Risk Assessment Case Study
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Keywords: autism social work case study
C is a 14 year old boy who has a diagnosis of autistic spectrum disorder and learning disability. C is a very active young boy. His mother is a P.E teacher and has him involved in many outdoor activities. C loves being outdoors and doing practical 'hands on' things such as cooking and outdoor activities. Although C is involved in various activities, these are all organised by his family. Mrs F feels that C constantly seeks reassurance when doing tasks etc. She would like to develop his dependence by involving him in activities which are not organised by the family. Furthermore Mrs F felt concerned that if anything were ever to happen to her or her husband, she would like to know that C has some experience within a different type of home care setting. I completed a UNOCINI assessment on C and a carer's assessment on Mrs F. From that I felt that C would benefit from some time spent apart from the family. After completing the carer's assessment with Mrs F, I determined that although the main reason for the parents was to develop C's independence now that he is 14, I felt they would also benefit from these few hours of respite. The need for respite was not initially an issue however when I got Mrs F to think about her caring role and the level of caring responsibilities and how this impacted on her socially and emotionally, she acknowledged that yes, these few hours would act as respite for her as she care for C full-time when she comes home from work on weekdays and at the weekends. This option would help to develop his independence and get him more socially integrated in activities not organised by the family. I also identified two other services called 'Enable' and 'Charis'. The family were informed of these services and given the appropriate information. I left this information with the family so that they could make an informed decision. Mr and Mrs F agreed that they would definitely want to consider the option of the respite unit for C to attend for a few hours every week initially, with the view that they may want to increase this at a later date.
The purpose of this piece of work is to carry out a risk assessment prior to C commencing the rest bite unit. This will need to consider any risks there are with C, how C may behave, what the triggers etc are and how the staff at O can best deal with these risks. Because there are significant behavioural problems with C, the risks are mainly centred around outdoor safety as he has a significant fear of dogs, his dislike of loud noises and consideration of his speech difficulties which will most likely result in communication difficulties. These factors all present risks to C and this meeting is an opportunity for C's parents, a staff member from the unit, C's teacher and I to come together, identify the risks, discuss how they are a risk to C and identify the best ways the staff can manage these risks.
Legislation that will guide my practice
As a student social worker I have a duty to practice in a professional and legal manner and it is important that I am aware of the legislation related to disability, which provides the mandate for the intervention.
The Health and Personal Social Services (NI) Order (1972) sets out the role of social workers in Article 4 as having a duty to promote the well being of all the public.
The Chronically Sick & Disabled Persons Act 1978 legally obliges Personal Social Services to disseminate information, assess need, collect and maintain confidential information and provide Social Welfare Services to meet the needs of any person defined as chronically sick and/or disabled. Under this piece of legislation disabled people have the right to live in the community and be provided with appropriate support services. Under section one, authorities have a duty to inform themselves of the number and needs of handicapped persons in their areas and a duty to publicise available services. Section 2 lists various services which should be provided to meet the needs of disabled people including; social work support to families, adaptations to the home and including special equipment, holiday arrangements and meals (Oliver&Sapey, 2006). An opportunity for C to develop his independence has been identified as a need for C. I have enquired into the services available and signposted the family to these services. It is now their decision as to whether they want to avail of them or not.
The Children (NI) Order 1995 is the main piece of legislation associated with the Children's Disability Unit. This piece of legislation sets out the powers and duties of the Trust in relation to Children in Need and others. The Trust sets out clear assessment procedures for children in need which take account of any special needs. The order outlines that children with a disability will, in many cases, require continuing services throughout their lives therefore the assessment process needs to take account of any special needs and to take a longer perspective than for other children in need. A holistic assessment is needed to determine what is best needed for that child, taking into account the child and family's strengths, weaknesses and capacities. I have assessed the needs of C and his parents and from that I feel that I strongly feel this service will be of benefit to both C and his parents.
Article 17 (c) defines a 'child in need' as a child with a disability; C has a diagnosis of autism and learning disability and therefore is considered a child in need due to this disability. Also I am aware that in accordance with this legislation (Article 17 a & b) I have a responsibility to ensure C achieves or maintains a reasonable standard of development or health through the provision of services. I will bear in mind Article 18 which sets out the trusts duty to support children in need. I had a duty to support C by carrying out an assessment of need which will allowed me to determine what type of support C required. Support may be provided in terms of providing services, signposting, referral to other agencies or the worker may provide emotional support, 1 to 1 work, advice, a listening ear etc. In this instance I have provided the appropriate support through signposting the family to two other services for C and I am in the process of providing them with a respite service.
