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There are many other issues that might impact social capital when associated with disability. Along with the narrowness of exposure and the tendency to congregate people who have disabilities, the notion of basic physical issues and architectural barriers often preclude participation.
Many brain injuries bring associated physical disabilities and this creates a variety of problems. First might be the attendant needs of the person. It is hard to expect a developing friendship to sustain some of the personal care needs. Indeed, any family caretaker will tell you how exhausting it is to take the most routine of trips into the community.
In some cases where individuals require wheelchairs or other mobility devices the simple elements of access might be mitigated by a curb or staircase. The sheer time demands that follow can also compromise a simple trip to a restaurant or theater.
Beyond all of these issues are stark behavioral manifestations that can also be a part of the brain injury reality. An outburst or narrow perspective that might be a new reality for the person who has a brain injury can wreak havoc on any community outing.
Clearly the challenges of engaging community and building relationships are difficult at best and any person reading these words who has been on a community outing with a person who has physical or behavioral manifestations related to brain injury can offer testimony. Still, we must try. In a simple equation, if treatment or clinical intervention can not change the person, then the target of action must shift to the community.
So, knowing what we do about community and social capital, what directions, actions, and new approaches might we consider in Brain Injury Rehabilitation? To this end I want to suggest some key adjustments and shifts in perspective that are much more from a macro framework than from a micro or clinical approach that the field currently uses to achieve its goals.
First we must understand that social capital is a cornerstone issue in experiencing success in the broader aspects of community. More than therapy or programs, friends provide the fulcrum in the following areas:
Clearly the more social capital you have the better your chances for getting a job, finding someone to live with, and getting a ride. Social capital is directly related to the key goals that people with disabilities report that they want from systems. But there is more.
If you push the outcomes discussion to a higher level, and think about the most important quality of life indicators known to people in general, we find that again, social capital is directly connected as well. When sociologists ask people to identify the most important things they want for the people they love the top three answers are health, happiness, and longevity. These three things — health, happiness, and longevity — are the highest measure of life success - for all people.
To this end, studies over the past 40 years show clearly that our health, happiness, and longevity are all enhanced by our social capital. Quite simply, the more relationships in your life, the healthier you are, the happier you are — and listen to this — the longer you live.
So the facts are clear: The very things that people with disabilities want from the human service system can and are enhanced by social capital. Yet the very notion of social capital has not at all been embraced or understood by these very systems that relate to people with disabilities. In fact, we don’t even know the extent of social isolation (except in anecdotal ways) that people with disabilities experience.
So what does all of this mean for us? Clearly, if we want to see people with disabilities be more successful in community outcomes, we must start with a shift in perspective and consider the power and potency of relationships. To this extent I recommend the following key actions:
From Brain Injury Professional, the official publication of the North American Brain Injury Society, Vol. 8, Issue 3. Copyright 2011. Reprinted with permission of NABIS and HDI Publishers. For more information or to subscribe, visit: www.nabis.org.
Brain Injury Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society. Brain Injury Professional is published jointly by NABIS and HDI Publishers. Members of NABIS receive a subscription to BIP as a benefit of NABIS membership. Click here to learn more about membership in NABIS.