As social workers we are supposed to be experts in managing risk. Apart from all the well-documented risks in children’s services, over in adults we are supposed to predict which elderly people may fall, leave the gas on, answer the door to rogue salesmen, digest the wrong medication, or even leave the premises altogether in the dead of night.
And that’s just older people’s services. Try working in mental health where clients ride a riptide of psychological troubles. One day they can be absolutely fine; the next they are suicidal. And you, the care coordinator, have to manage all this from the confines of your desk with scarce time and resources – while overseeing all your other clients who themselves are dipping in and out of crises.
The impossible task? It depends on what the expectation is. Here are 5 common misconceptions about risk assessments that can really trip a practitioner up:
Attend a multi-agency meeting and you’d be forgiven for thinking you are some sort of divine entity with the power to safeguard against all harm. Often you’ll be pressured to take the most intrusive action – whether that be forcing an elderly person into a care home, detaining a patient in hospital or sending someone with addiction to a rehab. Apart from the legal ramifications preventing this gung-ho approach of confining clients against their will, behind this is an expectation that risk can simply be taken away and extinguished in the safe confines of an institute, when all you’re ever really doing is moving risk from one environment to another.
Who doesn’t love the Mental Capacity Act and the idea that a person has the right to make ‘unwise decisions?’ Heaven knows, I’ve made plenty in my life. Clients have a right to live a life. In fact, it would be far from healthy to try and expunge all risk because what would remain afterwards but a sterile, inauthentic existence? Risk assessments aren’t there to eliminate every hazard but to help make informed decisions and even encourage therapeutic risk taking.
Contrary to popular belief, risk assessments aren’t empty templates to be filled with data and then placed on file until the next review deadline. Countless times I’ve been in multi-disciplinary meetings where we’ve updated risk assessments and then gone onto make critical decisions about a patient without once referring back to the forms – relying instead on gut instinct and general discussion. Once again we can blame an unhealthy work culture where frontline staff feel compelled to complete forms to appease senior figures and inspectorates rather than to actually help guide their practice.
Many believe that superseded risk assessments are historical artefacts of a bygone age which have no use once a newer version has been placed on the system. However, by referring back to numerous iterations of the same form, you can chart the fluid dynamics of risk over time, better understanding what factors are increasing, which diminishing, and what may happen next. You can even cross correlate this with old assessments and case notes to try and unpick the story behind this. If you have the time. Which none of us do.
People said the Titanic was unsinkable, the economy was fine back in 2007, and few predicted Donald Trump taking up residence in the White House. The truth is, no matter what forms we use humans aren’t great at predicting the future. Every risk assessment, once it’s written, is immediately out-of-date because time marches on and situations constantly evolve. Added to which there are so many unknowns. For all the tick boxes, sliding scales and robust logical thought, then, all risk assessments have an element of guesswork and conjecture built into them – because without a crystal ball that’s all we ever have. This isn’t to say risk assessments have no use – far from it – but they have strict limitations and can only ever be used as a guide.
Interested in exploring this subject more? Try Dan Gardner’s excellent 2009 book RISK. It’s not about social work. It’s not a best practice guide. But it is a fascinating and enjoyable read about how risk is conceptualised and how modern humans struggle to make sense of it
Matt Bee is a social worker and writer.
He also co-hosts The Social Work Tutor podcast.
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