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CHAPTER SIX: DISCUSSION AND CONCLUSIONS

INTRODUCTION

"We are all, it would seem, one step away from being 'at risk'." (Stanley, 2005: 25).

Social workers operate in an ever-changing social, political and cultural environment supporting people of all abilities, behaviours and expectations. Likewise, the factors at work in each of the three themes of criminal justice, community care and child protection are multi-faceted, dynamic and unpredictable, given the range of problems, attitudes and contexts which service users experience in each theme. The Changing Lives review seeks greater uniformity in social work practice, but in this multi-dimensional environment, one can only hope for greater consistency of approach whilst respecting the diversity of the client groups involved, the limitations of the agencies and the skills of their respective professionals. When dealing with risk in the social work field, as can be seen from this literature review, 'the only common characteristic is variability' (Coppock, 1997, Pers. Comm). This final chapter identifies the common threads and challenges from the literature, to inform the Changing Lives aspirations of a common language of risk, personalised services and a professional culture of learning and autonomy.

DISCUSSION

As mentioned in Chapter 1, the Changing Lives agenda highlighted several key objectives for 21 ^st century social work:

• Clear accountability frameworks that make explicit the accountabilities of social workers and enable them 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.

The Changing Lives review argues for the development of a model of social work governance, as opposed to management control, which enables professional autonomy in a culture not of blame but of learning from mistakes. Systems, it is argued, need to be put in place so that workers and managers can learn to improve practice. This should include the following objectives:

• having access to evidence to support decision making;
• career development initiatives;
• performance improvement frameworks;
• consultation and peer review;
• training; and
• joint working (including with users and their families).

This literature review has highlighted certain gaps in those objectives specifically in relation to risk assessment and management internationally. None of the three social work themes, according to the literature from several English speaking countries, seems to have accountability systems that are proactive, clear and which enable professional autonomy. At most, there are accountability systems in place which are reactive, open to interpretation and which stifle professional discretion. In criminal justice, the tensions are less obvious because actuarial and administrative functions have all but taken over from one-to-one work with offenders and there are fewer worker expectations of professional autonomy. Within the UK, arrangements to protect the public from violent and sexual offenders ensure that inter-agency collaboration takes place according to the level of risk rather than the needs of the individual offender, but these arrangements do not exist for other categories of offender. In community care and child protection, workers still expect greater discretion to work with clients and therefore the tensions over autonomy versus administrative regulations are all the more apparent. Equally in these two latter fields, there are no statutory arrangements in place to collaborate based on levels of risk.

Because of the lack of autonomy of workers and the reduced confidence placed in workers compared with risk assessment tools, there is not a culture present at practitioner level for voicing concerns, discussing failures or near misses and therefore learning from mistakes. This review could not access literature on the quality and value of supervision in the eyes of supervisees and supervisors, but it is presumed that such supervision will vary across departments and local authorities and will therefore impact on, and no doubt be influenced by, the culture of the organisation in terms of learning from mistakes. However, this somewhat begs the question as to what constitutes a mistake: creating headline news about an organisational 'error', or putting an individual at undue risk of harm.

The Research Specification for this review highlighted certain key principles of risk assessment:

• 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 management and minimisation of risk.

As with the objectives of the Changing Lives review, this literature review has also highlighted gaps in the above key principles. There was disagreement amongst commentators on the soundness and reliability of the evidence for risk assessment tools and guidance, given that no tool or procedure can adequately account for and predict human behaviour, not least when such behaviour is influenced by external structural constraints. Likewise, often tools were seen as replacing rather than informing professional judgement, with social workers relying primarily on their own or other professionals' scientific assessments rather than challenging these and engaging in dialogue with both agency workers and users and their families. As with the focus on risk assessment tools at the expense of the human element, so too workers may focus on the process of risk assessment at the expense of its ongoing management. Certainly in criminal justice, much of the literature on interventions currently talks of 'number crunching' or 'a tick-box mentality' where the administrative process takes over and the rationale for the intervention and its desired outcome is lost. One study (Mair et al., 2006) cited in Chapter 2 suggested that social workers prefer to use certain risk assessment tools because of their ease of administration, and yet many of these have poor levels of accuracy in prediction. There is also uncertainty about what factors create risk, not only amongst practitioners but also amongst leading academic experts in the field of risk prediction.

