Reflective Practice And Risk Social Work Essay
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"A good risk decision requires both good risk assessment and good risk management" (Carson and Bain, 2008: 156). The intention of this assignment is to critically evaluate this statement with reference to my own practice experience. With the focus of this piece of practice being on children, this assignment will predominantly explore risk from the perspective of children. The assignment will start with a brief outline of the practice experience that will be referred to and will explore the social, cultural and political concepts that shape practice in relation to risk. The concepts of risk, risk assessment and risk management will be examined along with what makes them good. The assignment will then explore how Brearley's (1982) risk assessment was used before looking at theoretical frameworks of reflection.
The practice experience that I will be referring to throughout this piece of work is the assessment process in preparation for a Full Assessment Report that had been requested from the Children's Reporter Administration due to concerns for the safety of a child. During a domestic incident between Mr and Mrs Hassan, their son Raj (aged 12) was struck on the side of the face by Mr Hassan. As a result of bail conditions Mr Hassam was not allowed within a certain distance of the family home and he was not present during the first half of the assessment process. However halfway through the assessment process Mr Hassam was charged and convicted a Schedule 1 offender, with bail conditions no longer in place Mr Hassam returned to the family home.
Towards the end of the twentieth century risk became a major concern within western society; Beck (1992) argues that we live in a risk society that has an emphasis on uncertainty and blame, and there is no longer a focus on succeeding in doing something good but where we are preventing the worst. Parton (1996) would agree with Beck and believes that globalisation has separated society and in turn created more uncertainty within social and economic life. As a result of the blaming culture professionals are finding themselves avoiding taking risks and feeling that they have to defend their practice and risk decisions (McLaughlin, 2007 and Barry, 2007).
The media and public blame practitioners, particularly when there is a child death, and state that they put children at unnecessary high risk as they fail to intervene quickly enough. Examples of high profile child death inquiry cases include Jasmine Beckford (1985), Caleb Ness (2003) and Baby P (2008). Baby P is an excellent example of how the media and public blame practitioners and received high media attention. Media coverage of how risk assessments and risk managements have failed along with demands for minimising risks and organisational and professional accountability has constrained the role of a social worker and The 21st Century Review of Social Work (2006) acknowledges this (Barry, 2007). It implies that social work professionals were lacking in confidence when it came to taking risks in what has become a risk adverse society. One of the main areas highlighted in the report was the need for a new organisational culture and approach to risk assessment and risk management which would promote merit (Scottish Executive, 2006).
Official policies and guidance have been developed in recent years with the aim of improving practices and knowledge where high risks can be identified (DOH, 1991 cited in Parton, 1996). This is evident in documents that influenced my practice and I referred to them before making risk decisions, some examples include; Getting it Right for Every Child: Proposal for Action (Scottish Executive, 2005), Every Child Matters: Change for Children (HM Government, 2004) and It's everyone's job to make sure I'm alright: Report of the Child Protection Audit and Review (Scottish Executive, 2002).
The word risk is a complex and comprehensive concept and there is no clear definition when it comes to defining what would be a low, medium or high risk (Stalker, 2003 and Barry, 2007). Many of the problems that arise during risk taking is a result of there being no exact definition of risk (Titterton, 2005). This in turn creates difficulties when defining definitions of risk, risk assessment and risk management.
The Oxford English Dictionary (2002) describes the noun risk as a situation that could lead to a bad outcome or the likelihood of something unpleasant happening, and the verb risk as being exposed to danger or loss or act in a way that something bad could happen. All dictionary definitions will give the word risk negative meanings. Alaszewski and Manthorpe (1991) would agree with the negative dictionary definitions of risk and define it as, "the possibility that a given course of action will not achieve its desired outcome but instead some undesired and undesirable situation will develop." Similarly Blackburn (2000) views risk as being a loss or cost as a result of uncertainty (cited in Carson and Bain, 2008).
Carson and Bain (2008) and Titterton (2005) disagree with negative meanings of the word risk; they argue that such definitions are not good enough as they pose more difficulties when taking risks with people's lives. They both argue that risk needs to be explained as looking at the potential benefits and also the potential harms. Alberg (1996) provides a useful definition of risk as, "the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale" (cited in Titterton, 2005:25).
