This section sets out the criteria to be considered in a risk assessment. It should be read in conjunction with the pages on Risk management - policy. Employers have a duty to identify risks in the workplace. Risk assessment should be a continuous process and part of the day-to-day running of the project. They will have to carry out a risk assessment on two levels - 1) The project in general and 2) An individual client. In this section we focus on individual client risk assessment.
Staff, consciously or not, are continuously assessing risk as part of the day to day running of the project, when meeting clients at the office, or on visits, and when visiting the home. The risk assessment procedures provides a framework for making this assessment explicit.
The procedures should:
The provider may decide to operate different levels of risk assessment depending on the client and the context of the project. The risk assessment may take place:
When a provider accepts a self-referral or an agency referral with little background on the client, gathering information for an initial risk assessment should take place as part of the process of admission to the service. This may involve discussing with the client their accommodation history, and their involvement with, for example, mental health services. Staff will have to exercise great sensitivity and explain carefully why this information is required.
As resettlement workers have several goals, including making the prospective client feel welcome and optimistic about the future while assessing the risk they pose to themselves and to others. Providers should help staff to meet this challenge through adequate training and support as well as clear guidance and procedures. (See Supervision and risk management)
Follow-up on areas of doubt should be undertaken as quickly as possible afterwards. The organisation’s procedures should stipulate how quickly this should take place.
The referral and risk assessment will inform (i.e. form part of the background) the development of the needs assessment and resettlement plan. For example, a client’s referral form may indicate that they left previous accommodation after a violent incident, perpetrated by themselves. The risk assessment will gather more information about this, analyse the extent and severity of the risk and set out a plan as to how to reduce the likelihood of incidents reoccuring, what should staff be aware of as trigger factors? All staff will have to know about this and will play a role in ensuring the plan is carried out and monitored.
A history of domestic violence may also increase a person's risk to themselves, and their coping strategies, mental and physical health should be discussed to the extent that both parties feel comfortable at this stage. If it is not appropriate, the worker may wish to make notes later that this is an area for exploration with the client and that support and therapies exist.
Risk assessment and recording is an area of professional development and staff should seek to continually develop their skills in this area, supported through supervision and training.
The main stages in risk assessment are:
It is good practice for the risk assessment to be written up using a pro forma (see example in appendices REF p) The pro forma should include:
There are some difficult ethical and practical dilemmas facing providers in relation to involving clients in risk assessment. Some providers have a policy that allows for flexibility and some discretion depending on the individual. Some of the reported difficulties include:
Normally and whenever safe, staff should carry out the risk assessment with the client’s involvement, explaining carefully the reasons for the procedure. Accurate recording of information is crucial. Clients have a right under the Data Protection Act to see information recorded about them and correct any erroneous information about them, including in risk assessments (Client’s Records_ REF p71).
If providers allow discretion around access to risk assessment information, guidelines should set out when staff are authorised to do this. In this situation risk assessment information should be kept in a secure place and removed from files if the client requests access. Providers should ensure that their action is defensible under the provisions of the Data Protection Act.
If staff have such strong concerns about revealing the risk assessment to a particular client, this would be an indicator that perhaps the project is not able to manage the risk that that client poses. This should lead to consideration about what steps might be taken to address this.
Clients will themselves provide valuable information for risk assessment and, generally, should be gently probed about the information provided by others. With sensitive interviewing, a client may offer their own insight, for example, on situations in which they have become violent in the past and even suggest how staff might respond to defuse such a situation. Of course, prospective clients may play down previous incidents and careful probing and follow-up of clues is essential. However, getting issues out in the open with the client – also helps staff with fear and concerns.
Involving clients and allowing access to risk assessment pro formas will demand that staff are very careful about how they record information. It should not lead to information not being recorded but working and clarifying opinion and fact will be crucial. Great care will be needed in recording input from third parties. (See `Client’s Records`_ )
The risk management policy should include guidelines on sources of information upon which they will base their risk assessment. Flexibility and creativity is important, and staff should be expected and empowered to investigate further when there are gaps in information.
Effective liaison and partnership working with other agencies (mental health services, probation services etc) helps to ensure that information is not withheld regarding clients who are known to those services. Inter-agency information sharing was one of the areas highlighted in the Newby Report as needing special consideration (Davies, Lingham, Prior and Sims, 1995). For clients already plugged into external services, the risk assessment may discuessed at the regular multi-agency care planning meeting.
Referring agencies can often provide critical information for risk assessment purposes and may have carried out a risk assessment. Where staff feel an agency withholds risk information during referrals, management level liaison may be necessary.
“It is worth reminding some referral agencies that we want to identify risk, not for the purposes of saying "no" but to see how best we can manage it.” Hostel Manager, Manchester
Finally, where no other information is available, the only source of information for risk assessment may be observation. Providers should help staff in developing their skills in observation and recording observation through training and support.
The risk assessment pro forma may be divided into “risk areas”, or provide a checklist reminder of the main groupings of risk. Risk areas are only a guide and staff need to be able to look beyond these where appropriate.
Under each risk area the relevant evidence that a risk exists should be recorded along with the source of that evidence. Wherever possible, it should include details of what, how, when, why, to whom, where, and any outcomes or consequences of the incident. The information should be assessed both for its reliability and for gaps in knowledge. It will sometimes be necessary to get an expert opinion from, for example, the local mental health team or GP.