Within my work with children I am conscious that the welfare of the child is paramount and that this supersedes all else (Article 3 (1). To ensure I achieve this I have knowledge of and will make reference to The Welfare Checklist Article 3 (3) (Children NI Order 1995)
The Disabled Persons Act (NI) 1989 also gives the mandate for the intervention. It gives individuals more control over their lives by providing them with the right to; representation, consultation, assessment, information this I consider to be my role. Carers also have the right to request an assessment and the ability to care is taken into consideration during the assessment process and when decisions are made. The legislation ensures that disabled people have equal opportunities in terms of services amongst other things. I have already completed a carers assessment with Mrs F which indicated that this service would also be of benefit for her as C's carer.
United Nations Convention on the Rights of the Child (1991) set out for the first time, the rights of the child. Article 2 states, 'Whereby appropriate measures should be taken to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child, parents, legal guardians or family member and under article 6 whereby all children have the right to life and to the greatest possible opportunities to develop fully. It is hoped that through C spending some time away from his family, it will develop his independence. Under article 3, whereby in all actions the best interests of the child shall be a primary consideration. In assessing the risks associated with C, we will be able to identify what the risks are, what the level of risk is, are there any triggers, what primary preventative strategies can be used to avoid these behaviors and reactions occurring, what secondary measures should be introduced if the behaviors become apparent, what reactive strategies should be required, specify any unmanaged risks and determine what should be the response following a behavioral incident.
The Human Rights Act 1998 brought the European Convention of Human Rights into domestic law. Human rights are universal legal guarantees protecting individuals and groups against actions and omissions that affect their freedom and human dignity (SHSSB, 2004: 42). Every child has rights under the United Nation Convention on the Rights of the child 1989. Every child has a right to survival, developmental, protection and participation rights. Article 23 of the UNCRC states that a disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self reliance and facilitate the child's active participation in the community.
I am mindful that the Data Protection Act (1998) must be adhered to at all times in order to ensure that information is accessed only by people who have a right to access it. This ensures that service user confidentiality is respected and that relevant and accurate information is stored. This legislation safeguards personal data i.e. personal information that is stored on computer and on relevant manual filing systems under eight principles.
Policies and Procedures
It is imperative that as an student of the trust I have knowledge of the Trust Policies and Procedures and how they inform my practice. It is important that I inform Mrs F about the complaints procedure and provide a leaflet advising individuals of how to make a complaint and express their views about the Trust services. It is important for the Trust to have feedback from service users as this enables the Trust to change and improve standards of services were appropriate. Furthermore it is important service users are aware of the confidentiality policy. I will explain to Mrs F that the information discussed within the meeting will be kept confidential.
Risk became a dominant preoccupation within Western society towards the end of the 20th century, to the point where we are now said to live in a 'risk society', with an emphasis on uncertainty, individualization and culpability (Beck, 1992). Social workers frequently have to deal with risk. Obvious examples would be when there are concerns about the safety of children. The process of assessing risk highlights the complexity of the social work role. The fact that decisions have to be made seems to require an element of control in people's lives and this can cause conflict for some workers. The question often arises about the obvious power imbalance between the worker and the service user and issues can surface around care versus control.
Burke and Cigno (2000) pose the question as to what degree of vulnerability in children reaches the degree of threshold for intervention, and what should be done to minimize the risks to children. These are difficult issues to reconcile. All parties concerned should be aware that allowing children to take a certain amount of risk is recognition of human beings to fulfill their potential. Denial of risk-taking greatly reduces steps towards independence and decreases quality of life. Trying to balance between parental and organisational protectiveness and acceptance of the child's need to take risks can be a difficult undertaking. There is also the problem of communicating effectively with children their wishes and needs. In the case of children and young people with learning difficulties, professionals are likely to have to learn additional ways of ascertaining the child's wishes and assessing his or her situation.
