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EXECUTIVE SUMMARY
Introduction
The need for a review of approaches to risk assessment was identified as part of the 21 st Century Review of Social Work (2006a) ( Changing Lives). It suggested that the social work profession was lacking in confidence, under-utilised its workers' skills, had become increasingly risk averse, stifled autonomy and lacked appropriate support. One of the key areas for change identified in Changing Lives was the need to develop a new organisational culture and approach to risk management and risk assessment which promoted excellence. The Scottish Executive Education Department commissioned the Social Work Research Centre at the University of Stirling to undertake an international literature review on risk assessment across the three main areas of social work expertise: criminal justice, community care and child protection. The main objectives of the review were to examine:
- the key differences in risk assessment approaches between the three categories of community care, criminal justice and child protection and what are the implications of such differences for a common language and understanding of risk assessment between and within the various professions;
- how risk is defined, assessed and applied in practice - what actuarial tools for risk assessment are available to social work, which ones are used and why, and how are differing practices justified;
- how information is shared between agencies and with users on risk assessment;
- to what extent organisational culture and organisational learning impact on risk assessment and management techniques, processes and outcomes;
- the implications of the varying approaches for future policy and practice in Scotland - including the development of nationally agreed risk assessment tools and procedures, learning from mistakes, staff training, professional autonomy, the need for a common understanding and language of risk assessment, inter-agency cooperation, user protection and public safety.
This report offers an international review of the literature (including refereed journal articles, policy documents, books and commissioned reports) within predominantly English-speaking countries about risk assessment in social work. The literature review includes an analysis of key research, policy, previously undertaken literature reviews and other relevant documentation primarily in the UK, North America, Australia and New Zealand.
Risk assessment in criminal justice
Criminal justice is the field possibly most influenced by the media and the wider public in respect of dangerousness of offenders and the vulnerability of [potential] victims. It is thus not surprising that the main focus of risk assessment in criminal justice is in relation to violent and sexual offenders, around which a centre of excellence in criminal justice risk management has been set up and a myriad of legislation and guidance has been developed. The criminal justice system also arguably houses the most risk assessment tools, mainly actuarial rather than clinical, which has resulted in a preoccupation with how to measure static risk factors perhaps at the expense of what exactly one is measuring, to what end, and whether other forms of intervention may not prove more effective in reducing longer-term offending. The focus currently in criminal justice seems to be on managing risk rather than alleviating other problems in offenders' lives that might influence their behaviour. Supervising social workers tend to resort, under advice from the guidance, to merely making defensible decisions and offending becomes a matter of containment rather than resolution. Guidance apart, however, there is little consistency in practice in criminal justice although it is the field most advanced in terms of inter-agency collaboration. The culture of the various organisations, however, is doubtless an influence on the way risk is perceived and managed within each agency, making the gains from collaboration less obvious.
Despite such findings from the literature, there have been recent moves to develop risk assessment tools and procedures which encourage both consistency of approach and the active participation of the offender in his/her ongoing risk assessment and management. Similarly the development of accredited programmes both in prison and in the community also ensures that the offender is involved in an ongoing self-assessment of risk and in joint decision making in relation to risk management.
Risk assessment in community care
The community care field is possibly most akin to criminal justice in terms of media interest in its assessment and management of risk, again because of past dangerousness rather than future risk. However, unlike criminal justice, the community care field has a better established practice of user participation in decision making and there is also a strong lobby of users (e.g., those with mental health needs and people with disabilities) who actively seek choice and participation in decision making. In community care, the risk-taking model is more in use than the risk minimisation model, although one suspects that if the user movement for greater choice and participation was not so strong, managerialist imperatives would result in a greater use of the risk minimisation model. Recent community care policies and legislation emphasise the importance of ensuring that people have more say and more control over their lives. The use of direct payments, brokerage and advocacy services are strategies which add impetus to this agenda. Legislation in community care protects the aspirations and capacities of users to take risks, within certain safety parameters, and risk assessment tools in this field are less well developed than in the criminal justice system, with workers often resorting to monitoring or medication to ensure risk reduction. Within the community care field, in contrast to the criminal justice field but more closely aligned with child protection, the range of agencies involved have differing remits, are accountable to differing stakeholders and thus operate under differing definitions and philosophies of risk. Medical staff, for example, may have the concerns of the family or wider public in mind whereas social work staff, carers and user-led organisations may give greater representation to the needs and rights of the service user. There is also arguably less time available for risk assessment and wider agency consultation in community care, as with child protection, since both tend to operate mainly in times of crisis. There has also been much criticism within the literature about risk assessment and management taking precedence over longer-term patient care and treatment.