Any factors affecting the risk should be recorded, along with any known "triggers" (events that might lead to incidents), factors that increase the likelihood of the risk and those that decrease the likelihood of the risk.
The assessment should consider the factors that might have an impact on the likelihood of an incident arising from the risk, such as:
For all these areas see the section on specific risks
The assessment should consider who is at risk.
Risk to the client:
Risk to other clients:
Risk to staff:
Risk to fabric of project:
Risk to the home when resettled:
Risks to themselves when resettled
Risk to public standing of organisation
Risk to general public
Risk to visitors or guests
To other agency or service
consider protocols on sharing risk assessment information (See REF p135).
Some providers assess the level of risk using a points system to identify in a systematic way whether the risk is high, medium or low. Others prefer to keep the assessment qualitative. Either way, the assessment should consider both the severity and the likelihood of incident arising from the risk. The more recent an incident of harm or the more frequent, the more likely is the risk of another incident.
“Experienced staff can sense when something is building up – need to have a way this is recognised” Hostel worker, Newcastle
In assessing the level of risk staff should consider:
If the risk is considered to be serious and imminent, review of the situation may be necessary during shifts and at each shift hand-over, until the status of the risk is reduced.
Information that might help assess the severity of the risk might include, for example, previous need to include the police in incidents.
The next stage is to establish a plan on how to minimise the identified risks. The plan should be written and should set out what action will be taken, by whom, when and how the outcomes will be monitored and evaluated.
“Every identified risk should be matched with corresponding action to lessen or manage that risk.” Thames Reach
If there are no immediate ideas on dealing with the risk, the person carrying out the assessment should seek assistance from the team, manager or an appropriate outside agency.
The action plan should:
For example, if the client is a schedule 1 sex offender, the plan will need to include contact details of their probation officer, relevant police contact and child protection teams. These contacts should be aware of the assessed risks and should be involved in creating plans to reduce the likelihood of incidents.
“This is a plan on how staff would work with that assessed risk, monitor and evaluate change, intervene or summon additional interventions, recognise significant changes to the level of risk and contingency actions if things deteriorate beyond a manageable level” Rogers (1998)
Where the risk involves issues around anger management and aggression, the response might be through the keyworker challenging behaviour patterns and supporting the client in finding alternative ways of expressing and dealing with their emotions.
The action plan might involve:
An integral part of the risk planning process is the question:
Changes may be possible in terms of:
If there are patterns in risks, such as increase in aggressive behaviour through binge drinking on giro day, visits or meetings should not be arranged for this day.
In the medium term, a project may adjust its admissions criteria to ensure that there is a manageable mix of clients, so that staff can cope with those presenting higher risks more effectively.
The need for longer term changes may be identified through risk assessment, such as alterations to the physical environment, such as where interviews and meetings take place, and individuals personal safety on offsite and home visits.
If resources cannot be found to reduce the risk to an acceptable level, then the client may need to be excluded and referred to another agency.
“Managers who set staffing levels need to ensure that there are always enough suitably trained staff to cope with any foreseeable violence or incident” Health & Safety Executive Report
The physical environment can have a significant impact on ability to observe and respond to risks. When planning new projects or redesigning existing ones, providers should take into consideration design elements that can have a positive impact on risk including:
The English Churches Housing Association Vaughan House hostel in Guildford, which has won the ‘hostel of the year’ award, uses aromatherapy burners within light fittings. The lavender scent creates a calm atmosphere.
The Health and Safety Commission’s recommendations for health service premises could also be considered for emergency accommodation:
It is unlikely that the risk can be eliminated completely. Staff should assess the likely risks remaining given the action plan and deployment of resources. The planning stage should be repeated until staff consider that the remaining risks are judged to be acceptable.
The results of the risk assessment and the subsequent plan must be properly communicated to all staff in the project and, where appropriate, to others outside the project. The limits of confidentiality in relation to risk management must be clearly set out in the organisation’s policy and procedures and understood by all staff
The risk assessment pro forma should indicate what information is to be communicated to whom, by whom and how. Special consideration must be given to ensure the risk assessment is communicated to staff returning from holiday, locum staff and staff from other agencies that may be working with the client.
The risk assessment plan may be communicated through discussing a particular client in hand-over meetings, team meetings or multi-agency case conferences.
The risk management procedure should include guidelines on reviewing each risk assessment setting out:
The guidelines need to allow for some flexibility and judgement. Where there is a high or imminent risk, reviews may be carried out frequently. On the other hand, where no particular risk is identified, a review may only be necessary where a change in circumstances is observed.
The Management of Health and Safety at Work regulations require risk assessments to be reviewed:
Providers should undertake regular evaluation of their risk management policy and procedures.
Two types of monitoring are relevant:
Evaluation should include:
Due to the corporate responsibility to ensure safety, management committees should be involved in the evaluation.
Providers might like to use benchmarking exercises or external consultation to assist in the evaluation. Setting specific targets around reducing risk may help in subsequent evaluation of the effectiveness of the procedures. Avoid creating targets that reduce the likelihood of incidents being reported.
The Health & Safety Executive guidelines (1997) say that monitoring and evaluations should look at:
Kemshall, H. & Pritchard, J. Ed. (1997) Good Practice in Risk Assessment and Risk Management 2 – Protection, Rights and Responsibilities, Jessica Kingsley Publishers
Health & Safety Commission (1997) Violence and Aggression to staff in health services – Guidance on assessment and management, Health & Safety Executive SE, ISBN 0 7176 1466 2