"All forms of risk need to be acknowledged in any assessment or evaluation" (Trevithick, 2003: 115). A risk assessment is only valid for the situation which it has been carried out in and needs to be an ongoing process as the child develops. It is important to recognize that the situations of children and families are not static they are fluid and changing. Each individual risk has a lifespan and needs to be constantly monitored and reviewed. However, it is important not to give the concept of risk more weight than is needed by becoming too focused on controlling risks. Questions should be asked about whether or not the level of risk is acceptable, sometimes risk is inevitable and to try and control everything a person can or cannot do can be a breach of a person's basic human rights. The Bamford's Review of Mental Health and Learning Disability Equal Lives Group argued how service users want the chance to make their own choices in life and to be supported by the professionals around them, not simply told what they can and cannot do. Hope and Sparks (2000) suggest that a risk assessment can only identify the problem of harm, assess the impact of it on key individuals, and pose intervention strategies which may diminish the risk or reduce harm. They do not believe that assessments can prevent risk completely. This is something which I would be inclined to agree with.
Beckett and Maynard propose that control may be used to protect service users, staff and other members of the community and that by controlling the extent of potential risks that we are ensuring that the best possible care can be delivered. They feel that "control" used appropriately is not the opposite of care, but on the contrary is an expression of care. We should not fall into the simplistic idea that the use of statutory powers is necessarily 'oppressive' or that working in other ways is necessarily anti-oppressive.
There has been a concurrent growing mistrust of professionals in social work and an increased reliance by the profession on complex systems of assessment, monitoring and quality control (Stalker, 2003). Parton (1998) proposes that the 'blaming society' is now more concerned with risk avoidance and defensive practice than with professional expertise and welfare development. However, risk is a normal and often beneficial part of everyday life. While it enables learning and understanding, in the case of potentially destructive consequences it may need to be monitored and restricted.
The Southern Health and Social Care Trust (2008), define risk as "the chance, great or small, that damage or an adverse outcome of some kind will occur as a result of a particular hazard. It is the threat that an event or some action will adversely affect the Trust's ability to successfully execute its strategies and achieve its objectives. It is a process of continual improvement which requires the identification, assessment, analysis, evaluation, treatment, monitoring and communication of risk." The Southern Trust 'Risk Management Strategy' recognizes the need to reduce and eliminate or reduce all identifiable risk to the lowest practicable level. The trust is committed to achieving this through a holistic approach based on the principle that "risk management is everybody's responsibility".
There are two important models to consider when assessing risk, that of Brearley and that of Greg Kelly. Brearley's analysis of risk talks about predisposing hazards, which are factors that cannot be changed or are difficult to change before decisions are to be taken. He talks about situational hazards, which are factors specific to the situation that can be changed. Brearley also takes into account the strengths of the situation as factors that decrease the possibility of a poor or 'loss' outcome. This is a positive step which may encourage families if their strengths are acknowledged. The Children's (NI) Order 1995, promotes the welfare of the child and risk assessment and risk management are now a central part of the social work role and should acknowledged accordingly.
Greg Kelly's model is designed for use when there are serious concerns for the welfare of the child. It is designed to help clarify the issues in relation to the protection of children, to address key questions in decision making in situations where risk is present, 'what is the problem and how serious is it?' The development of a non-technical language (strengths and weaknesses) has made the model useful in sharing and discussing issues with parents. What is very useful about this model is that it categorises risk. Thus to agree on the degree of risk is to agree on the harm that is more likely (high risk) or less likely (low risk) to occur in the absence of preventative measures. It inevitably involves a degree of predicting future events. Almost by definition taking decisions in situations of risk means taking them not in ideal circumstances and with less knowledge than we feel we need. Despite the dangers, however, children's circumstances sometimes require that we take decisions based on our best estimate of the risk of harm to them in a particular situation and at a particular time.
The risk assessment pro-forma used at O respite unit is based on Greg Kelly's model in that it categorises risk as high, low or medium. High Risk would be recent and regular occurrence of behaviour, for example in the past 3 months. Medium risk would be recent and only occasional occurrence in the past 3 months. Low risk would be seen as having happened in the past but would only have occurred very minimally in the past 3 months. The assessment here is not just the potential of risk of harm to the children, but also the individual measures staff can take to prevent the likelihood of the risk actualizing and any steps that management may need to take.
Person centred planning is rooted in the belief that people with disabilities are entitled to the same rights, opportunities and choices as other members of the community. Person centred planning has been around for about twenty-five years and its principles are about sharing power with service users and community inclusion. This way of thinking insists that people with disabilities have the same quality of life and position in society which is equal to people without disabilities. It challenges the idea of grouping people together on the basis that they are perceived as needing the same level of assistance. Person centred planning asks how the client wants to live their life and ways that they think could make this possible and if they require any support with this. Person centred planning has five key features:- The person is at the centre, family members and friends are partners in planning, the plan reflects what is important to the person, their capacities and what support they require, the plan helps build the persons place in the community to welcome them. It is not just about services and reflects what is possible, not just what is available. The plan results in ongoing listening, learning, and further action. Putting the plan into action helps the person to achieve what they want out of life.
