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CHAPTER ONE: BACKGROUND TO THE REVIEW

INTRODUCTION

A risk assessment can only identify the probability of harm, assess the impact of it on key individuals, and pose intervention strategies which may diminish the risk or reduce the harm. Assessments cannot prevent risk (Hope and Sparks, 2000: 137).

Risk became a dominant preoccupation within Western society towards the end of the 20 ^th century, to the point where we are now said to live in a 'risk society' (Beck, 1992), with an emphasis on uncertainty, individualisation and culpability. Parton (1996) sees globalisation as fragmenting society and creating further uncertainty within social and economic life. There has been a concurrent growing mistrust of professionals in social work and an increased reliance by the profession on complex systems of assessment, monitoring and quality control (Stalker, 2003). The 'blaming society' is now more concerned with risk avoidance and defensive practice than with professional expertise and welfare development (Parton, 1998). However, risk is a normal and often beneficial part of everyday life, but while it enables learning and understanding, in the case of potentially destructive consequences it may need to be monitored and restricted. Cooper et al. (2003) argue that cultural factors relating to organisations and families are crucial to effecting positive change and that an over-emphasis on 'automated' risk assessment systems will reduce the likelihood of being able to identify and manage risk.

"The apparent inability of government to think in terms of systems instead of structures, and cultures instead of procedures, is extremely damaging." (Cooper et al., 2003: 12).

Hood and Allison (2001) note that there is a general lack of understanding of the role of risk assessment and management within the local authority context, not least because of a persistent preoccupation with insurance and health and safety:

"… there is a clear dichotomy between the managerialism implicit in any corporate risk management strategy and the exclusively professional risks which Social Work staff feel more comfortable with." (ibid: 15).

It is in the light of these changes in attitude towards, and experience of, risk in a 'risk society' that this literature review was commissioned.

THE CONCERNS AND ASPIRATIONS OF THE CHANGING LIVES REVIEW

The need for a review of approaches to risk assessment was identified as part of the 21 ^st Century Review of Social Work ( Changing Lives) (2006a). It suggested that the social work profession was lacking in confidence, under-utilised its workers' skills, had become increasingly risk averse and stifled autonomy and 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 assessment and management which promoted excellence. The review also recommended a personalised delivery of public services which included a therapeutic approach to change, building on the capacities of individuals and communities and developing 'collaborative forms of provision which are person centred, flexible, adaptive and supportive' (ibid: 33). However, the findings of the Changing Lives review suggested that effectively managing risk while encouraging innovative and personalised practice was one of social work's biggest challenges. It acknowledged that personalising independently provided services meant possibly less regulation and therefore, arguably, greater risk. To address this issue, a range of strategies for managing risk were suggested in the Changing Lives review, including:

• Clear accountability frameworks that make explicit the accountabilities of social workers
• Within such a framework of accountability, for social workers to exercise professional autonomy
• A new approach to governance of social work services that emphasises continuous improvement, effective risk management and creates an environment in which excellence can flourish
• Strengthening of professional leadership and governance roles of the chief social work officer
• Structuring approaches to managing untoward incidents that enable learning from mistakes
• The need to develop evidenced based approaches to risk assessment and management

Changing Lives acknowledged social work's expertise in professional risk assessment and management and yet saw as a challenge the increasing risk aversion mentality within the profession which constrains both workers and users alike: 'Many of the people who responded to our survey spoke of working in a climate of fear, hoping that nothing would go wrong that would open them up to media vilification' (Scottish Executive, 2006a: 52). Media coverage of 'failures' in risk assessment and management, coupled with growing pressures for organisational accountability, risk minimisation and public safety have increasingly constrained the role of the social worker. And yet a key role for the profession is to identify and assess not only a client's need for protection from self or others but also public and professional safety more generally.

Within this context of both uncertainty and optimism about the role of social work in risk assessment and management, 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.

AIMS AND OBJECTIVES OF THE REVIEW

In order to inform and develop these aspirations in Scotland, this report reviews the international literature within predominantly English-speaking countries about risk assessment in social work in relation to vulnerable groups. Pritchard (1997) defines 'vulnerability' as being at risk of abuse or injury resulting from age, gender, disability or mental capacity, but it also includes being at risk from perpetrators of acts of violence. Through an examination of refereed journal articles, policy documents, books and commissioned reports, this review aims to identify good practice and highlight the implications for policy and practice in Scotland. The review is informed by certain principles relating to rigorous risk assessment which were identified in the Research Specification. These principles include that:

• risk assessment should be based on sound evidence and analysis;
• risk assessment tools should inform rather than replace professional judgement;
• all professionals involved in risk assessment should have a common language of risk and common understanding of the main concepts
• information sharing for risk assessment should be based on clearly agreed protocols and understanding of the use of such information;
• risk assessment should not be seen as a discrete process but as integral to the overall management and minimisation of risk.

