Reflective Practice And Risk Essay Social Work Essay
The purpose of this essay is to critically evaluate the following statement with reference to my own practice experience in working with risk. "As social workers it is especially critical that we apply a resilience-lens, that is, a strengths-based practice approach..." (Saleeby, 2006, p.198).
With the focus of this piece of practice on working with a family, this essay will predominantly explore the above statement from the perspective of a Children and Families placement. The essay will start with a brief outline of the practice experience that will be referred to and will then explore the concepts of resilience and strengths-based practice as well as risk assessment and risk management. The social, cultural and political concepts that shape practice in relation to risk management will also be explored. A reflective discussion of my practice will follow and this will incorporate the concepts of resilience and strengths-based practice as well as risk assessment and risk management and how this approach was utilised to complete BB's Pre-Birth Assessment. This discussion will also be set within a theoretical framework of reflection.
The practice experience that will be referred to within this essay is the assessment process I undertook in order to prepare for the completion of a Pre-Birth Assessment which had been requested by the Community Ante-Natal Midwife. The completed Pre-Birth Assessment would be sent to the Local Authority's Child Protection Officer. This was in line with the Local Authority's High Risk Pregnancy Protocol. BB is 18 years old and pregnant with her second child. She lives alone in local authority housing in a small village. Her oldest child, CA, was at the time of the referral 9 months old. BB's partner, BA, who is aged 21, is currently in prison serving a two year sentence for Assault to Severe Injury. BA is not expected to get released from prison until October 2010. The Midwife was concerned that BB would find it difficult to cope with the new baby as well as her daughter and described BB as appearing to lack capacity in her understanding of responsibility of CA's health and welfare and the health and well-being of both herself and her unborn baby. The midwife also raised concerns about BB's mental well-being with respect to her partner's long term prison sentence and in particular raised concerns that BB was finding it difficult to contemplate the birth of her second child without the support of her partner. The Midwife was satisfied that substance/drug misuse was not an issue with BB.
The concept of resilience refers to a dynamic process of overcoming the negative effects of risk exposure, coping successfully with traumatic experiences and avoiding the negative pathways associated with risks. (Rutter, 1985; Luthar et al, 2000). From a developmental perspective, a pathway can become negative when circumstances lead to lower than expected progress or regression. Positive pathways occur as individuals or families overcome adversities. Turning points represent times when a pathway alters direction, such as when professional intervention enables a family or individual to start on or return to a positive pathway. (Hill et al 2007). Gilligan (2004) also suggests that three elements are seen as essential to understanding resilience which arises from a process and results in positive adaption in the face of adversity. Further to this, Fergus and Zimmerman (2005) argue that a key requirement of resilience is the presence of both risk and protective factors that either help bring about a positive outcome or reduce and avoid a negative outcome. In order to illuminate how resilience may operate, the key relationships in the lives of children and their families should be explored. The relationships the children and their families have with the wider world as well as their relationships with professionals should also be included in this exploration. (Gilligan, 2004).
According to Hill et al (2007) many of the findings concerning resilience among young people as they move into adulthood are relevant to parents. The capacities and supports that assist their resilience also help them manage stresses arising from parental roles. However, much of the work on parent and family support has been based on the concept of 'coping ' and the development or building on the strengths of families facing difficulties rather than that of 'resilience' (Pugh et al, 1995; Quinton, 2004). Nevertheless, as Hill et al (2007) point out "successful coping equates to resilience" (Hill et al, 2007, p.19).
In order to identify and bolster strengths, as well as reduce risk Corcoran and Nichols-Casebolt (2004) consider how a risk and resilience ecological framework (Kirby and Fraser, 1997) can fit with social work's emphasis on empowerment and the strengths-based perspective. Corcoran and Nichols-Casebolt (2004) put forward the ideas that the strengths perspective underlies the concepts of 'protective factors' and 'resilience' in which people are not only able to survive, but also triumph over difficult life circumstances. The ecological emphasis of the framework expands the focus beyond the individual to a "recognition of systemic factors that can create problems as well as ameliorate them." (Corcoran and Nichols-Casebolt, 2004, p.212)
In describing elements and principles of strength-based practice, Saleeby (2000) asks us to imagine an equilateral triangle. P at the apex stands for promise and possibility whilst C on the left represents capacities, competencies and character. R on the angle to the right symbolises resources, resilience and reserves. Taking into account the character and tenor of the helping relationship using the work of Carl Rogers (1951) by utilising respect, genuineness, concern, collaboration and empathy as well having useful and appropriate interventions can provide a context for the family and/or individual to confront the difficult and consider the future.