Person centred planning is about the social worker facilitating the service user to take control of his or her own lives and move forward as much as is possible. Coulshed and Orme (2006) illustrate how it focuses on the individual as unique and special in their own situation. It is important for the social worker to develop a good relationship with the service users for this approach to be successful. "It encourages the development of an equal, non-authoritarian relationship where both service user and social worker work together to establish a significant and meaningful relationship." (Trevithick, 2006: 271)
It is important in person-centred planning to work out what is important to the client but also what is important for the client, which can sometimes be difficult. This can even be simple things such as pen pictures which illustrate the things which are of most important to our clients. This can include information such as favourite foods, colours, clothes, possessions, people, activities or place. It is important to remember these principles when I am completing the risk assessment and ensuring that it is a personalised account of this child.
My knowledge of risk assessment is initially very limited. Although I have completed various UNOCINI assessments, and within that you are thinking about risk and identifying potential risks for that child or family if certain support networks or services etc are not put in place, this is not as extensive as this specific 'risk assessment' I am to undertake with C. I read around the topic of risk assessment and took into account the different models, especially the Southern Trusts Risk Management Strategy. I also considered number 4 of NISCC objectives which was to "manage risk to individuals, families, carers, groups, and communities, self and other colleagues. This increased my sense of purpose and direction in which the risk assessment was to take.
I have good knowledge around C and the family as I had completed the initial assessment. I have previously met with C's teacher which gave me an insight into Cs daily routine at school and explained the best way to communicate with C. Further to this I read a completed risk assessment which used the same pro-forma to gain a better understanding of how the information gathered should flow.
It is important to have an understanding of what autism is and how it can impact on a person and their family as C has autism. Having shadowed the autism support worker few home visits to see children who have autism, I already had an insight into the importance of the schedule and routine for children who have autism. I had also previously increased my knowledge base by talking to the autism support worker within the team about the disorder and its effects. My first degree in Psychology also looked at autism and its effects on development so I have refreshed my memory and read my notes again.
Tuning into my own feelings as a worker
I feel a little nervous as I will be facilitating this meeting. I feel nervous about the fact that there will be other professionals such as C's teacher and the social worker and manager from the respite unit. Furthermore, Mrs F is also a teacher. Considering Mrs F's profession, she may have standards and I hope I am able to effectively facilitate the meeting in a professional manner which meets her standards. In saying this, I have met with Mrs F on a few occasions and I feel very comfortable with her. I want to be able to facilitate this meeting as effectively as possible in ensuring everyone gets an opportunity to contribute, all opinions are considered, all risks are identified and a plan is set in place which will effectively manage these risks. I feel slightly more confident in that I have met with the social work manager and C's teacher before and feel I have built up a good rapport with Mrs F.
Tuning C's feelings
C is unable to contribute to the meeting due to his learning disability.
Tuning into parents feelings
This is a new experience for Mrs F as she is C's main carer and the only time they are ever apart is when C is away at school. She may be feeling anxious about considering the risks there are with C. She is placing a lot of trust in the staff at O in order to be aware of these risks and manage them. However this is an opportunity for Mrs F to inform the staff on how to best, most effectively manage the risks associates with C. In turn this meeting may consequently lessen Mrs F's anxieties in knowing that we have identifies the relevant risks and we are fully aware of how to most appropriately manage these risks. This will hopefully provide reassurance for Mrs F in knowing that the relevant safeguards will be put in place prior to C commencing the unit.
It is important that I am able to analyze the information from the O assessment in order to determine if there are any risks, what they are, how they are currently managed and how they could be best managed by staff members. I have already analyzed what the risks are. I have determined that C's communication is a risk as there is a risk he may become distressed if the staff at O do not understand him. I thus felt inviting C's teacher to the meeting was important. I felt this could also act as an information sharing meeting whereby the people that C spends most time with such as his mother and teacher would be able to give input on how best to communicate with C. C's teacher previously informed me that use of the PECS and super symbols would be essential to apply in order to effectively communicate with C, until such times as the staff familiarise themselves with C. The ability to analyze involves breaking a situation or issue down into its component parts so that the inter-connections and patterns can be uncovered (Thompson, 2005). I need to be able to analyze the information gathered to determine what the risks are, to determine the level of risk and determine what safe guards need to be put in place in order to try and reduce these risks.