The main questions to be addressed from an analysis of the literature included:

• what are the key differences in risk assessment approaches between the three main social work 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 is risk defined, assessed and applied in practice and how are differing practices justified;
• how is ambiguity and uncertainty about risk assessment managed at both the manager and practitioner level in social work;
• how is information shared between agencies on risk assessment, including how service users are involved in identifying and assessing risk. To what extent does this involvement vary between agencies and user groups;
• how effective are lines of communication between managers and practitioners; how is practice modified and improved based on successes and failures;
• to what extent does organisational culture and organisational learning impact on risk assessment and management techniques, processes and outcomes;
• what are the implications of the varying approaches for future policy and practice in Scotland - including the implications for the development of nationally agreed risk assessment tools and procedures, staff training, professional autonomy, leadership and decision making, the need for a common understanding and language of risk assessment, inter-agency cooperation, user protection and public safety.

THE RESEARCH PROCESS

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, but also in other countries where relevant. It covers the following three social work categories:

• community care (physical or learning disabilities, older people, mental health)
• criminal justice (youth justice, adult offenders, accused persons, sexual and violent offenders)
• child protection (child abuse and neglect).

It has not been possible within this review to cover all categories under these three broad themes, not least because the available literature tends to focus on those groups most 'at risk' of risk assessment and management procedures. One specific gap in the literature, and therefore in this literature review, is an examination of the risks associated with children and young people who are looked after, either in residential or foster care and the concurrent decisions made by youth courts, the Scottish Children's Hearings system and other youth tribunals internationally.

A manual and internet search ¹ of all relevant journal articles, books and grey literature was undertaken and references and other publications accessed via colleagues in a range of academic, policy and practice settings. Summaries of articles and documents were examined and full articles read where appropriate. This report explores the issues and highlights the variations and commonalities between the three categories of criminal justice, community care and child protection, and suggests tentative ways forward for policy makers, policy analysts, practitioners and researchers.

DEFINITIONS OF TERMS

It is worth noting that the language used in this review reflects that found within the literature which may be considered to be outdated given new developments in policy and practice in risk assessment and management. For example, recent policies in community care emphasise risk enablement and risk empowerment. However, the literature doesn't necessarily reflect these terms in the same way, although it is recognised that there is an established practice of user participation in decision making in the community care field.

Given one of the objectives of this review was to assess the potential for a common language of risk assessment throughout the three main social work themes of criminal justice, child protection and community care, it seems imperative that definitions and understandings of key terms are at least broadly compatible if not wholly consistent. The following, therefore, is a brief examination of the current use of language in relation to risk, risk factors, risk assessment, risk management, risk assessment tools, perpetrator/victim and vulnerability.

Risk originally meant calculating the probabilities of events, both positive and negative and yet increasingly, in social work at least, has come to be associated with negativity or adversity: 'the relative variation in possible loss outcomes' (Brearley, 1982: 82). Whilst there is no clear definition of risk, equally there is little consistency in definitions of high, medium and low risk across agencies and fields, especially in the criminal justice field. According to the Risk Management Authority ( RMA), which oversees risk in criminal justice in Scotland, risk is defined as: '[the] nature, likelihood, frequency, duration, seriousness and imminence of an offence' (2006b: 50), but argues that the level of risk presented is a matter of 'professional judgement' (ibid: 27). Stalker (2003) notes that risk tends to relate to vulnerability in older people, to dangerousness in offenders and to harm in children. 'Dangerousness' itself is another contentious word. The term is deemed more appropriately applied to situations (a hazardous incident) than to people (an inherently dangerous person), but increasingly in the mental health and criminal justice fields, it applies to people more than to situations (Malloch, 2002). Risk management has become synonymous with managing the dangers posed by the 'heavy end' mental health sufferers, offenders, child abusers, etc., and risk itself tends to be categorised into static and dynamic factors, as defined below.

Risk factors comprise static and dynamic factors. Static risk factors (age, sex, offence history, health record, etc.) do not change and perhaps for this reason are seen as more reliable indicators of future risk. Dynamic factors, on the other hand, include drug use, employment status, traumatic events, income, etc, and are both variable and often outwith the control of the individual. They are also deemed less promising indicators of future risk. Most academic commentators suggest that static factors on their own are unlikely to gauge future risk, given the interplay between personality, background, current circumstances and extraneous factors, but that when combined with dynamic factors are more likely to effectively predict risk.

Titterton defines risk management as 'developing a systematic approach which allows for the planning of risk-taking strategies and for monitoring and reviewing… accountability, clarity and support for staff' (2005: 92). Stalker (2003) quotes Gurney (2000: 300) as defining risk management as 'the processes devised by organizations to minimise negative outcomes which can arise in the delivery of welfare services', along a continuum from control through legitimate authority to empowerment. However, risk management also means maximising potential benefits (Stalker, 2003; Titterton, 2005) and Stalker notes that service users can also play an important role in managing risk alongside organisations. Risk management is often seen as being overshadowed by risk assessment and yet an assessment without an action plan will not reduce the risk but only identify it. Titterton (2005) argues for both assessment and management to be interrelated within the same risk framework.

