Title: Effective Approaches to Risk Assessment in Social Work: An International Literature Review
Author: Monica Barry
Publisher: Scottish Executive Social Research, July 2007
This international literature review aims to identify good practice in risk assessment. It analyses key research and policy by drawing on a search of publications mainly from the UK and other English speaking nations. The report highlights policy and practice accounts in three categories: criminal justice, community care and child protection. The aim is to explore the differences and common areas between these three areas of social work, setting this in the context of debates about the future of social work in Scotland.
Specific objectives included exploring the implications of different approaches to risk for the development of a common language and understanding across the professions establishing how risk is defined and assessed outlining how information is shared interrogating the impact of organisational culture and learning and considering the implications of the various approaches to risk for policy and practice in Scotland.
In her review, Monica Barry observes that social workers’ opinions of and experiences of risk assessment feature briefly in the literature, despite the centrality of risk to their work. She portrays their role as largely that of strategists, because they work in building up knowledge on risk. While there are many risk assessment tools, there is limited confidence in them. She concludes that social workers use the language of risk to focus their work and to legitimise their interventions.
However, this is hazardous because apparent objectivity can weaken communication with people using services and reduce trust, diminish willingness to change and undermine co-operation. The review argues that there is a lack of common understanding of risk as well as a lack of common language. Barry argues that social workers are placed under different expectations, have to employ different meanings of risk and need to respond to different work or professional cultures according to their job role.
While organisational culture is important, the literature indicates that so too are accountability systems and any reliance on risk assessment tools. Barry considers that social workers’ autonomy is particularly restricted by current accountability systems because these discourage learning from or even admitting to mistakes. She warns that while the literature suggests we should only give limited support to risk assessment tools, these seem to be prized above professional judgement and are being increasingly used. This may further reduce contact between social workers and people using services. While self-assessment may have its advantages, Barry warns that, though it may be objective, the relationship between social worker and service user benefits from personal contact and subjectivity.
Findings from each of the sectors reviewed reveal significant commonalities. All are influenced by media portrayals of dangerousness and vulnerability. In criminal justice offenders are more likely to be portrayed one-dimensionally as dangers, although their own risks and vulnerabilities are evident. Criminal justice work is where most risk assessment tools are found, with a purpose to help manage presenting risks. This is also the area where there is considerable interagency collaboration, although not high levels of consistency.
In contrast, community care work (here, meaning social care with adults, including mental health services) generally appears to have a better record of engagement with service users about risk. The literature review touches on the strong lobby of service users whose engagement with issues of risk has helped to promote ideas of positive risk-taking. Barry suggests that the personalisation of services may enable disabled people to take more risks to their benefit. While the literature remains limited, it is in this area that there are more reports of what it is like to be subject to risk assessments and service users’ perspectives of managing risks.
However, the vulnerable status of people using community care services is still a strong theme in research. In the community care field different approaches to risk are evident between agencies. Fear of blame among professionals is a common theme in studies, not surprisingly since its prominence was fuelled by high profile inquiries into mental health homicides (often depicted as failings in community care). Barry notes that current debates reveal “bifurcation” at work the division or splitting of citizens into those who are high risk (and thus in need of services) and others who do not present risks and so are ineligible for support.
Likewise, in child protection services risk appears to be often part of a process of assessment, evidence and calculation. In many countries, child welfare services are being split into child protection and family support, with levels of risk being the central focus and perhaps being the very definition of child protection when the family is construed as dangerous.
Central government has tried to encourage greater consistency and to promote interagency collaboration. A wide variety of risk assessment practices and debates about the relevance of risk factors continue to make social work practice an area where professionals have some autonomy. This does not lead to shared language about risk but Barry notes that research does not always depict this as simply a split between agencies, or professional perspectives, because within agencies there are also many different views. Professionals lack evidence about the effectiveness of risk assessment tools and so many place great value on professional judgement.
One of the advantages of this review is that it is wide-ranging and so can draw on social work in criminal justice settings that are often located apart from community care and child protection debates in England. This enables Barry to point to three different approaches and to variations within them. The many risk assessment tools on the market in criminal justice and youth settings remind us that this is an area with strong interest groups. Across all sectors, the influence of the media is identified as a factor in highlighting risk or dangerousness.
This review comes at a time when risk is being renegotiated. The Department of Health has recently produced a Risk Framework.(1) This framework talks of the need to view risk “proportionality and realistically”, to distinguish “reasonable” risks from others and then to accept these reasonable risks. The framework is complemented by another review of risk, produced by the Social Policy Research Unit (SPRU) that focuses on social care services for adults.(2) The changes in practitioner behaviour that are encouraged are very much those espoused by the Better Regulation Commission (3) and the Commission for Social Care Inspection.(4)
In her summary, Barry points to the importance of the organisation of risk and the key question of whether approaches are conflictual or co-operative. Organisational culture plays a key part here, with agencies having different frameworks for accountability but finding it difficult to learn from mistakes. Links in this chain are also weak, such as supervision and training.
The promise of risk assessment tools is not always realised, since many are narrow or inflexible. Barry suggests that one overall message from the research is that social workers are attracted by the ideals of risk assessment but are thwarted by them in practice.
In conclusion, Barry doubts that there exists a common language of risk and her analysis suggests that service users and carers are largely silent in any conversations about it. She locates some research that suggests many social workers lack confidence in such debates, despite it being germane to their practice. This belies their experience in managing the conflicts around risk and eliciting co-operation from some service users who are not keen to self-identify as risks.
Barry portrays social work as operating in certain ways but then demanding a form of flexible, autonomous discretion. She sees social work as being tied down by systems that are adversarial and hierarchal. Admitting to mistakes is discouraged, so learning from them is unlikely. Despite little confidence in the evidence base of risk assessment tools, their use is encouraged.
In the context of Scottish social work, the value of the review for researchers lies in identifying the limited understandings of risk as a subjective state for practitioners its value may lie in the evidence it supplies about the importance of organisational frameworks and, for policy makers, the review emphasises the importance of joining up debates about risk one important start of which might be to promote greater sharing between areas of social work practice.
Jill Manthorpe is professor of social work and director of the Social Care Workforce Research Unit at King’s College London.
(1) Department of Health (2007), Independence, Choice and Risk: a guide to best practice in supported decision-making, Department of Health
(3) Better Regulation Commission (2006), Risk, Responsibility and Regulation – Whose Risk is it Anyway? Better Regulation Commission.
(4) Commission for Social Care Inspection (2006), Making Choices, Taking Risks, Commission for Social Care Inspection.
Risk assessment tools
These may be attractive but need to be part of organisational culture and not imposed without the support of staff.
Learning from mistakes
The extent to which this becomes merely an organisational slogan will be challenged the moment something goes wrong. Examples of learning from mistakes are likely to be influential and should convince sceptics
Personalisation of support
Risk will be part of this service users and social workers will need to work out ways of minimising harm and to learn from mistakes.
Communicating with colleagues
The growing separation of social work means opportunities to share ideas and to sustain value-based approaches may be limited. Ways of fostering professional contract will be important at local, regional and national levels and could benefit from the support of all sectors and local stakeholders.