Ms Ang Bee Lian, 22 December 2014
We hear about how social workers and caseworkers should conduct risk assessment and consider how to manage the risks. In reality, activities such as risk assessment, risk management, monitoring risk and actual risk-taking should be considerations for both practitioners and managers. All of these should be part of the assessment process.
However, as services expand and assessment or a lack of it becomes more widespread, there is greater reliance on managerialism implicit in corporate risk management strategy. Some may even advise that this takes the form of an automated risk assessment system. But as one researcher, Cooper et al (2003) would argue, such systems can decrease the chances of being able to identify and manage risk productively1.
So what has happened in some social care and case management settings is that escalating assessment, monitoring and quality control procedures and systems take priority over the personal care dimensions of service delivery. While it is not completely bad, there is a need to balance such defensive practice where risk avoidance dominates, with professional assessment and risk taking. We need to recognise and acknowledge that risk is part of everyday life from which we can learn. To create positive change we need to move away from an over reliance on risk assessment systems which are ‘automated.’
So how should we think about risk and how can we look at risk during our assessment of cases? Risk can be defined as ‘the possibility of beneficial and harmful outcomes, and the likelihood of their occurrence in a stated timescale’ (Alberg et al in Titterton, 2005)2.
Firstly, we need to understand the context of the assessment and secondly, we need to know that any risk can move along a continuum. In other words, it is good to understand risk assessment as a dynamic process.
The aim of risk assessment is to consider a situation, event or decision and to identify the chances of the risks falling into a matrix with dimensions of ‘likely or unlikely’ and ‘harmful or beneficial’. The aim of risk management is to devise strategies that will help move risk from the likely and harmful category to the unlikely or beneficial categories.
Most models of risk assessment recognise that it is not possible to eliminate risk. What a caseworker or case manager does with a comprehensive risk assessment however is equally important to identifying risks. As a general rule, good and professional practice would take a stronger interventionist approach where the risks pertain to health and safety matters.
When risks are marked along a continuum, they call for a response or an approach to managing the risks. The continuum generally can be marked by controlling attitudes at one end and more empowering approaches at the other. The more controlling and strong interventionist approach would be evident in the form of risk avoidance strategies while the more empowering approach would take the form of positive risk-taking.
We must remember that it is crucial to have good risk assessment to identify the probability of harm and assess the impact of it on key individuals. It is equally important to have intervention strategies which may diminish the risk or reduce the harm. Assessments however, cannot prevent risk.
Social workers are also expected to balance rights and responsibilities in relation to risk; to regularly re-assess risk; to recognise the risks to their clients, significant others, their colleagues and themselves; and to work within the risk assessment procedures of their organisation and the profession.
Most of the time, risk assessment and its management are discussed by caseworkers and service providers. The views of service users (including carers) and their involvement are generally not actively sought in discussing the risk issues. Yet their role in taking and managing risks on a day to day basis can be important.
Risk assessment is not taught widely and there is an increasing realisation that using a framework can be useful. It starts with the context of assessment and knowing what the purpose of the assessment is. For example, it is important to consider if the assessment is taking place in the context of legislation, a legal framework or policy intent. This then determines the identification and management of risk.
So the objective of each framework is different and the nature of the risks that are of concern will be different too. The frameworks for the assessment of children, families or vulnerable adults would address client vulnerability and the avoidance of significant harm while in the case of older persons, the framework for assessment would address the loss of independence.
What is important to remember is that the assessment of carers must focus on the risk of the breakdown of the carer’s role (Crisp et al, 2005, p 47). Reviews of serious incidents often show these learning points. Firstly, risks need to be monitored after risk assessment is made as situations and circumstances especially of vulnerable clients can be very changeable. In the situation where a carer is a key factor in moderating a risk, the breakdown or the instability in the carer’s role can raise a risk significantly. Another common risk moderating factor that can change quite easily is the physical separation of a perpetrator and a victim or vulnerable person which lowers a risk. This risk can however escalate very quickly when both are together again without supervision and when the trigger that caused the risk has resurfaced. Secondly, a deterioration or relapse in the mental or physical condition of a client can put the person at higher risk.
Sometimes the presence of alternate supplementary caregivers in the form of a grandparent could give the impression that there were fewer child risk issues. It is nevertheless useful to bear in mind that when there is an adult with a mental health condition, the family’s circumstances should be monitored as changes could give rise to stressors or relapses. There is also a need to monitor both the adult’s and the family’s coping abilities especially when there is a child with special needs involved.
Risk should be at the core of assessment. And the extent of attention we should give to it would depend on the purpose of an assessment. As risk is based on a perspective, what is perceived as a risk is not necessarily always agreed by all involved with the family or individual. Based on the context of assessment and being able to have a plan to manage the risk, presupposes that there needs to be an agreement of what those risks are.
The challenge with risk assessment is that it can cause stress for the professional especially in situations where there are few options for alternative placement or support for clients. In some instances, it can also give rise to a phenomenon called “talking down a problem” to address this dilemma of not having an alternative. So risk management is not easy and we need to begin to dig deeper into the “contested” nature of risk assessment, the different perceptions among different groups about risk and what the approach to risk management might be.
1 Cooper, A., Hetherington, R. and Katz, I. (2003). The Risk Factor: Making the child protection system work for children. London: Demos
2 Titterton, M. (2005). Risk and risk taking in health and social welfare. London: Jessica Kingsley
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MS ANG BEE LIAN
Director-General of Social Welfare