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

Accurately predicting whether a client will cause harm in the future isn't all science fiction, you need to spend time getting to know them and carry out a good risk assessment, says Matt Bee

Photo: Jakub Krechowicz/Fotolia

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

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

  1. Cath Hogan September 25, 2015 at 11:28 am #

    I agree that these checklists can be useful, but they are only a tool, and should not take the place of the thought process in relation to risk issues. In helping staff to get from A to B, it’s generally better (in terms of their long term learning and skills) if they use a map rather than a sat nav. There is a danger with these forms that they lead passive staff by the nose, rather than actually enabling them to consider and weigh the issues, and draw reasoned and defensible conclusions . In the mind of the social worker, the task can sometimes become the completion of the form, rather than the consideration of the risk, it can all become a bit ‘painting by numbers’. It’s helpful of course to ensure that every possible facet has been considered, and this can be the main use of the tick box format, but they are not an adequate substitute for thoughtful consideration of the particular circumstances.

  2. Stephen Bourne September 26, 2015 at 8:27 pm #

    Social workers rely on far to much gut instinct and this can get them into trouble which some then try to cover up.

    The profession is in disrepute due to personal bias and assumptions in some individuals.

    It is imperative that SWs can have suspicions but should base reporting on fact based evidence.

    there should be a fixed pathway for them to follow as when they get it wrong it wrecks decent peoples lives.

    Remember being A Social Worker is a position of Trust.

  3. David Steare September 29, 2015 at 5:53 pm #

    As social care has seemed to be following in the footsteps of the business sector readers might be interested in a piece about pension funds in the 15 September 2015 Financial Times: “… John Kay, economist and chair of 2012 review of UK equity markets, said there was ‘no such thing as an objective measure of risk… Regulation is pushing us to behave as if there is an objective measure of risk, when there isn’t'”

    This assertion should not come as a surprise to anyone familiar with the origins of assessments within social care. Writing in 1970 Barbara Docker-Drysdale wrote: “The word ‘assessment’ has a final ring; there is something absolute about the statement or series of statements which may alter the entire life of an individual human being. Those people who make assessments are in an omnipotent position: how they move and countermove will depend on many factors – and ultimately the arrangements of words written on paper will tend to lead to instant action, since in the circumstances, if such action were not needed there would not be in the first place a request for an assessment.”