The power of risk

What do you do when a 17 year old girl presents herself at the office telling you that she wants to die? After briefly recalling a fellow student’s confusion at my lecturer’s dry comment; “You cover your back”, my mind immediately started grasping at notions and approximations of risk, “Is she drunk? How likely is she to kill herself? How will she do it? When will she do it?” And for that short time, as momentary as it was, she was no longer a person and I was not a ‘skilled helper’ (Egan, 1998) Rather, she was a fraction, a percentage, a statistic, waiting for me the systematic actuary to measure and analyse her. But unlike an actuary, I do not have formulae and equations to inform my steps. I rely upon my Supervisor (who was out of the office), the Team Manager (who was in an emergency meeting) and members of the team (nowhere to be seen) to advise me. So, with options A, B and C out the window, I had no choice but to do the unthinkable. Donned only with the knowledge that there is no common approach to risk within Social Work (Crisp et al. 2005), I used my ‘professional judgement’.

Thankfully, the young girl has not (yet) killed herself and having followed the incident up immediately with my supervisor and other professionals involved in her care I feel confident that I responded appropriately. Nevertheless, since the incident I can’t help but question the uncertainty that I feel when assessing any level of risk, a concept which underpins so much of what Social Workers do.

I was recently asked to help undertake appropriate risk assessments to review the contact arrangements for a 14 year old boy and his father. “Great!” I thought (I’d meet A LOT of NOS units doing this!) But the process is burdening me. Not only am I petrified that I will get it wrong and that a Serious Case Review will be falling on my lap before I am even qualified, but I am also daunted by the prospect of my interpretation of the situation shaping this boy’s future.

So why am I so afraid to trust myself? Is it because I am a student? Will these feelings fade with more experience?

I think for, the task of completing a risk assessment is challenging because it has made me realise how much power, even as a student Social Worker, I have. What is more, the process itself seems to sit uneasily with some of the professional values and codes of practice that I have been internalising over the last 17 months. Almost every referral that I have completed has been accompanied by a risk assessment, the content of which I am well aware will greatly influence the likelihood of the young person concerned being granted access to or denied a service. Often, these assessments are quite arbitrary and service user participation is rarely incorporated into the process because the assessments are supposed to be objective. Furthermore, I am deeply uncomfortable with the manner in which risk assessments often seem to problematise the young person concerned, failing to appreciate how societal and cultural factors have influenced their situation. What is perhaps most concerning for me is the routine manner in which I observe workers in my team complete risk assessments. Not helped by the standardised ‘High, Medium and Low’ forms, the extent to which Biestek’s ‘individualisation’ principle (Biestek, 1961) informs the content of the form is questionable, but the consequences and outcomes of these forms are highly personal for the young person concerned.

So just when I was beginning to think how oppressive my professional judgement could be, I remembered observing a Youth Offending Service Social Worker professionally override a risk assessment score to give a young person more support than his initial score entitled him to. This gave me hope that the upcoming Munro Report will initiate moves towards a clearer framework for risk assessment which will make it easier Social Workers to, in the midst of a climate of risk management, pursue the principles upon which the profession is founded. Whether or not Social Work will adopt the Child Risk Assessment Matrix is yet to be known, but I do think that the idea of answering a series of questions to record how much workers know about a young person could help to prevent the arbitrary, standardised tick box completion of risk assessments and the all too definitive outcomes of one ‘professional judgement’.

As I questioned above, my thoughts and feelings could just be attributable to my lack of experience and it might be that, over time, I become more comfortable with the conflict between this professional duties and some professional values. But until that time, inspired by that one Social Worker, this Actuary hopes to learn a formula which will enable her to use risk assessments to promote social change, to empower people and, in that ‘Measures to control risk’ box, find room for a little bit of social justice too.

References

Biestek, F. (1961) The Casework Relationship. London: George Allen and Unwin

Crisp, B.R., Anderson, M.T., Orme, J. and Lister, P.G. (2005) Knowledge review 08: Learning and teaching in social work education: textbooks and frameworks on assessment, London: Social Care Institute for Excellence.

Egan, G. (1998) The Skilled Helper: A problem-management approach to helping, California: Brooks Cole.]

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5 responses

  1. Great post which strikes at the heart of many decisions that are made in social work. I can say that after 10 years, I still have wobbles of judgement. The important thing is – just as you are doing, to think through the decisions and reflect on them although you're probably tired of hearing about reflection. I laughed at our lecturers when I was studying and their constant pounding on about reflection, reflection, reflection – but in practice it is absolutely the difference between good and poor practice. And there is the context of values and ethics that tend to exist in services where there is a statutory function. One of the things I love about this job is the way that these dilemmas are thrown at us and we can never be complacent with other peoples' lives. Good luck with the placement. I enjoyed reading your post a lot.

  2. Good post pity you were left on your own but you seemed to of handled very well yes you will have thousands of risk assessments to do just remember even the best ones are only right 50% of the time. At leaqst the ones we use have a free text box for comments so we can try and put risks in context hope you post again its good to get a students perspective

  3. Carrying risk is a difficult thing to do and experience doesn't necessarily make it easier, nor does a clearer methodology.Risk is an inherent part of life and risk assessment is part of that. We can, like the autistic though, be overcome with anxiety in the face of the rear it provoke and retreat into ritualistic defences.Having said that not learning form others is just plain stupid.I think there is something that is urgent in the need to promote 'wisdom': the integration experience.Risk, if it is to be held, though, has to be held on the team/group level and that has to permeate up in organisations. Without falling into the trap of cronyism.All of this is to say that it doesn't get easier post 'qualifying' as qualification in holding risk has a habit of being like a graph. It goes up over time. So as one meets the capacity to hold risk within any given level, the operational level of the risk grows. There is something in this about the need to promote 'resilience' in the capacity to hold risk. Providing enough of a secure base for the professional to roam from the secure lap and explore the strange situation.That isn't a functional need only of someone pre-qualification. It's a lifelong need.There is a tendency to internalise the lack of security of the clients and act this out in the work space. To forget we have a brain and can actually use them.Loved the honesty and clarity of the post!

  4. Re: the question about when does the doubt end. It doesn't- and the day it does – you should stop practicing.One of the first things to go when you qualify is time to reflect in the way you do in this post. Please do not ever stop doing that- you will feel like you should. Like noone else does, like it is pointless because your hands are tied- but I implore you not to stop reflecting on your practice, feelings, values and judgements. It is precisely that doubt and self analysis which will make you a good social worker. Even if it makes your life more difficult. Great post. I wish I had kept a blog instead of my practice diary.Finally- if you had made the 'wrong' judgement. If she had died, or had tried to kill herself-you have to know when you are responsible and when you are not.She may have hurt herself regardless of what you did or said, and that is a brutal brutal thing to realise. We make risk assessments on the basis of evidence that is ambiguous at best, in circumstances where we see only a sliver of what is going on with a service user. We use the knowledge and skills we have- and you can't be 'right' all the time. If in doubt, make sure your manager knows what is happening, that everything is recorded, and that you are only taking responsibility for what you are actually responsible for.Good luck with the rest of your course.

  5. Doubts are not necessarily bad after all the saying goes: Fools rush where angels fear to tread. I for one think there is a lot of truth in this. Someone beleiving they are always 100% right is far more dangerous than someone who has a degree of doubt.

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