Decisions Decisions Decisions!

Staff who work in front line, direct contact supportpositions with community based clients with acquiredbrain injuries (ABI) hold unique responsibilities,and face unique challenges in their work due to thecombination of three key factors: autonomous workenvironments, socially sanctioned power status overclients, and the decision making deficits of clientswith ABI. These factors further contribute challengesto staff in the presently complex and ambiguousoutreach context, where the embedded ideologies ofthe medical model of treatment remain in tension withthe purported ideologies of the social model ofdisability and client self determination that driveoutreach services. This work documents decisionmaking strategies used by interview participants,examines the factors that influence their decisionspace when in the field with clients, and exploresthe role staff awareness of professional and personalvalues plays in making decisions in the best ofinterest of the client. Staff awarenessis shown tobe a critical, yet oft neglected factor inconsideration of staff ethical decision making in ABIoutreach. Implications for best practices in thefield are discussed.