What is Risk?

What is Risk?What is Risk? Risk taking can have beneficial outcomes as well

as harmful outcomes. We should be prepared to identify the types of benefits and harms which may occur, as well as their likelihood.

We can try and be more specific about the range of factors which affect the likelihood or probability of certain kinds of outcomes.

We can also attempt to specify the time-scale within which the risk taking activity is intended to take place.

A handy definition of 'risk' is:“the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated time-scale”.

Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

Ministerial StatementMinisterial Statement

“There will, unfortunately, sometimes be cases which go wrong. We have to accept this in the

uncertain environment of risk assessment.

But when this happens, the public needs the assurance that everything that could reasonably have been done to prevent it was done, and the highest standards of management and practice

must come into play.”

Henry McLeish

ADSW Seminar on Risk Assessment

(February 1998)


DefensibilityDefensibility The key concept of risk assessment and

management Remind us that 'risk' is not just a practice,

operational or management issue Risk has a 'political' dimension When disaster strikes ministers and civil servants

need to be able to say: 'In this case practice and management in all involved services was exemplary'

Defensibility is a bridge concept linking the inevitability of a serious incident happening with best practice/best professional judgement


Defensibility Defensibility (cont)(cont) Serious incident – the working assumptions must not be

'if' or 'whether'... but 'when' When a serious incident happens we might expect to be

asked two types of questions: General Questions about the use/management of

resources, decision making rationale in services. Our best practice/best judgement and our commitment to implementation

Specific Questions about the specific offender in specific situations – 'the foreseeability' of his actions and the quality of our responses to this

Defensible practice is not the same as defensive practice Mike Titterton, The Vision Thing & Sheena Robertson, Fife CouncilMike Titterton, The Vision Thing & Sheena Robertson, Fife Council

PRAMSPRAMS

The Person-Centred Risk Assessment & Management System involves work on these main elements :

Establishing Principles Creating Policies Assessing Risk Devising Risk Plans Managing Risk


Squaring the CircleSquaring the Circle


Risk Assessment- MDO'sRisk Assessment- MDO's(Complex Issues)(Complex Issues)

Offending may not be strongly, clearly, directly associated with mental disorder and vice versa


Previous Research and its InfluencePrevious Research and its Influence

Not all previous research reflects current thinking For example:

– The close linkage of predisposition to offending and the triad of childhood enuresis, fire-raising and cruelty to animals no longer appears to be a strong indicator of MDO


Risk Assessment ToolsRisk Assessment Tools

Use of measurements of risk must be considered in context

Different areas prefer different tools Some tools lend themselves better to certain

purposes You do not need to be an expert on any given

tool to be competent in risk assessment


Influence of Personal and Influence of Personal and Professional IssuesProfessional Issues

Your own attitude to risk will influence your judgement – e.g. are you a high risk-taker in your personal life?

Past experience will influence your judgement – e.g. If you have been run-over in the past you will

take less risks crossing the road in the future Influence of your employing authority

– Is it complacent, has it just undergone an inquiry etc.…?


Assessing the Risk of Assessing the Risk of Re-OffendingRe-Offending

Two approaches:

– Actuarial/Static Factors– Clinical/Dynamic Factors


ActuarialActuarial

Has roots in insurance Relies on mathematical statistic Involves assigning offenders to a group of

people shared profiles Makes inferences/predictions on basis of

'average' member of the group


Examples of Static FactorsExamples of Static Factors

Present age Age when started offending Sex Number of custodies under 21 Number of convictions Offence seriousness


Examples of Dynamic Factors-Examples of Dynamic Factors-Focus of Clinical AssessmentFocus of Clinical Assessment

Accommodation

Mental illness

Alcohol/drug misuse

Employment difficulties


Problems with Clinical AssessmentProblems with Clinical Assessment

Undue emphasis on relationship between assessor and offender

Depends on interviewing skills of assessor (open to manipulation)

Clinical optimism Draws casual links where perhaps none exist Frequently downgrades situational factors


Collect Clinical/Contextual Collect Clinical/Contextual InformationInformation (dynamic) (dynamic)

Consider how this affects risk – e.g. Are there media/victim concerns?)

Is deteriorating mental disorder responsible for raising risk?

Is risk raised/lowered if subject is in employment? Is in a relationship?

Is risk raised if the subject is in a stressful situation?