Central to the strengths approach is to begin making an assessment of the assets, resources and capacities within the service user and equally within their environment e.g. household composition, extended family, neighbourhood and local amenities as well as access to community resources. (Saleeby, 2000; Corcoran & Nichols-Casebolt, 2004). Further to this, professional assessment needs to focus on strengths as well as deficits, on protective as well as risk factors. (Werner & Smith, 1992; Gilligan, 2001). What also needs to be understood, in terms of professional assessment is that protective and risk factors have been found to vary according to the type of adversity, type of resilient outcome and life stage. Also risk factors in one context may by protective in another. (Rutter, 1999; Ungar, 2004).
Risk assessment should be understood as collecting information on the two key risk elements; these are known as the outcomes (also known as the consequences, harm or damage) and their likelihood (also known as chance or exposure) and to assess a risk both should be taken into consideration. (Carson & Bain, 2008; Titterton, 2005). Risk assessment is also described as a systematic collection of information to identify if risks are involved and identifying the likelihood of their future occurrence. It can also be used to predict the escalation of the presenting behaviour as well as the service user's motivation for change. (Calder, 2002)
When considering outcomes Carson & Bain (2008) argue that a risk assessment only requires from a legal, ethical and professional perspective to cover 'reasonable' outcomes. The goal should be to include as much information, and as many considerations as necessary but to keep the decision as simple as possible. Including unreasonable outcomes quickly become counterproductive and thereby show poor practice. Further to this beneficial outcomes should also be taken into consideration. Risk assessment should also take into account that risk is being considered, and can be justified because its likely benefits may be more important than the possible harms. Quality risk assessment requires us to think about the amount of harm and/or benefits which might be achieved.
When assessing likelihood Carson & Bain (2008) suggest that the knowledge source and the quality of knowledge are variable. They advocate the adoption of the cognitive continuum model by Hammond (1978 cited in Carson & Bain, 2008). This suggests that we should be able to distinguish six 'levels' of knowledge. The lowest level being 'intuitive judgement' next is 'peer-aided judgement' where two or more people will share knowledge, experience and discuss assumptions and predictions. The third is 'system-aided judgement' e.g. supervisor/manager aided. The final three levels relate to the quality of scientific and empirical research which may or may not be available. However, as Carson & Bain point out the value of the cognitive continuum is that it reminds us that
"When making an assessment of likelihood we ought to use knowledge from the highest level, providing it is relevant knowledge."
(Carson & Bain, 2008, p.142)
Therefore, when conducting an assessment, it is important that the nature of the interactions between the family and environmental factors are examined carefully, including both positive and negative influences and knowledge and meaning attached to them explored and weighed up with the family. What is useful in this respect is the use of grids and visual aids such as resilience/vulnerability matrix (Daniel & Wassell, 2002), My World Triangle and genograms. The usefulness of these is enhanced when completed together with the service user. At this point it is useful to mention that there are two basic assessment tools used to assess risk. These are clinical which involves professional judgement, information from research on risk factors and constructs risk management as well as allowing intervention strategies to be tailored to situation. The other is actuarial and is based upon statistical calculations of risk and uses scales to assess parental dangerousness. This method does not allow for children and their families unique cluster of circumstances and also takes no account of child development theory. (Barry, 2007; Davies, 2008).
Risk management is discovering and controlling the dimensions of the proposed risk into a plan to manage the risks; it is involved with implementing, monitoring, influencing, controlling and reviewing the risk decision. Risk dimensions are features of risk that could be influenced by the practitioner, for example the available (and the availability of) resources to manage the risk and uncertainty (Carson and Bain, 2008). Gurney (2000) defines risk management as processes devised by organisations to minimise negative outcomes and suggests that risk management moves along a continuum between control, legitimate authority and empowerment. Between the empowering and controlling ends of the continuum lie models of risk minimisation which seek to reduce harms and maximise benefits. (Manthorpe, 2000).
However, in order to have good risk management we must be able to make effective use of all the dimensions of the risk assessment. Risk management suggest ways in which a decision may be best implemented. Different levels of resources may be applied. For example, the child who is perceived possibly to be at risk may be visited more frequently. People are an example of a major resource for risk management. The number of people being able to visit to check on a risk decision will be important but will be of little advantage if they are not sufficiently knowledgeable or skilled in identifying problems or opportunities and to make appropriate interventions. However, the availability of resources is money orientated and the availability of risk management resources in one part of the country (or neighbouring local authorities) could lead to a different risk proposal being assessed from that in another local authority that does not have those resources available. (Carson & Bain, 2008)
Webb (2007) identifies social work as operating within a 'risk society', that is, a society which views risk as something which should be managed and can be identified and eradicated. Since the beginning of the 21st Century there have been several reports regarding child abuse deaths and, as pointed out by Ferguson (1997), there are
"Few more disturbing phenomena in advanced modern society than the premature deaths of socially valued children who were known to be at high risk."