Communication has been defined as, 'the verbal and non verbal exchange of information, including all the ways in which knowledge is transmitted and received' (Barker, 2003: 83). I will be facilitating this meeting and thus I need to communicate in a clear and concise fashion in explaining the purpose of the meeting, what I hope to cover, why and what I hope to achieve. I will explain the relevance of inviting Miss V, C's teacher and explain how I hope she will be able to contribute to the meeting. This will reassure Miss V of her role, purpose and prepare her for what she may want to say with regard to how the staff can best communicate with C. I will similarly explain the relevance of why C's parents are there also, in that they know C best as his parents and carers and their input and advice will be most valuable with regards to identifying any additional risks I may have missed, and how to manage these and give any input they wish throughout the meeting. This is also an opportunity for C's parents to ask any additional questions, be reassured that we are aware of the risks involved with their son, the appropriate safeguards will be put in place to try and minimize the risks and what plan they have in place if something does happen to C.
Negotiation skills are vital as a result of this Risk Assessment. I have invited the relevant persons to this meeting so important information can be shared with regard to how certain risks can be most effectively managed. Miss V, C's teacher has a good insight into effective communication exchange techniques which will allow the staff and C to effectively communicate with each other and understand what C is communicating. This is vital in order to prevent C from feeling frustrated if noone understood what he was saying or what he wanted etc. I will be looking upon Mr and Mrs F are experts in their own family lives. Noone will know C better than themselves and thus their input is vital in indentifying any additional risks, how they can best be managed. Before we end the discussion, in order for the risk assessment to be effective I feel it is necessary that everyone negotiates on how the risks can most effectively be managed.
Trevithick (2005) proposes that listening provides a creative opportunity to demonstrate our commitment and care. The essence of good listening is learning about how to reach the emotions and thoughts of others; it requires active involvement and engagement with the client. I am confident in my ability to convey that I am valuing Mrs F's contribution as she is the expert her family life with C and Mrs V's contribution as C's teacher.
I am committed to anti-oppressive practice and Thompson's PCS model of discrimination helps me to be mindful of this. Thompson analyses discrimination in terms of three levels: the personal, which highlights the feelings and attitudes at an individual level; the cultural which refers the social "norms", and the structural level which is the way that oppression and discrimination can be institutionalised in society.
Biesteck value principles are principles of the social worker-service user relationship which are deemed to be effective forms of practice. The principles are:- individualization, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality.
I think these value principles have a lot to offer professionals. I think in terms of this risk assessment I will be aware of the importance of individualisation. This is a specific piece of work which directly impact on the care and support that C will receive while he is at O for respite. It is vital that the work is an accurate representation of C and his individual needs. Biesteck's value principles are a useful checklist to ensure that we are practicing in an anti-oppressive manner.
One of the core values that I believe to be relevant in all of my work is respect for the person I am working with. Valuing Ms F and treating her with dignity is fundamental to a good working relationship. This should be a part of my everyday practice, part of empowerment, participation and choice (Payne, 1998). Thompson acknowledged the importance of respecting persons and "not treating them in a way that you would object to if other people treated you like that" (Thompson, 2000).
In order to build trust and a positive working relationship with Ms F, Roger's (1961) core conditions of empathy, congruence and unconditional positive regard are vital. I need to be able to convey to Mrs F that I understand their situation and their feelings. In order to do this I need to be open and honest and convey warmth and a non-judgmental attitude to Mrs F. If my work is to be effective it needs to be based on partnership. I hope to convey to Mrs F that she will always will be the expert on herself and C and their family situation. Within a social work context, it is the service users who should define their own needs and dictate wherever possible how their needs should be met (Parker & Bradley 2003). Useful pointers in developing a relationship based on partnership include: do not do most of the talking, do not put words into peoples mouths, help everyone feel comfortable, particularly Mrs F.
Empowerment involves seeking to maximise the power of clients and to give them as much control as possible over their circumstances. It is the opposite of creating dependency and subjecting clients to agency power (Thompson 1993:80). I will be reminding Mrs F of the importance of her contribution in identifying any risks and advising on how she best manages those risks at present as no one knows C better than herself. Hopefully this reassurance will empower Mrs F to contribute as much as possible to the sharing of information.
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