Why tick boxes and score sheets trump gut instinct when assessing risk in social work

By Matt Bee

Making predictions is a game fraught with danger. For one thing, we’re not very good at it. I’m not just talking about social workers here, I mean anyone. Look at election night: all those polls, surveys, data analysts and experts predicting which box the population would tick on their ballot slips. And they got it wrong. Paddy Ashdown and Alastair Campbell were forced to eat their hat and kilt respectively, albeit chocolate ones.

If this is what befalls the great and good when they make predictions, then what hope for the rest of us? What hope for social workers? Tony Stanley, a principal social worker, compared the whole thing to science fiction when it was suggested that practitioners could second guess which children would grow up to be terrorists. The stuff of make believe.

Bold statements

And yet, making bold statements about the future is something social workers do all the time. We’ve all been to funding panels. We’ve all painted a picture of our client’s future if the proposed care package isn’t approved. “It is a critical need,” we say. “They’ll come to serious harm without it.”

How do we know? What makes us so sure? What’s more, when I attended mental health review tribunals as a forensic social worker, what made me so sure that a person would relapse and reoffend if they were released? More to the point, what made me so sure they wouldn’t when I was arguing for their release? That’s a serious question to answer, especially if a patient has murder on their charge sheet.

The answer can be found (at least in part) in paperwork, and lots of it. Risk assessments abound in the modern world and never more so than in mental health services. But the idea that tick boxes and score sheets can be relied on to predict future harm is something that still makes many experienced practitioners guffaw. Surely they can’t be a substitute for professional judgement and plain old-fashioned ‘gut instinct’?

Well no, they’re not. But that doesn’t mean these lengthy forms aren’t any use. In fact, quite the opposite. I always found it reassuring to find a risk assessment properly completed in a service user’s file. It meant someone had spent time thinking about it, sifting through the data, working through the task methodically and drawing a conclusion based on more than a feeling. It gave me something to work on, to build on, and it was consistent.

Nailing down specifics

The best risk assessments are sophisticated. A gut instinct is vague and imprecise. I’m not saying it’s without merit, but it is hard to quantify and impossible to transfer from one practitioner to another – you can hardly stick it inside the front cover of a file.

By contrast, a form reads much the same whoever picks it up, and the best examples can nail down all the specifics – splitting historical risk from present, strengths from weaknesses, internal factors from external. It can show how danger is fluid and changeable, so that a distinction can be drawn between when a service user is safe and when they aren’t. That makes positive risk taking a whole lot easier.

All those tick boxes and separate data fields have another benefit as well.

There is a fine line between assessing a person and judging them – a line that seems all too easy to overstep when working with violent offenders.

But whereas personal prejudice can sometimes fly under the guise of ‘professional judgement’, it has nowhere to hide among all those tick boxes on a form. A practitioner can’t make sweeping generalisations. They can’t make a blanket judgement (with emphasis on the word ‘judgement’).

So I’m a big fan of those risk assessments. If you want to accurately predict the likelihood of future harm, there really is nothing better.

First crucial step

But there is a caveat to all this…handled badly and the paperwork can leave experienced, gifted and compassionate practitioners feeling undermined – as if all their employer wants from them is a set of fingers to type with. What’s more, if an organisation swamps the workforce in a deluge of forms, what chance is there to complete them properly? And what use is a risk assessment then?

More to the point, what chance has the practitioner of spending any time with the client? This is the first crucial step – and one that a lot of the training misses out. There’s a lot of focus on filling out the forms and totalling the scores. There are handbooks and handouts. But there isn’t so much emphasis on getting to know the person you’re assessing.

And that really is the key. After all, if you don’t actually know the client as they are now, how are you supposed to predict what they’ll do next?

Matt Bee is a social worker based in the north east of England