MASH – Set 2 Assessing Risk

In relationship to MASH Team risk assessments of referrals

Risk Assessment

“In the child protection/safeguarding context, risk assessment means looking for characteristics of the child, person, family or environment which are highly associated with harm to children to include harm arising from witnessing harm to others.” S120 of Adoption and Children Act 2002

What is a risk?

• A risk is a chance that something unpleasant or dangerous might happen – a child or young person might suffer from abuse or neglect (significant harm) • All circumstances and events in life carry some risk, but it is the role of the MASH team (their duty of care) to identify and assess the risk for vulnerable children and young people

MASH and risk assessment

• The firewalled co-located MASH system allows access to information from each partner agency that will enhance risk assessment and decision making • This way of working will assist when assessing the following: – missing people, domestic abuse, child exploitation, child abuse and neglect

What is Risk Assessment?

• A risk assessment can identify – The probability of harm – Assess the impact on key individuals – Post intervention strategies which may diminish the risk or reduce the harm • Assessments cannot prevent risk (Hope and Sparks, 2000: 137).

Risk taking involves judgement and balance, with decision makers required to consider the value and likelihood of the possible benefits of a particular decision against the seriousness and likelihood of the possible harms

Prof. E. Munro

Best practice in risk assessment

• Poor information sharing has been identified in serious case reviews and public inquiries • Clear communication standards are essential • Harm and risk must be recognised and addressed • Only a full picture can minimise poor outcomes • Only good information sharing can result in best practice

Always remember......

• Risk cannot be eliminated • Risk is dynamic and constantly changing • Risk needs to be child focussed • Risk assessment is the foundation for effective intervention • Risk needs to be specific • Risk needs to recognise diversity • Risk is everybody’s responsibility

CRAM

• Child Risk Assessment Model has six core elements: – Intelligence –

Risk Factors

–

Risk Assessment

– Supervision – Records – Communication

CRAM Risk Factors

• These are grouped into three areas: – Circumstances relating to the child – Behaviour and circumstances of a perpetrator – Circumstances relating to the household – More details about these can be found in the London MASH Project Tool Kit – Risk Assessment and Research

Changes in status

• An enquiry within MASH may change its priority status at any time • This will depend on information and research that informs the evaluation and decision making about level of risk • This allows for early intervention when this is needed • It prevents unnecessary intervention or disruption

Case study – Gemma Green

• Using genograms in assessment can – clarify relationships – offer information about past events – identify gaps in information – offer families the opportunity to help build a picture

Useful tools

• Genograms • London Research Project Tool Kit Version 4 (Risk Assessment and Research) • The Risk Analysis Grid • Assessment Framework • CAADA Dash Risk Identification Checklist • SCODA Assessment Questionnaire • Resilience/Vulnerability Chart • Child Risk Assessment Model

Essential skills in risk assessment

• Good (and timely recording • Ability to analyse • Accurate estimating/predicting • Clear presentation of conclusions • Systematic collection of information from all relevant sources • Skilled interviewing • Good communication skills and information sharing • Regular reviewing of data

Team dynamics and decision making

Your team are planning a social outing. You must make a decision about what you will do in ten minutes.

Use the information on your card to inform your arguments ( even if it would not be your personal choice ) Do not tell anybody what is on your card

Challenges to good risk assessments

• Do protocols and systems clash with each other?

• Are goals and values shared in common?

• Are there differences in the culture of information sharing?

• Are there different thresholds for action?

• Are actions procedure driven or person centred?

• Are the dynamics in a team recognised and addressed?

Strategies to better safeguard children in highly diverse communities

• We need to – Think about the child’s experience – Consider the needs black and ethnic minority children – Remember cultural norms, values and beliefs and parenting practices – Think ethnicity, faith, gender and generation

Identification of the impact of race, culture, language and communication, or any other diversity factors should always be present in an assessment of risk and safety (4.3.17, Safeguarding Framework 2010)

Serious Case Reviews

“Professionals are rarely criticised for making poor predictions per se but for making poor assessments of what is or has been happening” (Munro, 2002)

Khyra Ishaq

• Khyra died of starvation at the age of seven – Her mother said she would teach her children herself because, as Muslims, they were treated differently in school – She alleged that one of her children had been racially bullied but the school did not take this seriously, resulting in the child lacking trust in teachers • SCR stated: – The resistance and hostile approach demonstrated by the adults influenced and affected the professional actions.

– The approach reinforced that the power dynamics lay with the parents and not with the rights, welfare and protection of the children

Peter Connelly

• Peter died at the age of 17 months from repeated abuse – His mother said she “loved her child” and professionals took this statement at face value, alongside mother’s constant phone calls to social workers to show interest and involvement, to indicate that the child will not be harmed.“ – •

SCR stated

: – these statements clearly described parents who are overly eager to work with practitioners and appearing to co-operate, this is a tactic known as

disguised compliance

.