Risk assessment is the stage in risk decision making where information on the elements of risk is collated and assessed, they are usually made to inform risk management. Risk assessment is concerned with 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 we must consider both (Carson and Bain, 2008, Titterton, 2005). The two basic assessment tools used to assess risk are; clinical which involves professional judgement and information from research on risk factors, and actuarial is based upon statistical calculations of risk and is used in the insurance industry (Barry, 2007 and Davies, 2008). Although not exclusively, actuarial data tends to be used during risk assessments and clinical during risk management (Carson and Bain, 2008).
In order to undertake a good risk assessment we should include all the outcomes that could occur as a result of the risk decision and which could happen in the period that the risk is being assessed. If an outcome would happen regardless of a risk assessment being made then it did not happen as a result of a risk decision. The risk decision must have made the outcome more likely or serious; both the seriousness of the outcomes and their likelihood must be considered (Carson and Bain, 2008). When assessing the likelihood of a situation it should be based upon the best knowledge available and whether the decision would have been the same had a responsible body (i.e. SSSC) had considered it (Carson and Bain, 2008).
A good risk assessment has a purpose and this is to explore the potential benefits over the possible harms. If the value of the likely benefits outweighs the value of the likely harms then we will be able to justify taking a risk decision (Titterton, 2005). We need to be able to justify taking a risk before we can learn whether harm will result. If harm does result then it is not bad risk assessment, similarly if a risk decision leads to successful outcomes we cannot say it is good risk assessment. A risk decision needs to be judged on the risk decision processes and procedures, not by the outcomes (Carson and Bain, 2008). It could be argued that there are no benefits of taking a risk and this would be deemed as bad risk assessment and must be challenged (Carson and Bain, 2008).
After a risk assessment has been carried out a decision needs to be made on how to manage the situation. 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 (Carson and Bain, 2008). Risk dimensions are features of risk that could be influenced by the practitioner, for example the available resources to manage the risk and uncertainty (Carson and Bain, 2008). Risk management also means making the most of the potential benefits and including service users in managing risk decisions (Stalker, 2003).
In order to have good risk management we must be able to make effective use of all the dimensions of the risk assessment. This includes the time during and the amount of time of a risk decision being made and the time available to intervene if necessary. We need to be able to identify people and their skills as a resource and use their qualities, knowledge and ability to recognise problems and opportunities should they arise. We should identify and consider both positive and negative opportunities that arise at different stages as we go along a risk path. Before making a risk decision we must explore the quality and quantity of available knowledge and its significance. Knowledge is a form of power and this creates degrees of control, this includes recognising our professional, ethical and legal limits to intervene and control a risk. Good risk management is being able to use all of these resources however there is a barrier, they all cost money. Risk management is political as it is about resources, we require adequate resources for a good risk management plan and lack of resources will have an impact on this (Carson and Bain, 2008).
Risk decisions are complex and may be based on unreliable or uncertain knowledge. If harm could not occur then it would not be a risk, if harms do occur then decision making and risk management will need to be examined and a risk decision that was justifiable before the event must remain justifiable after the event. The practitioner will also need to show that any decisions they did make were in line with best current practice on risk assessment and risk management. Many risk decisions will be good irrespective of poor risk management. (Carson and Bain, 2008 and Davies, 2008).
Risk management is often overshadowed by risk assessment, despite the fact that it can only identify a risk and not lessen it (Stalker, 2003 and Titterton, 2005). It is important to give risk management more credit as it can prevent bad risk assessment. If a poor risk assessment is made then it can result in harm, inquiries and court proceedings. As risk management comes after the risk assessment has been made it can in turn prevent a poor risk assessment from causing harm (Carson and Bain, 2008). Also risk management concerns the implementation of the risk decision and can therefore protect against the consequences of poor risk assessment. In order to make a good risk decision we therefore require good risk assessment and good risk management (Carson and Bain, 2008). Titterton (2005) argues that risk assessment and risk management should be interconnected within the same risk framework.
Brearley's (1982) definition of risk focuses on the negative outcomes of risk (i.e. damage and harm) however despite its restrictions it is argued that it is relevant as he has provided a framework that provides a good starting point for understanding and assessing risk, and that helps assist workers to recognise risk factors when faced with risky situations (Watson and West, 2006 and Kemshall and Pritchard, 1996). Brearley's risk assessment framework is interactive and uses concepts of the systems approach, task centred approach to the actuarial assessment of risk. His framework identifies two types of hazards which he refers to as general predictive hazards (background hazards) and situational hazards (current hazards); a hazard is the possibility of loss or damage that will result in danger. These hazards need to be weighed up with the strengths in order to identify if a risk decision has to be made (Kemshall and Pritchard, 1996).
