

Evaluating Risk
• List potential benefits and negative consequences of taking the risk
• How much danger is involved?
• Is the danger real (based on data) or imagined (based on beliefs that may not be relevant)?
• How likely are the negative consequences to occur?
• Who will be affected?
• Do the likely negative consequences of initiating a trial in the real world outweigh
the benefits of increased independence and self-esteem?

Preparing for Community Trials
• Identify activity with acceptable level of risk
• Get everyone on board
• Establish clear evaluation criteria
• Specify supporter’s role in the trial
• Specify strategies the person with brain injury should use and activities in which the person with brain injury should not engage during the trial

Follow Up
• Identify what problems occurred
• Determine level of risk problems represent:
   -Low risk: Try again
   -Moderate risk: Practice new strategies and/or enlist new supports, then try again
   -High risk: Reformulate parameters of goal
• Identify supports and strategies to address problems
• Reemphasize the learning aspect of the trials
• Provide support

Advantages of Approach
• Decreases arguing over whether person with brain injury can or cannot do something; reduces tension in relationships
• Increases sense of support and working together to achieve goals
• Offers opportunities for learning
• Gives persons every chance to reach their greatest potential
• People succeed!

The greatest risk is not taking one. Be an advocate for planned risk taking.

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