Remember RESPECTFUL UNCERTAINTY – when assessing and observing client

Foster Carer Abusers

•

Ian Wathey and Craig Faunch were foster carers who abused boys placed in their care between 2003 and 2005

– The SCR quotes staff as saying: “The fear of being seen as prejudiced, the risk of talking about the words gay and paedophile together, was too great.” – There was a pervasive anxiety that, if this view was put forward in writing or verbally, the person putting it forward would be accused of being prejudiced and homophobic – rather than just asking the simple question: “Are they abusing kids?” – The SCR concluded: “It is clear that there were forces at work in this case about sexuality which clouded workers’ ability to observe, interpret, think and make judgments in a way which should have been expected of professionally qualified social work practitioners and managers”

Serious case review findings

1 • Making overly pessimistic assessments for fear of getting it wrong.

• Focusing on one type of abuse and not considering other types of risk.

• Failure to take a long-term perspective, to note emerging patterns • The ‘start-again’ syndrome, especially in cases of neglect (M Brandon et al, 2008 SCR review) • Undue weight to dynamic rather than static factors.

Serious case review findings

2 • Over-reliance on a mechanistic process OR on personal judgement not supported by evidence.

• Being put off assessing a situation as risky due to ‘cultural sensitivity’ (NSPCC 2008) • Being put off gathering evidence due to a ‘scary’ carer • Missing risks to child because worker feels (often justifiably) sorry for the carer.

Common Errors of Reasoning

1

“The single most pervasive bias in human reasoning is that people like to hold on to their beliefs”

Munro (2008) • Failure to revise risk assessments – difficulty in changing mind or considering alternative perspectives • Failure to look at own files, past information overlooked • Written evidence overlooked in preference to direct (verbal) reports • Scepticism about new evidence that challenges existing views

Common Errors of Reasoning

2

“The single most pervasive bias in human reasoning is that people like to hold on to their beliefs”

Munro (2008) • Uncritical about evidence that supports existing view • Parents reactions during assessment taken as representative • Failure to check ‘facts’ and information • Tendency to ‘group-think’ – conformity

Analysis

• Assess the impact of each risk factor on the child’s safety and its significance in terms of the harm caused – impairment of development in the immediate, mid and long term. • What will be the child’s experience should any of the above points be present?

• What will the likely outcome for this child should they experience any of the above risk factors?

• Is there the likelihood of future harm and why? What risk factors inform this?

Static and Dynamic factors

Static Risk Factors Dynamic Factors

Also Consider…..

Timing

the more recent the higher the current risk.

Frequency

the more frequent the higher the current risk.

Escalation

increasing in frequency or severity?

Severity

the more severe the higher the current risk

Vulnerability

estimating the vulnerability of the child.

Age, disability, medical needs or behavioural problems

Pattern

recurrent pattern or the context in which it occurs?

Minimal

results in no detectable injury (equivalent to common assault)

Probability

estimating the likelihood that harm will occur again ( history is important )

Moderate

results in bruising or abrasions or minor lacerations (equivalent to ABH)

Serious

results in major injuries including large lacerations, fractures, loss of consciousness and injuries requiring medical attention (equivalent to GBH).

Rigorous Risk Assessment

• • • • Risk assessment should be based on sound evidence and analysis Tools should inform rather than replace professional judgement All professionals should have a common language of risk and common understanding of the main concepts Information sharing should be based on clearly agreed protocols and understanding of the use of such information Risk assessment should NOT a discrete process but as integral to the overall management and minimisation of risk.

• • • • • • • • • •

Risk Assessment –The Overview

What is the nature of the risk?

Who is at risk?

Who poses the risk?

When and where is the child at risk?

What are the vulnerability factors?

What are the protective factors?

What is the likelihood of harm occurring? Within what timescales?

What is the impact or likely impact of harm to the child from the risk?

Is the assessment plan holistic? Others’ views?

What is the risk management/reduction plan?

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Making Recommendations

Defensible Decision Making – staying within agency policies and procedures – taking all reasonable steps to safeguard the child – taking an evidence-based approach – ensuring direct participation of the child – using reliable assessment methods – collecting and thoroughly evaluating relevant information – recording and accounting for the decision making – communicating with relevant others, seeking information you do not have – not working in isolation or taking the most critical decisions on your own (Home Office, Mappa Guidance 2006) & Safeguarding Framework 2010 30

Finally……..

"We are all, it would seem, one step away from being 'at risk’ " Stanley, 2005: 25 • As practitioners we operate in an ever-changing social, political and cultural environment supporting people of all abilities, behaviours and expectations • Factors at work in child protection, criminal justice, health and community care are multi-faceted, dynamic and unpredictable, given the range of problems, attitudes and contexts which service users experience in their lifetime