I incorporated Brearley's (1982) framework with the assessment triangle (DOH, 2000 and Aldgate and Rose, 2006) during my risk assessment and I identified that identified that there were no general predictive factors for Raj, he was not known to social work prior to this assault and there was no evidence to suggest that there had been any issues in the past. The situational hazards for Raj were; he had been assaulted by Mr Hassam, his behaviour changed and he became withdrawn and angry, poverty and poor housing. His strengths were; he was resilient, he attended and enjoyed school, he openly spoke out about how he felt. The danger for Raj was that he was at risk of further physical and/or emotional abuse for being open and honest with me after his father had warned him not to speak to any professionals.
During my risk assessment I had to consider how capable Mr Hassam was of further assaulting Raj and how likely it was to happen. I thought about the severity of the outcomes, for example if I thought there was a chance that the outcome would be death then the likelihood would be lower than if I thought the outcome could be assault. I therefore considered the outcome of my assessment to be that Mr Hassam could assault Raj again and although the outcome could be very serious but I felt that the likelihood of it happening was very low as Mr Hassam had never been violent towards his son before and showed true signs of remorse for his actions. However just because it was extremely unlikely that Mr Hassam would assault Raj again did not mean that I could consider it a low risk. An unlikely event does not become any more likely merely as it could have serious outcomes (Carson and Bain, 2008). During my assessment I referred to The Children (Scotland) Act 1995 as I had a duty to safeguard and promote the welfare of Raj and his welfare is paramount (SCLC, 1995), and also to the values of the SSSC (2005), particularly codes 4.1 and 4.2.
When considering the risk period to work within and how we are basing our assessment we should examine research based upon that period. During my risk assessment I looked at research on domestic violence and child abuse and several studies show that there is a high association between domestic violence and child abuse (physical and emotional); Morely and Mullender (1994) found that between 40-60% of children are physically assaulted by the perpetrator and Epsein and Keep (1994) found that 38% of children who called Childline had been assaulted by the perpetrator. To make the use of the highest knowledge available I also consulted with my practice teacher and PTL and considered their recommendations before making my decision. My risk decision was that it was safe for Raj to remain in the family home with his father, as the potential benefits (e.g. prior to the assault Raj and his father had a good relationship) outweighed the likely harms. I was able to work in partnership with Mr and Mrs Hassan and the school and they were all resources that assisted me with identifying opportunities for Raj. 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.
Reflective practice involves being able to think holistically and in turn this includes exploring facts and feelings, the knowledge and understanding of the situation and being able to look at perspectives subjectively and objectively (Wilson et al, 2008). Schön (1983), Kolb (1984) and Boud et al (1985) have given reflective practice currency in recent years by developing ideas and using and applying them to reflecting on experience and improving action and practice (Brown and Rutter, 2008). I based my reflective accounts in practice on Kolb's (1984) model of experiential learning. Kolb's model explores having concrete practice experience which we then reflect and observe on, construct new ideas on and then experiment with. His model emphasises the importance of using observation and testing our reflection on what we see and experience and being able to build upon how we experience the real world (Adams et al, 2002). Kolb's model has helped me understand that learning is individual and I have to make the connections to existing knowledge, theories and legislation when reflecting on what I have learned.
A number of self evaluation questionnaires derived from Kolb's learning cycle with the aim of helping people identify their learning styles. I used Honey and Mumford's (1992) learning style questionnaire to discover that I am a reflective learner; I will watch and reflect, gather relevant data and examine all the possible options available before making a decison. Using my learning style as a reflector and incorporating Kolb's model of learning I was able to confidently make a risk decision for Raj. I used the supervision process to discuss my learning style and how this assisted me when I put plans of action in place with the Hassam family and how I went through the cycle of experience, reflection, conceptualisation and experimentation (Parker, 2006).
To conclude this piece of work has proved that in order to have a good risk decision then we must have a good risk assessment along with good risk management and my own practice experience was integrated throughout as an illustrative. Today's risk society has a lack of confidence in professionals and this has an impact when they need to make risk decisions, although after using risk and reflective frameworks along with supervision I was confident to be able to make my risk decision and justify it. With the right policies, procedures and support professionals will be able to make good risk decisions and feel confident when doing so.
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