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Social & Policy Envrionment & Cognition

For background information on the characteristics of cognitive abilities and limitations, a description of who is affected, and the types of issues functional limitations in cognition can create, please refer to Cognitive Abilities & Limitations.

Issues Specific to the Social & Policy Environment

As with every other kind of functional limitation, attitudinal issues are the most important element of the social environment to address and improve. The goal is to replace low expectations and anxiety with knowledge and confidence that you can make a positive difference in minimizing the limitations of a woman with cognitive limitations through the choices you make about your program’s environment.

Agency policies can be inflexible, making it difficult to create flexible solutions that can enhance the experience of a survivor with a cognitive limitation. Policies should be scrutinized with an eye toward how they can support a more responsive and flexible environment.

As always, diagnosis has limited value in predicting what someone needs or can do. In the cognitive spectrum, there are many survivors who have never been diagnosed nor identified themselves as having a limitation. Undiagnosed learning disabilities are common, particularly among poorer woman. Women with IQs between 71 to 85 (which would be above the usual cut-off of 70 for state services for intellectual limitations/mental retardation) would still encounter significant barriers.  

Examples of Problems

  • When a survivor changes the description of what happens to her several times, her advocate begins to question her credibility.  The advocate does not understand the difference between consistency in memory and reliability in memory. It may also reflect a common tendency to suspend disbelief when memory limitations are present.
  • A survivor is having great difficulty processing information during a safety planning session. She becomes increasingly anxious and has trouble concentrating. This makes it even more difficult for her. The provider does not seem to notice that she is having a hard time and hasn’t said anything about continuing the discussion at another time. The survivor does not want to do the wrong thing or disappoint the staffperson. She walks away with her safety plan, though she does not understand how it will be used or how it will be helpful to her.
  • A provider assumes that a survivor with memory problems cannot retain the information that is normally shared with survivors.  Rather than learning techniques to assist the survivor with her memory limitations and the learning process, the provider chooses to not share the information.  The survivor with a functional limitation in cognition is therefore denied the services provided to other survivors.  
  • People with intellectual limitations are overlooked or excluded from chairing or co-chairing meetings, providing input on outreach materials, and helping to design new programs and policies.

Suggested Solutions

  • Each person who uses your services should be asked for any known behavioral or emotional tendencies when in crisis. Ask for the person’s own advice about what works to alleviate her response to crisis. Take any preventative measures the survivor suggests.
  • The inability to maintain a recollection consistently does not mean the specific recollection itself is flawed. Post-traumatic amnesia affects the variability of memory. It isn’t that the memory is unreliable, but that the survivor has trouble with accessing memories in a consistent way. She may remember her trauma 3 days after the incident but not one week after. The memory she can access – where it begins and ends - changes over time. Once a recollection disappears, it can come back again. Especially with concussion and TBI, a survivor’s condition will change over time, and in most cases improve.
  • A calm and predictable environment is important to anyone having difficulty processing information. For people with intellectual limitations, learning disabilities, or other cognitive issues, any counseling or safety planning should occur in an environment with a minimum of visual or auditory distractions.
  • People with developmental delays like mental retardation are capable of learning new information and taking steps to increase their safety. Providers do not need to become specialists to serve people with developmental disabilities. Specialists in this area have developed curricula on safety and abuse that everyone can use.