Risk assessment in child protection
As with the other two fields, risk assessment in child protection is seen by practitioners and commentators as focusing too much on the process and not enough on the outcome of assessing risk. Legislation in this field, more so than in community care, takes into account the rights of families as well as the rights of the child and often this can cause tensions in risk identification and decision making. As in community care, there is also the issue of differing agencies having differing priorities and it seems from the literature that social workers tend to defer to the decisions of the judiciary and the medical profession in relation to risk assessment in child protection. There is also coverage in the literature of differing approaches to children's versus families' rights between the UK, North America and Australia compared with mainland Europe for example, where the latter see intervention to bolster family cohesion as the priority rather than the removal of the child to a place of safety. Risk assessment tools in child protection are criticised in the literature for being overly actuarial and time-consuming to complete, and little is known about the related risk factors. Culpability in child protection is also focused on the family (rather than external factors such as poverty in terms of child neglect, for example) and/or on the practitioner, and there is little evidence of corporate responsibility for child protection issues. This often results in practitioners working defensively and applying objective and often compulsory measures to families rather than building trusting relationships with families.
Organisational issues in managing risk
In order to learn from mistakes, as the Changing Lives review encourages, organisations involved in risk assessment and management have to adopt a participative, holistic and proactive approach which allows dialogue between workers, users and managers and organisational flexibility and performance incentives. Not only should working conditions be appropriate for such an approach, perhaps equally importantly, supervision needs to be non-judgemental and encouraging and training needs to be ongoing and relevant to, and encompassing, the ethos and expectations of all collaborating organisations. Equally, users should be seen as equal partners in the process and outcomes of risk assessment and management, giving greater respect to the views, rights and needs of offenders and accused persons as well as those with mental health needs or disabilities and those suffering from neglect. Given that Changing Lives promotes greater user involvement in risk assessment and other social work interventions, there is a need to find ways of better developing trust, reciprocity and openness between all parties - users, carers, workers and managers alike. However, to do this requires not only cultural change within organisations but also political change in the governance of risk. Policy and practice initiatives in risk management need to demonstrate confidence and commitment to encouraging rather than restricting the capacities and wellbeing of the vast majority of service users and not be driven by a hostile media backlash in a small minority of cases. Equally, professional autonomy and recognition of the skills and experience of workers should not be dismissed in favour of administrative convenience or managerial 'back covering'. Risk has to be seen as a positive and enabling as well as a potentially harmful issue, that allows worker discretion to support risk taking amongst client groups but also ensures that proportionate efforts are made to reduce the likelihood of harmful outcomes.
Conclusions
Changing Lives seeks greater uniformity of purpose and practice in risk assessment and risk management which mirrors recent policy and legislation in the criminal justice, community care and child protection fields. However the findings from the literature review suggest that the experience at the time of writing may have been different. The review highlighted certain anomalies - for example, in organisational cultures, accountability frameworks and levels of accuracy of, and dependence on, risk assessment tools - which need to be addressed in order for social work to move in the direction advocated by Changing Lives. The review concludes that:
- most of social work's current accountability systems are reactive, adversarial and stifle professional autonomy;
- there is not a culture of learning from mistakes that enables confidential reporting and discussion of near misses; likewise, there is no culture of corporate responsibility;
- there is little confidence in the predictability of risk assessment tools and yet they are becoming the priority and the focus of much worker-client contact; tools thus tend to replace rather than inform professional judgement;
- social workers' views of risk are largely absent from the literature and yet they actively engage with risk on a daily basis;
- differing organisational cultures, differing definitions of risk and a hierarchy of professional expertise may deter the development of a common understanding and language of risk;
- the relationship between worker and client is paramount to effective working and yet is being eroded by the language and politics of risk.
In English speaking countries, the preoccupation is with thresholds and short-term crisis intervention, resulting in risk aversion and a questioning of the professional role. In European countries, however, it is the relationship with the family that engenders trust and risk taking and validates the professional role. Technical manuals tend not to work because they become part of the system rather than external to it. Human relationships cannot be predicted like machines can and manuals are also static instruments which can never fully or effectively measure dynamically evolving human processes. What is needed is a different method of achieving the same result. Cooper et al. (2003) recommend setting up 'confidential spaces' where those concerned can explore the problems without recourse to compulsory measures and to establish 'negotiation forums' where formal steps are taken to resolve conflicts before resorting to adversarial means. These authors argue for increased professional autonomy, accountability, reflection, community involvement, mediation rather than adversarialism, and diverse access points to services and advice. Such change will encourage worker confidence, authority and therefore job satisfaction; and the public will trust professionals more if they are seen as responsible, open to negotiation and accountable to all stakeholders. This vision fits well with that of the Changing Lives review. It moves away from an overly risk-averse, managerialist and regulatory form of government to one of proactivity, risk-enablement, professional autonomy and a more open form of governance. It also allows for an organisational environment which has a confident workforce, sound leadership and a culture open to learning from mistakes.
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