A Review of an Approach and Methods of Assessing Risk Arising from Behaviour that Challenges. Rai Turton [email protected] Behaviour that challenges (BtC): Causes harm or presents risk of harm. A challenge to services:
A Review of an Approach and Methods of Assessing Risk Arising from Behaviour that Challenges
Behaviour that challenges (BtC): Arising from Behaviour that ChallengesCauses harm or presents risk of harm
A challenge to services:
To support safely in least-restrictive environments with maximal social inclusion
Risk assessment: Arising from Behaviour that ChallengesEstimating the probability and severity of future harmA simple example (uncontextualised)
The need for accurate and contextualised risk assessment Arising from Behaviour that Challenges
Focus of this presentation Arising from Behaviour that Challenges
This presentation focuses on approaches to risk rating.
Contextualisation is mentioned when appropriate but not properly addressed because it is too large a topic.
Two risk-rating methods developed for people who have LD Arising from Behaviour that Challenges
The BILD method (Powell, 2005)
Included harm: physical injury/illness, criminal offending and property damage
The Mersey Care method (Greenhill et al., 2008)
Includes the same harm and also emotional harm, restriction and social exclusion
Both methods actuarial, risk rating based on severity and frequency of previous harm
Both assign numerical value to severity of harm and modify ratings according to previous frequency
Both embed risk assessment in support and risk management planning
Example: Rating risks using the BILD method (non-contextualised)
A person who caused small abrasions four times in the past month
A person who caused a broken leg in the past month
Sources of information (non-contextualised)
“A-B-C” analyses of records will support contextualisation.
In simplified form:
In situation X, the risk of (harm) is (rating);
In situation Y, the risk of (harm) is (rating).
Strengths and weaknesses of the BILD and Mersey Care methods of risk rating
Alternative methods of risk rating
Forensic risk assessment:
Challenging behaviour scales:
Suggestions of risk rating
Use adapted forensic instruments for those cases in which the predicted outcomes and the risk factors are appropriate.
Use the BILD or Mersey Care procedures but be aware of the hazards of their weighting systems.
Identify situational factors that modify risk and qualify risk predictions accordingly.
Contribute to the development of better methods.
References of risk rating
Greenhill, B., Whitehead, R., Grannell, M. et al. (2008) Human Rights Joint Risk Assessment and Management Plan (HR-JRAMP), Mersey Care NHS Trust.
Powell, S. (2005) Risk in Challenging Behaviour: A good practice guide for professionals. BILD Publications, Kidderminster.
(Turton, R.W. (2014) Assessing risks arising from challenging behaviours: A model and a brief review of existing resources. Advances in Mental Health and Intellectual Disabilities, 8, 32-42)