The objective of this essay is to critically evaluate the following statement with reference to personal practice experience when assessing and managing risk. As my practice experience was based in a Children and Families Area Team, this essay will therefore explore the statement from this perspective.
"A good risk decision requires both good risk assessment and good risk management." (Carson & Bain, 2008, p.156)
This essay will, initially, explore and demonstrate a critical understanding of the key concepts of risk assessment and risk management. It will then provide an analysis of the political, cultural and social contexts that shape practice in relation to risk management. Following this, a critical appreciation of the concept of risk decision making will be considered. Finally a reflective discussion of a case study drawn from my practice will be evaluated in relation to risk. This reflective discussion will be set within a theoretical framework of reflection.
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In order to critically understand the concept of risk assessment, the question of what risk is ought to be defined. According to Alaszewski & Manthorpe (1991) risk may be defined as the probability that a course of action will not achieve the desired result but instead some unacceptable circumstance or event would prevail. McCarthy et al (2004) furthers this point as they also suggest that the term 'risk' implies the possibility of undesirable or negative outcomes. Furthermore, McCarthy also indicates that within the concept of risk it is also implied that these outcomes can be avoided. (McCarthy et al, 2004).
It is additionally pointed out that risk has both an objective and subjective dimension. For example, when viewing risk objectively it is possible to identify that any surroundings or environment will be hazardous and associated with danger. Defining risk from a subjective perspective means that the possibility of danger or an unacceptable event taking place will vary from individual to individual as well as social groups. (Aleszewski & Manthorpe, 1991). Nevertheless, Houston and Griffiths (2000) question the validity of the objectivist paradigm that they identify as the basis of risk assessment and point to its "failure to provide valid and reliable measures of risk." (Houston & Griffiths, p.1) They argue for a move toward a subjectivist paradigm, and a return to the concept of 'relationship' as the rationale of social work intervention.
On the other hand, there can be value in taking risks. Indeed, risk taking can be seen to have beneficial as well as harmful outcomes to the life of an individual. (Titterton, 2005; Carson & Bain, 2008). As Titterton points out
"Risk taking is a course of purposeful action based on informed decisions concerning the possibility of positive and negative outcomes...and levels of risk appropriate in certain situations."
(Titterton, 2005, p.25)
Consequently, the concept of risk assessment is a core activity within social work and further to this minimising risk has become a central element. Indeed, Calder (2002) describes risk assessment as a systematic collection of information in order to identify if risks are involved and identify the likelihood of their future occurrence. It is further suggested that risk assessment should be understood as collecting information and assessing any information gained regarding risk elements. These two elements, which are central to risk assessment, are consequences (or outcomes) and likelihood (also known as chance or exposure). (Carson & Bain, 2008).
As most of the situations social workers deal with contain considerable uncertainty about the meaning of events, the reasons for referrals, the accuracy of assessment, and the consequences of taking one course of action instead of another, it is reasonable to assume that assessment of risk is not an exact science. Further to this, the possible outcomes or consequences could be infinite and consequently impossible to predict with absolute certainty. Therefore, the element of uncertainty must be acknowledged as a core feature of professional judgement. Certainly, it is suggested that when considering the possible outcomes (including beneficial outcomes), a risk assessment should only require that reasonably predicted outcomes are met and that a lawful, moral and professional objectivity is upheld at all times. (Titterton, 2005; Carson & Bain, 2008; Macdonald & Macdonald, 2010). As Webb (2006) points out social workers have
'an ethical disposition to do the best for clients and insofar as they have the resources to do so..."
Always on Time
Marked to Standard
(Webb, 2006, p. 203)
Within risk assessment literature, Titterton (2005) also argues that the emphasis remains on assessing for the risk of harmful or adverse outcomes but how this is completed can depend on which assessment framework is used. For example, within Criminal Justice Teams a more actuarial assessment is utilised. An actuarial assessment is based on statistical calculations of risk and, for example, uses scales to assess recidivism. Within a Children and Families Area Team the assessment framework used could be described as a holistic and inclusive assessment which is child-centred and addresses three domains: developmental needs, parental capacity and environmental factors. The GIRFEC practice model therefore aims for early identification of risk in all three domains as well as analysis of evidence, decision-making and planning. (Scottish Government 2008) Furthermore, it allows the practioner to utilise a developmental-ecological approach which is grounded in theories of child development and emphasises interaction between child and environment as well as taking a resilience approach which weights strengths as well as vulnerabilities. (Local Authority Risk Assessment Training Handout, 2009).