There is also the problem inherent in all social work fields, that whilst the client may have the potential for exhibiting or being the victim of risky behaviour, that risk may never manifest itself in a negative light: what for one person is a risk factor may for another person be a protective factor (being a member of a large family, for example). Risk may be correlated with outcomes but not necessarily cause them. Professionals are under pressure to focus on a snapshot in time, to focus on negative rather than positive outcomes and to think of targeting services rather than needs. For children, amongst others, risk does not necessarily manifest itself at the same stage, in the same context and in the same way. Equally, different combinations of risk will have different impacts on people depending not only on the age and stage of the person in the life course but also on environmental and social factors extraneous to the individual.

Stanley (2005) explores how social workers actively construct knowledge around risk identification, assessment and management. He theorises the relationship between meanings of risk and decision making, and suggests that approaches to risk run along a continuum from realist to constructionist: from scientific and forensic evidence to historically, politically and socially constructed perceptions. Social workers' views and experiences of risk assessment are largely missing from the social work literature and yet they are strategists, actively engaged in constructing knowledge around risk. Social workers tend to use the language of risk to legitimate their intervention decisions, thus rendering the work more orderly and focused. Applying objective measures of risk to families is thus seen as preferable to building subjective assessments with families. And yet the social work literature generally stresses that the relationship between worker and client is crucial to developing trust, cooperation and motivation to change. But such relationships are being dissipated by the politics and language of risk.

This review has demonstrated a distinct lack of a common understanding about risk (both within and between agencies) as well as a lack of a common language. Organisations have differing cultures, differing definitions of risk and differing expectations of frontline staff. There is also the inference from the literature that there is a professional hierarchy which may deter negotiation about a common language or understanding. The confusion around the terminology itself ( see Chapter 1) does not auger well for devising a common language of risk but as suggested in the introduction to this final chapter, perhaps the language of risk is not as important as the overall approach to risk, a theme which is the focus of the following conclusions.

CONCLUSIONS

Changing Lives seeks greater uniformity of purpose and practice in risk assessment and risk management which mirrors recent developments in 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 the language of risk are largely absent from the literature and yet they actively engage with risk on a daily basis;
• the relationship between worker and client is paramount to effective working and yet is being eroded by the language and politics of risk;
• 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 Changing Lives review stresses the need for flexible, participative, adaptable and preventive measures in supporting individuals and families. The findings of this literature review complement that vision. However, there is one anomaly in the Changing Lives review that has been highlighted by recent literature. The Changing Lives review recommended developing self-assessment procedures, and this was subsequently welcomed by the Scottish Executive. Self assessment may well seem empowering and participative, and no doubt would ease social work budgets. Nevertheless, it is argued here that self-assessment procedures go against one of the crucial factors for effective working identified not only in the work of McNeill et al. (2005) but of many other contributors cited in this literature review: that of worker-client relationships. It is one thing to check in one's own baggage at the airport, but there is a limit to how well technology can cope with human feelings, fears and inconsistencies in risk assessment, and how wise it is to reduce risk and vulnerability to an administrative process of accountability. Social workers have the skills, the experience and the commitment to work closely with people at all levels of vulnerability and risk, irrespective of policy directives and guidance; equally, those in need of such personal social services (not only practical but also emotional) often find the face-to-face contact and understanding a vital source of support, confidence and comfort. Many authors in this review suggest that risk assessment needs not only to be objective but also subjective - from the individual and family perspectives as well as based on the worker's assessment. Where individuals and their carers/families are capable and willing to participate in such a dialogue, their interpretations of risk are perhaps the most expert, accurate and 'telling' and should be taken into account in a consensual and combined assessment. But this cannot be done easily without a worker-client relationship, a listening ear and a sounding board that is free of compulsion and fear.

The vision of Cooper et al. outlined in the preceding chapter 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-taking, 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. Social work is not only about risk but also about supportive relationships. Social work in the early 21 ^st century could well learn from social work 100 years ago when, in 1907, the Probation Act recommended that practitioners 'advise, assist and befriend' their clients. That message still holds true today, whatever the risks.

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