(Ferguson, 1997, p. 228)
Examples of high profile child death inquiry cases include Victoria Climbié (2003), Caleb Ness (2003) and Baby P (2008). These are all very good examples of how the media and public blamed practitioners. The resultant media coverage of how risk assessment and risk management have failed along with demands for minimising risks and organisational and professional accountability have, over the years, constrained the role of a social worker. With respect to this Houston and Griffiths argue that
"Approaches to risk assessment and management in child protection have led to an emphasis on prediction, control and culpability." (Houston and Griffiths, 2000, p.1).
Furedi (1997) argues that the worship of safety and the avoidance of risk make up the new moral order, an order which is prescriptive, intrusive and deeply anti-humanistic. From this perspective, concern about identifying risk is becoming more dominant than concern about identifying need in assessment and resource allocation in risk management.
Avoiding risk is a difficult business which cannot be reduced to simplistic methods and rather than try to calculate the incalculable social workers should develop mutually trusting, respectful relationships with service users. Also this approach to risk assessment and risk management may deny the social worker empowering approaches which respond to need, focus on prevention and which more centrally tackle issues of poverty and social inequality. (Stalker, 2003; Ritchie & Woodward, 2009). Further to this Ritchie & Woodward (2009) point out that if social workers are preoccupied with high risk situations they are less likely to find the space to work either creatively or therapeutically. Additionally, the Changing Lives Report (2006) suggested that the social work profession had become increasingly risk averse. One of the key areas identified in Changing Lives was the need to develop a new organisational culture and approach to risk management and risk assessment which promoted excellence. (Scottish Executive 2006).
In order to complete BB's pre-birth assessment I took into account risk factors and strengths which I had to analyse and reflect on. Calder (2002) offers a framework for conducting risk assessment by assessing all areas of identified risk and ensuring that each is considered separately e.g. child, parent and surrounding environment. To counteract the risk factors present family strengths and resources were also assessed, for example good bonding, supportive networks. I undertook research regarding parental resilience and according to Hill et al (2007) a vast array of research shows that parents in poverty or facing other stressors usually cope better when they have one or more close relationships outside the household and these are activated to give practical, emotional or informational support. In the case of BB she had a practical and supportive relationship with her mother as well as the support of her extended family which included her grandmother. BB also had a good relationship with BA's family and his mother in particular was a source of support for BB as she regularly took CA overnight.
Whilst completing the assessment I centred my practice on the strengths-based perspective. As Saleeby (2000) explains the work of the strengths-based approach is the work of empowerment as both a process and a goal. As a goal, those who are empowered seek a firmer sense of purpose, self-esteem, the possibility of choice and connections to resources. As a process it is the collaboration between a social worker and a family or individual, working together on a mutual plan that will move them closer to their aspirations.
Utilising a strengths-based practice with BB was important as she was finding it difficult to interact with the Community Health Visitor and Midwife. BB felt that she was a 'bad parent' as she was not conforming to the routines the Health Visitor had recommended. BB also described how she felt that the Health Visitor was 'judging her and finding her wanting as a parent'. Taking this conversation into consideration I realised that BB had no sense of self-efficacy, self-esteem or self-concept which Payne (2005) describes as resources that people have in order to cope. However, BB's strengths lay in the care of her daughter. She had a good bond with her daughter and was quick to attend to her needs. BB also had a routine in place with regard to mealtimes, naps and a bedtime routine. CA was also reaching her developmental milestones, had age appropriate toys and had the freedom of the living area. BB had also erected a baby gate to stop CA from gaining access to the kitchen and stairs.
After a thorough analysis and supervisory discussions with my practice teacher I recommended that a Post-Birth Multi-Agency Conference not be convened. BB was happy to continue to work voluntarily with the Children and Families Area Team which would allow ongoing assessment and intervention. However, I recommended that a Post-Birth Multi-Agency meeting be arranged to discuss future interventions as I was aware that the birth of the new baby could be a future pressure on BB. I also recommended a further assessment take place when BA returns to the family home in October 2010. These recommendations were accepted by the Child Protection Officer at the Local Authority.
In conclusion, Kolb's Reflective Cycle (1984) was useful in the reflection of my practice concerning BB as it allowed me to take into account Scottish Social Services Council (SSSC) Codes of Practice, particularly Section 4.1 and 4.2. This reflective cycle also helped me look at BB's situation holistically by looking at resilience and risk, strengths-based practice and risk assessment and management. On reflection I felt confident that I had used the resources available to me well, particularly research and knowledge and I could justify my risk decision if harm was to occur and would be able to explain how I came to my risk decision. Overall, I felt that my first practice was very much influenced by the negative issues associated with risk however, I believe that this placement allowed me to put risk, risk assessment and management into perspective and accepting that risk decisions should not be influenced by the 'blame-culture' but from a balanced approach which takes into consideration beneficial outcomes. This will in the future enable me to better support service users.
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