However, what all risk assessment tools have in common is that all information gathered is analysed to allow an understanding to be developed which then allows a professional judgement to be formed. Further to this risk assessment should take into account risk factors and protective factors that can anticipate and justify strategies of risk prevention as well as risk management. (Kemshall, 2003; Parton 2006). This should enable the social worker to utilise all appropriate interventions and/or decisions. Analysis of information, therefore, is an important factor when considering outcomes, likelihood and suitable action and accordingly, social workers require a good grasp of probability and statistical reason to interpret research and assessment information, organise their thinking and be able to draw sound provisional conclusions which are open to change in the light of new information. (Helm, 2009; Macdonald & Macdonald, 2010).
Risk management, in its simplest sense, describes the development of strategies to reduce the severity and frequency of identified risks and adverse outcomes. This involves discovering and controlling the dimensions of a proposed risk into a plan which involves implementing, monitoring, controlling and reviewing the risk decision. Further to this, at an organisational level, risk management requires a service that is adequately staffed with personnel who are fully trained and sufficiently knowledgeable and skilled in identifying problems or opportunities and to make appropriate interventions. (Vincent, 1995; Kapur, 2000; Carson & Bain, 2008). The Scottish Government (2008) further suggests that risk management should be understood as risk reduction and that collectively professionals should have confidence, through defensible decision making, that measures implemented will reduce risk sufficiently.
Taking these definitions into account, risk management suggest ways in which a decision may best be put into practice. What also should be included within a risk management strategy is the embracing of opportunities which could arise from any potential risk decisions. Another point which is important is that in order to make and manage a risk decision the quantity and quality of knowledge available to the social worker should meet the requirements needed to make a sound decision. Accordingly, before making a decision, consideration should be given to what is already known and its worth as well as reflection and contemplation of what is not known and any implications arising from this. Included in this should also be the consideration of any opportunities which may arise which may have the prospect of potential benefits. (Carson & Bain, 2008).
Littlechild & Blakeney (1996) further suggest that the management of risk should be adaptable. This refers to the notion that families and their lives do not stay stable and changes can take place in their ability to cope therefore the risks can change too. Monitoring, for these reasons are important as is communication with the family and other agencies who are involved. Littlechild & Blakeney go on to state that this is where the professional expertise of the social worker should be focused and not in an ineffective attempt to anticipate every potential risk. Consequently, the principles for risk management should be the need to ensure that the ongoing shared plan manages the risk, records decisions that shows how and why decisions were reached and ensures that decisions made have actions with named persons, clear timescales and review dates and also ensure that any agreed timescales may be reduced if new risks/needs become more apparent.
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Beck (1992) suggests we are living in a 'risk society' in which he believes that late modernity, as a reflexive social order, 'manufactures' new risks and uncertainties. Furedi (1997) also determines that we live in a populace obsessed with risk and that safety has become the "fundamental value of our times." (Furedi, 1997, p.1).
Furedi (1997) further suggests that the risk aversion culture we live in today is based on the way that risk and its negative effects are represented in the media and by politicians. Barry (2007) extends this claim by arguing that child protection work has become more reactive since the death of Maria Coldwell in 1973 which has resulted in a preoccupation with culpability, blame and retribution. This, has allowed social work practice to become
"...very defensive, overly proceduralised and narrowly concerned with assessing, managing and insuring against risk."
(Parton & O'Byrne, 2000, p.1)
Green (2007) upholds this notion by suggesting that governments, and the excessive number of regulatory agencies, are anxious to control the identification and deployment of risks, particularly within the context of high-profile media stories such as reports of child abuse cases and deaths of children previously known to social work departments.
In retrospect, this socially acceptable requirement to minimise risk if not avoid taking risks altogether, has led to a social work profession that has become increasingly risk averse. (Scottish Executive, 2006). This approach to risk assessment and risk management has led to the introduction of more and more formal procedures to guide practice which could be argued is denying the freedom of the social worker to work in an empowering capacity. Working in an empowering capacity allows the professional practioner to focus on prevention and more centrally tackle issues of poverty and social inequality. What is also needed is a culture which is open for professional practioners to enable them to voice concerns and being able to discuss errors and therefore learn from mistakes. (Stalker, 2003; Barry, 2006; Ritchie & Woodward, 2009). However, the Changing Lives Report (2006) has signified that one of the key areas identified was the need to develop a new organisational culture and approach to risk management and risk assessment which would promote excellence.
Within risk decision making Macdonald & Macdonald (2010) argue that a focus on high-profile cases of low-probability events distorts decision making and this makes for a larger number of children taken into care after such cases. They advocate that decisions about children's lives should be based on professional judgement rather than media vilification and political pressure.
When social workers make a professional judgement within risk decision making, the starting point must be the collection of information through professional observations and enquiries as well as from past information and information held by other professionals. It is that judgement that is carried forward into the decision making field. (Hollows 2003). However, the expression 'error of judgment' is offered as an explanation for most of the high-profile child cases as well as in other professional activities. It is for this reason that judgement making should be viewed as a serious task.