Piecing it TogetherPiecing it Together

Bring together these static and

dynamic factors


Combined Approach: Combined Approach: Antecedents, Behaviours, ConditionsAntecedents, Behaviours, Conditions ANTECEDENT (PATTERNS)

– Collect information on previous convictions and history of behaviour

– This information can answer the question: IS IT LIKELY? The indicators used are usually static (ACTUARIAL)

BEHAVIOURS

– Collect information on behaviour traits and learned responses etc. This information can answer the question IS IT LIKELY AND WHY IS IT LIKELY?

– The indicator used are a combination of ACTUARIAL and CLINICAL


Combined Approach: Antecedents, Combined Approach: Antecedents, Behaviours, ConditionsBehaviours, Conditions (cont) (cont)

CONDITIONS– Collect information on situation triggers,

stresses, conditions and circumstances of behaviour.

– This information can answer the question:

WHEN AND UNDER WHAT CONDITIONS WILL OFFENDING TAKE PLACE?

– The indicators are usually clinical


Popular ToolsPopular Tools

RAMAS

HCR 20


Component of Good Risk AssessmentComponent of Good Risk Assessment

Collecting full information concerning the offender Using actuarial as well as clinical data Awareness of the range of risk “situational

triggers” or “risk factors” Communicating with all interested parties Identification of all potential outcomes and their

likelihood, i.e. Identification of danger(s) Clarify individual roles and responsibilities


Process of Risk AssessmentProcess of Risk Assessment

Share info re risk in multi-agency setting Ensure clear communication and

understanding Seek multi agency agreement and record and

dissent Move on from assessment to risk

management


Crucial to the ProcessCrucial to the Process

When/how/why is the process of risk assessment triggered?

Is there a clear and agreed process for identifying those who need formal, multi-agency shared risk assessment?

Is it shared and articulated by all partners?


What Helps/What Should What Helps/What Should We Be Aiming For?We Be Aiming For?

Process agreed in multi-agency environment Collect historical information (static factors) Cross reference historical information for

verification Information should be collected from all

agencies (are there issues of confidentiality?)


Risk ManagementRisk Management

It involves developing a systematic approach which allows us to plan risk taking strategies and to monitor and review what is happening

A good risk management process will help to ensure accountability, clarity and support for staff involved in the risk decision


Risk Management Risk Management (cont)(cont)

The management of risk must be adaptable and flexible

Risk Management = Process of Compromise and Negotiation


Key Steps for Risk Management

1. Consult & Communicate There needs to be a process of

communication with everyone involved: Be prepared for negotiation and

compromise on all sides Consultation with all involved is essential in

order to reach clear and shared understandings


Key Steps for Risk Management Key Steps for Risk Management (cont)(cont)

2. Prepare Risk Plan

An Individual Risk Plan (linked to the Care Plan) should include clear statements on: a) who has been consultedb) who is responsible for planning and implementationc) the steps that will be taken to minimise possible

harms d) the steps to be taken to enhance possible benefitse) agreed timescalesf) the points at which intervention would occur and

how this will happeng) the milestones for measuring success or failureh) arrangements for record keeping


Risk Management for MDO'sRisk Management for MDO's

Look at risks identified and how dynamic factors affect them

Identify which risks are acceptable/ which are not acceptable

Identify positive and protective factors Identify de stabilisers Identify needs for treatment, social care and

support


Creating a PlanCreating a Plan

Identify what needs to be provided and by whom

Identify a system whereby information is shared re incidents (major and minor)

Ensure that all players have back-up Consider potential scenarios


Drafting a PlanDrafting a Plan

Develop management plan in format

– i.e. CPA or RAMAS or HCR 20 or other risk formulation (note ref HCR 20 etc, the distinction between the use of the tool as assessment and its structure as a format)

Ensure risk formulation considers proactive and reactive strategies

Consider protocols should “?” occur


Why do People Change Why do People Change Risk Behaviour?Risk Behaviour?

Costs outweigh benefits Rewarding behaviour is framed as risk Risks and harms to others recognised Motivation to change is established Desirability of change is accepted Risk taking behaviour is limited by external

constraints


Principles of Risk ManagementPrinciples of Risk Management

Limit opportunities to carry out risky behaviour Restrict access to victims If appropriate warn/protect victims Reduce triggers, stressors and situational

factors associated with the risky behaviour of the offender


Principles of Risk Management Principles of Risk Management (cont)(cont)

If possible change risky behaviour and where possible promote self-risk management by offenders

Adopt the most effective intervention methods (cognitive behavioural)

Recognise false compliers – those who continue risky behaviour while presenting compliance to programmes and orders

