What is Risk?

1. 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

2. Ministerial 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

3. Defensibility • 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

4. Defensibility (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 Council

5. PRAMS 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

6. Squaring the Circle  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

7. Risk Assessment- MDO's(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

8. Previous 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

9. Risk 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

10. Influence of Personal and Professional 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

11. Assessing the Risk of Re-Offending Two approaches: • Actuarial/Static Factors • Clinical/Dynamic Factors  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

12. Actuarial • 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

13. Examples 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

14. Examples of Dynamic Factors-Focus of Clinical Assessment • Accommodation • Mental illness • Alcohol/drug misuse • Employment difficulties  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

15. Problems 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

16. Collect Clinical/Contextual Information (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

17. Piecing it Together Bring together these static and dynamic factors  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

18. Combined Approach: Antecedents, 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 ACTUARIALandCLINICAL  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

19. Combined Approach: Antecedents, Behaviours, Conditions (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

20. Popular Tools RAMAS HCR 20  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

21. Component 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

22. Process 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

23. Crucial 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

24. What Helps/What Should 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

25. Risk 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

26. Risk Management (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

27. 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

28. Key Steps for Risk Management (cont) 2. Prepare Risk Plan An Individual Risk Plan (linked to the Care Plan) should include clear statements on: a) who has been consulted b) who is responsible for planning and implementation c) the steps that will be taken to minimise possible harms d) the steps to be taken to enhance possible benefits e) agreed timescales f) the points at which intervention would occur and how this will happen g) the milestones for measuring success or failure h) arrangements for record keeping  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

29. Risk 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

30. Creating 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

31. Drafting 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

32. Why do People Change 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

33. Principles 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

34. Principles of Risk Management (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

35. Key Steps for Risk Management contd 3. Sign Up This 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

36. Sharing & 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

37. Key Steps for Risk Management 5. Monitor & Review Provision 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 Staff Support 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

38. Implementation • 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

39. Organizational 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

40. Management 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

41. Principles • 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

42. Policies 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 whichrisks 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

43. 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

44. Risk 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

45. Risk Taking Approach (cont) We need to develop of a “risk taking approach” which: • Celebrates the taking of risks as a way of enhancing people’s lives • Recognises the importance of psychological and emotional needs, as well as physical needs • Promotes choice and autonomy for the individual • Values the individual, irrespective of whether they live in community or institutional settings • 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

46. Welfare 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

47. Welfare Dilemmas  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council

48. Safety 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

49. Risk 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

50. Conclusions Key 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 • The importance of managerial support in helping practitioners to make difficult decisions about risk  Mike Titterton, The Vision Thing & Sheena Robertson, Fife Council