Hammond (1996) advocates that there are different kinds of judgements, made under different conditions. These different conditions are the time available, the kind of knowledge available and the judgement task itself. Hammond went on to develop a 'cognitive continuum' of judgement making. This recognises that there are different approaches to judgement making. Examples of these are: on the spot processing of information and knowledge, known as intuition; peer-aided judgements where two or more people will share their knowledge and discuss outcomes and likelihoods. Finally, there are system-aided judgements that are supervisor or manager aided. Accordingly, application of the Cognitive Continuum allows the practioner to utilise the highest knowledge available and further enables the practioner to ensure that the acknowledged goals of efficacy, accuracy and consistency can be promoted. (Hollows, 2003; Carson & Bain 2008).
However, risk decision making is also subject to personal values and subjective perceptions of risk and dilemmas which continue to challenge social workers. Low-probability events such as child abuse or extreme violence can make prediction difficult. In these circumstances social workers can be challenged by risks that are high profile but typically infrequent and therefore, have a tendency to either overestimate risks because of anxiety or to underestimate risks which they are unaccustomed to. (Kemshall, 2002). From this perspective it is crucial that reflection, continuous review and the opportunity for regular supervision is supported particularly when research by Janus & Mann (1977) found that stress generated a limited capacity to make a judgement as well as, and more crucially, an inability to make a decision.
BL was referred to the Children and Families Area Team by his school. This was after a meeting with his primary carers regarding BL's increasingly emotional and angry outbursts and lack of attendance at school. The referral was made with agreement from his primary carers. BL is 12 years old and lives with his maternal grandmother, step-grandfather and his maternal aunt and has done since he was 18 months old. His step-grandfather is paraplegic as a result of an accident when BL was 3 years old. BL's maternal aunt has Prader-Willi Syndrome, she is 40 years old. BL has to share a bedroom with his aunt as the house only has two bedrooms and is privately owned. BL maintains contact with his mother and her long-term partner on a fortnightly basis and also goes on holiday with her but he has no wish to live full-time with his mother as she lives approximately 50 miles away. BL stated both to his grandmother and to me that his home is with 'Gran and Gramps'. Mrs. L independently confirmed that BL had no wish to move to the city as did Ms. L (Ben's mother). Ms. L has no other children.
In order to understand Ben's emotional frustration, I undertook some research on Prader-Willi Syndrome. I discovered that disordered night-time sleep patterns as well as emotional outbursts of rage were part of the symptoms. Coupled with this obsessive and/or compulsive behaviour including argumentative or oppositional behaviour were also predominant. (Clarke et al 1996). I also spoke with Mrs. L at length about her other caring commitments and discovered that she also drives to England on a monthly basis to visit her father, who is 90 years old, to make sure that his financial commitments are paid as well as making sure his carers are supporting him. Contact was also made with the social worker assigned to BL's aunt whereby I was informed that his aunt was in the process of being allocated a home of her own. This would take at least three months as adaptations had to be made to the house and suitable care arrangements had to be put into place. The social worker realised that these circumstances were affecting BL and we arranged to contact each other on a weekly basis regarding exchange of information. This was agreed with the L family.
I placed my assessment and intervention practice within a developmental/ecological approach which has links with a strengths based approach. This allowed me to consider BL's protective factors as well as risk factors. BL has a secure base and has close bonds with his grandparents. He also had two very close friends from primary school and who continue to good friends. BL admitted that he was frustrated he had to share a bedroom. This meant no privacy in his home and he found it difficult to complete his homework or even relax as carers for his aunt came in at different times to get her ready for bed. This meant that he had to go to bed when his aunt's carers were getting her ready for bed. BL also admitted that he felt that he sometimes had to compete for his grandparents' attention. His absences from school appeared to coincide with the times his grandmother returned from her visit to England.
After analysis of potential risk factors to BL such as possible self-harm, withdrawal from his family and friends, I made a referral to the local young carers group. This would allow him to spend time away from the family home with other young people who lived in similar circumstances as well as broaden his social network. This organisation would also be able to support him on a one-to-one and group work basis. Support was also made available to his primary carers, particularly his grandmother. Through the use of a personal diary I supported BL to talk to his grandparents about the frustration and emotional anger he felt which was relatively successful in the short term.
In conclusion, Kolb's Reflective Cycle (1984) and Hammond's Cognitive Continuum (1996) allowed me to take into consideration BL's whole situation and promote protective factors and minimise risk. With reflection and supervisory discussion I believe I used my analytical skills and utilised my professional judgement to the best of my ability. However, as has been pointed out 'uncertainty' is an important element in any risk assessment and/or decision and has to be taken into account when managing risk. Taking all these concepts regarding risk and reflective practice into consideration when I start to practice should enable me to better support service users in the future.