Carry out appropriate monitoring surveillance and control


Key Steps for Risk Management Key Steps for Risk Management contdcontd

3. Sign UpThis should be a “signing up” process where

the individual, their family and formal and informal carers are fully aware of the risk assessment and risk decisions. All parties to the risk decision should provide their signatures with dates attached

4. Share Information An information strategy for managing the

risks is essential: everyone involved must be prepared to share information and maintain awareness


Sharing & CommunicatingSharing & Communicating

Discuss risk management plan in multi-agency arena

Ensure clear communication and understanding

Ensure sign-up of professionals and record of dissent

Consider “senior” sign-up


Key Steps for Risk ManagementKey Steps for Risk Management

5. Monitor & ReviewProvision must be made for regular

monitoring and reviewing: the frequency of reviews, intensity of monitoring and extent to which other staff and agencies are involved should be made clear and written down

6. Support StaffSupport and supervisory arrangements for staff involved in making difficult risk

decisions should be clearly spelled out. It is vital that staff are given support when there is an adverse outcome to the risk decision


ImplementationImplementation

Recognise that there will be events

As soon as possible undertake multi-agency

critical analysis of event (not blame pointing)

Amend risk management plan accordingly


Organizational ErrorsOrganizational Errors Poor flow of information Poor information exchange Veneer of precision Risk management procedures often presented to

staff/and public as controlled Step by step procedures subject to strict monitoring with

well prescribed rules covering every eventuality of risk Failure to understand that general principles and rules

have to be carried out within particular local contexts Response to complexity translated into “worker

resistance” Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

Management WeaknessesManagement Weaknesses

Poor resource allocation to risk work Poor case allocation/case management procedures Poor training and support of staff Poor range and quality of risk indicators employed Administrative systems inadequate to support

effective risk work Over reliance on 'launch' of risk policies, launch as

event rather than policy Ducking responsibilities


PrinciplesPrinciples What we need is a positive conception of risk and

a more balanced approach to risk and safety.

Risk involves the following:

– It is an essential and unavoidable part of everyday life

– It involves choice

– It can help promote the dignity and rights of the individual

However we also have to acknowledge that rights have to be balanced against responsibilities.


PoliciesPolicies

Setting Out a Risk Taking Policy This is a written statement of the aims and values

of your agency describes the role that staff have. It deals with what your agency expect of its staff and what users and carers can expect of your agency

What a policy on risk taking does:

– Outlines the principles upon which risks are treated in your agency

– Defines the roles, rights and responsibilities of staff and your agency

– Includes a code of practice governing the conduct of staff within your agency


What is risk taking?What is risk taking?

We can define the concept of “risk taking” as follows:

'Risk taking is a course of purposeful action based on informed decisions concerning the possibility of positive and negative outcomes

of types and levels of risk appropriate in certain situations.'

(Titterton 2005, p. 25)


Risk Taking ApproachRisk Taking Approach

Professionals working with vulnerable people must be prepared to accept the challenge of finding imaginative answers to the problem of the balance between danger and safety


Risk Taking Approach Risk Taking Approach (cont)(cont)

We need to develop of a “risk taking approach” which:

1. Celebrates the taking of risks as a way of enhancing people’s lives

2. Recognises the importance of psychological and emotional needs, as well as physical needs

3. Promotes choice and autonomy for the individual4. Values the individual, irrespective of whether they live in

community or institutional settings5. Promotes the rights of vulnerable people and their

carers, while accepting that these will sometimes be in conflict


Welfare DilemmasWelfare Dilemmas

A welfare dilemma involves choices that welfare professionals, vulnerable people, their informal

carers and their communities face between options that entail possible benefits and

possible harms. These choices may be

equally acceptable but their outcomes

essentially remain unknown.

(Titterton 2005, p.50)


Welfare DilemmasWelfare Dilemmas


Safety First ModelSafety First Model

Focus on:

– physical health

– disabilities (what person can’t do)

– danger

– control

– what assessor thinks is right


Risk Taking ModelRisk Taking Model

Focus on:

– Physical, psychological and emotional well-being

– Rights and responsibilities

– Abilities and disabilities (what person can achieve)

– Choices and opportunities

– Involvement of individual and family/carers


ConclusionsConclusionsKey points emerge:

1 The necessity for training and development of practitioners and manager

2 The need for identifying good practice in risk assessment and risk management

3 The need for identifying good practice in risk taking

4 The importance of multi-agency signing up to the process

5 The importance of managerial support in helping practitioners to make difficult decisions about risk


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What is Risk?

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