Risk assessment has been defined as 'the process of estimating and evaluating risk, understood as the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale' (Titterton, 2005: 83). Two models of risk assessment have been identified (Davis, 1996):

• the risk-taking model (risk is normal and positive and assessment focuses on mental wellbeing, rights, abilities, choice and participation); and
• the risk minimisation model (which targets those most at risk and assessment focuses on physical health, danger, control and incapacity).

However, risk assessment also has a therapeutic role beyond that of mere information gathering (Millar & Corby, 2006), not least if the risk assessment is a two-way process of mutual respect and creative learning. Nevertheless, much risk assessment work currently focuses on information gathering only, mainly through the use of risk assessment tools.

Most risk assessment tools involve a form or table which the worker completes either on a one-off basis or over a period of time. There are three broad types of risk assessment tool: clinical, actuarial and structured clinical judgement. Clinical methods involve professional judgement about the individual plus information from risk factor research. They are deemed impressionistic and subjective, and are made with little information or scientific evidence about accuracy. They are also poor predictors of future harm. The actuarial approach involves a mathematical calculation of risk, comparing key factors about an individual with the statistical frequency of such risk within a matched sample. They may result in greater predictive power but offer no guidelines for managing risk. The structured clinical judgement approach combines clinical and actuarial methods to enable both assessment and management of risk. It includes consideration of static and dynamic risk factors and a multi-disciplinary approach. However, many academics caution against the emergence of false negatives or false positives ² in risk assessments, which may skew the findings and have cost implications as a result. Likewise, many workers may be lulled into a false sense of security in dealing with actuarial risk assessment tools, not least because of the seeming reliability of mathematical calculation and scientific sophistication. There are, however, mixed feelings in the middle ground, where a combination of actuarial calculation and clinical judgement are seen as having both advantages and disadvantages, and these will be explored in greater depth in each of the three themes described in Chapters 2 - 4 below. In all three themes discussed in this report, there is a dichotomy for workers in assessing whether the risk is to the person being assessed (the recipient of the potential harm) or from the person being assessed (the source of the potential harm). There is also a significant difference in the way risk is perceived and therefore assessed and managed by different workers and managers both within and between organisations.

To talk of victim and perpetrator is misleading in the field of risk, not least because an individual can be both recipient/victim and source/perpetrator of harm simultaneously. There are also other recipients and sources of harm beyond the 'victim'-'perpetrator' divide: notably, the family, the public and, as will be seen from this literature review, governmental and non-governmental organisations. Listed briefly below are the distinguishing features of recipients/sources of harm in each theme:

• within the criminal justice field, the accused or offender is the person being assessed (as the source of potential harm to other individuals and to the public);
• within community care, the individual 'client' is the person being assessed (as both the recipient of potential harm and the source of potential harm to other individuals and to the public); and
• within child protection, the child is the person being assessed (as the recipient of potential harm). However, increasingly, parents and wider family are being assessed, directly or indirectly, as sources of potential harm.

Examples in community care and child protection have more similarities to each other than in criminal justice, not least because it is argued that offenders and accused persons are not considered a threat to themselves but only potentially to other people (drug-related offending being a usually ignored exception to this rule). Offenders and accused persons also tend not to be termed 'service users' (and do not have the same participatory rights and lobbying powers that many disabled service users have, for example), not least perhaps because they are considered potentially culpable rather than vulnerable and issues of 'duty of care' tend not to arise; which brings us onto the meaning of vulnerability in risk assessment.

Vulnerability has been defined as risk of abuse or injury because of age, gender, disability or mental health problems - for example, older people, young girls, wheelchair users or people suffering from psychotic disorders. Vulnerability to abuse or injury can be both self-inflicted and inflicted on others, inadvertently or otherwise. Likewise the abuse or injury can vary between individuals and groups: older people living alone can fall or wander off; young girls can be both the victims and instigators of inappropriate sexual activity; wheelchair users may have restricted access and mobility as well as be subjected to discrimination; and people suffering a psychosis may have sudden relapses following the relaxation of medical and other support in an otherwise illness-free period.

LAYOUT OF THE REPORT

This introductory chapter has outlined the context in which the risk discourse has developed, including the concerns and aspirations of the Changing Lives review. The aims and objectives of this literature review were outlined and key terms defined. Chapters 2 - 4 explore the meaning and implications of risk in relation to the three main areas of social work - criminal justice ( Chapter 2), community care ( Chapter 3) and child protection ( Chapter 4). Each chapter explores the current legislative and guidance frameworks, and briefly discusses risk assessment tools and any variations in practice, before discussing the overall messages from the literature. Chapter 5 explores the risk discourse from an organisational perspective, including the influence of organisational culture, accountability frameworks and inter-agency collaboration. It also questions whether social work is currently operating within a conflictual or cooperative model of risk assessment and management. Chapter 6 concludes the review with a summary of the key findings and suggested ways forward for policy and research.

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