Care & Support Services - Safeguarding Standards
Considering Risk
In understanding individual needs and supporting people with learning disabilities, it will be necessary to consider the issue of risk. This section is merely an introduction to a complex and substantial subject area. The thoughts offered in this section are intended only to highlight areas to be considered. It seems that when people think about risk it is usually in the form of a hazard or danger. This is particularly true of those who care for people who have learning disabilities, who can be understandably protective. The hazard is therefore considered in terms of its degree of seriousness and impact potential, before considering the likelihood of it occurring.
At various times those working in the field can be faced with a legalistic requirement, such as 'organisations have a duty of care', whilst at another point they are told they have to 'empower people with learning disabilities and to also afford them the dignity of risk'. Whilst such concepts do not necessarily have to be in conflict there can be confusion and tension about how to approach either, especially when considering their convergence.
Times have changed, different philosophies of care and changing public attitudes have rightly brought about the potential for a better and more inclusive lifestyle for individuals with a learning disability than they would have experienced just a couple of generations ago. At the same time we are also faced with changes regarding over-bureaucratisation of care and an emerging blame culture, arising from an increasingly litigious society. The worst thing for staff and services supporting individuals with a learning disability would be to see the scenario as a potential minefield not willingly entered. With sound policies and appropriate safeguards, individuals with a learning disability can be supported to embrace reasonable and responsible risk taking.
Andy Alaszewski et al (1999) talked about a risk and empowerment divide in their research 'Empowerment and Protection'. Their work looked at the development of policies and practices in risk assessment and management in services for adults with learning disabilities. A major conclusion of this study was that if individuals with a learning disability are to enjoy full lives in the community, then organisations and agencies need to develop risk policies which embrace both protection and empowerment issues.
The Alaszewski study also states that procedures for planning and assessment should start with the needs and wishes of the person. Person Centred Planning (PCP) philosophy can ideally be used to support the notions of empowerment and protection. The wider use of PCP approaches is proposed as a priority in the Government's 'Valuing People' (2001) White Paper.
The issue of reasonable risk taking is closely related to choice and is of great importance if individuals with a learning disability are to lead full lives in the community. PCP approaches use the views and wishes of the individual as a catalyst for developing their life plans. The people who are involved in supporting this process are likely to be those who know the person the best and therefore can offer informed comment on issues surrounding risk taking.
In addition to the PCP approach there are numerous risk assessments and documents in operation which can be included and utilised. They can vary from agency to agency and may have matrixes or questionnaires to assist in the evaluation and recording of risk. Some risk assessments may be very specific to a special set of circumstances (e.g. whether someone is likely to commit sex offences again). However, risk assessment in the mainstream of care of individuals with a learning disability is likely to embrace the following areas:
Identify clearly what the perceived risk is
Everyone needs to agree and understand what the risk is. It is surprising how often people will differ in their perceptions. Clear language (not jargon) should be used to explain and share with the subject what the concerns are.
Frequency of risk
What is the frequency of the behaviour or concern in the past? Is there any warning that something is going to happen? Does it happen at the same time, place and to the same people? Is there anything we can identify or use to predict events?
Consequences or outcome
What are the impacts if something goes wrong for the individual, the public (including family) and the organisation (including staff). What opportunities for the individual are lost if the risk is not embraced? Can these still be achieved in another, safer context? How essential are they to the individual's goals and aspirations in their PCP?
Management of risk
Can the risk be managed? Can it be reduced? What safeguards need to be brought into an environment? What extra support does the person need? What extra support do the staff need? Is there a necessity to research further before trying to reach a conclusion? When should any review take place?
An overall plan of some description
By the end of the risk assessment it should be clear what the exact risk is, when and why it is likely to happen, what the potential consequences are, how best to manage it and where various people's responsibilities lie.
Maintain appropriate records
Records of all meetings should be kept. Contributions should be noted along with decisions made and the basis for reaching those decisions.
When approaching the small minority of risk assessments which involve a set of serious circumstances such as re-offending, it could be seen as potentially important to have the opinions of those experts or services which are engaged in the management of the possible consequences. For example, it may be appropriate to approach psychiatrists, psychologists, police or child protection authorities, or to consult a representative of the public protection panel when considering certain forms of risk to the public.
