What is Risk? Risk taking can have beneficial outcomes as well as harmful outcomes. We should be...
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Transcript of What is Risk? Risk taking can have beneficial outcomes as well as harmful outcomes. We should be...
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)
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Squaring the CircleSquaring the Circle
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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.…?
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Assessing the Risk of Assessing the Risk of Re-OffendingRe-Offending
Two approaches:
– Actuarial/Static Factors– Clinical/Dynamic Factors
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Examples of Static FactorsExamples of Static Factors
Present age Age when started offending Sex Number of custodies under 21 Number of convictions Offence seriousness
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Examples of Dynamic Factors-Examples of Dynamic Factors-Focus of Clinical AssessmentFocus of Clinical Assessment
Accommodation
Mental illness
Alcohol/drug misuse
Employment difficulties
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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?
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Piecing it TogetherPiecing it Together
Bring together these static and
dynamic factors
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Popular ToolsPopular Tools
RAMAS
HCR 20
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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?
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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?)
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Risk Management Risk Management (cont)(cont)
The management of risk must be adaptable and flexible
Risk Management = Process of Compromise and Negotiation
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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.
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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)
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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)
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
Safety First ModelSafety First Model
Focus on:
– physical health
– disabilities (what person can’t do)
– danger
– control
– what assessor thinks is right
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council
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
Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council