Transcript Orange Earth

That’s too risky.. OR is it just your opinion?
A R.E.A.L Conference Presentation
Amanda Wood,
Definition
A situation involving exposure to danger.
The possibility of suffering harm or loss
Hazardous
Endangered
RISK - defined
• “a hazardous or
dangerous chance”
• “risk concerns expected value of one” or
more results of one or more future
events” wikipedia
• “a hazard that is incompletely
understood, and thus whose occurrence
can be forecast only with
uncertainty”(Boer et al, 1997)
What are the risks associated with
getting to the conference today?
Why measure risk
• Identify situations where harm could occur
• Minimise likelihood of harm to worker and clients.
• Prevent situations that cause harm.
• Duty of Care – prevent foreseeable harm
without breaching a persons rights too much.
Identify the Risk
What Might happen NOT What Could Happen
John likes to sit on the driveway to the house without his
t-shirt on laying on the concrete.
What are the risks?
Brainstorm the
risks
Hit by a
Vehicle
Outline all the risks to John
from this Behaviour.
Some will be more likely than
others and the level of
seriousness of each will be
different.
Need to decide how serious
these are
Need to determine the
likelihood of these occurring.
Catch a cold if
raining
Sunburnt if
sunny
How
Likely?
Risk Classification
How Serious?
High- Life threatening or
cause serious injury
Mod- Could result in
temporary incapacity
Low- Could result in
inconvenience/ first aid
Very likely- Known to routinely
occur or very likely to given
current circumstances/
environment
Likely- Known to occur often/
good chance wil occur given
current circumstances/
environment
Unlikely- Some potential to occur
based on previous occurrence or
current circumstances/ environment
Category 1 (red)
Category 1 (red)
Category 2 (blue)
Category 1 (red)
Category 2 (blue)
Category 3 (green)
Category 2 (blue)
Category 3 (green)
Category 3 (green)
Example
Risk
Risk
Categ behaviours
ory
/
Conditions
.
Indicators/
Triggers
Prevention
Response
Further
Information
Staff are to follow
the IPRP. Joe is
verbally
encouraged to
participate in
another activity
(redirection).
Staff should
make sure Joe
has taken
medication. Staff
should carry a
mobile phone
with them at all
times A familiar
staff member
should
accompany Joe
at all times.
VERBAL THREATS OF HARM:
Joe will
verbally
threaten to
cause harm
to himself
and others
Other people are
receiving attention
from staff whilst Joe
is not; Joe is hearing
voices
Staff
to interact with
Joe on a regular
basis, redirection to
another activity/task
-
Subjectivity and Bias
•
RISK ASSSESSMENT RESEARCH:
• Clinicians/ Professionals are
poor at judging probability of
risk, biases.
• Better off flipping a coin to
predict risk.
• Optimism Bias:
• Causes a person to believe that
they are less at risk of
experiencing a negative event
compared to others.
Risk Aversive vs Risk Accepting
• Risk Aversive
• Wanting to avoid risk unless
adequately compensated for it
• Risk Accepting/Tolerant
• Risk tolerance affects how
psychologically receptive an
individual is to decisions
involving risk.
• Four types of risk tolerance:
physical, social, ethical and
financial.
• People behave consistently
within type not BETWEEN
types.
What happens when we make
judgements about risk for others?
• Research suggests the more we see the person as being Similar to
us the more we judge their risk to be the same as ours*.
• When person has different values to the judger they showed
greater risk aversion for the decision made for themselves than
the other person*.
• Suggesting that our belief about the persons values impact on our
decision making for them and hence our judgement of risk.
*Harvey, Twyman & Harries (2006), Making Decisions for Other People: The Problem of Judging Acceptable
Levels of Risk
Know your own Values and beliefs
Our own beliefs, values can impact on how we classify a risk.
How do you classify possible sunburn?
Life threatening or inconvenience requiring first aid??
Is it very Likely or unlikely?
Balancing Act
Classifying Risk and Making a Decision of whether to act or not
act is a balancing act of:
• Rights and need of individual
• Safety of person and/or others
• Need to have an understanding of persons CAPACITY
Inherent vs Residual Risk
Inherent Risk:
The risk of something if no controls or other mitigating factors
were in place (risk before controls).
For example the risk a persons behaviour poses if there is no
Support Plan or Reactive Strategies.
Residual Risk:
The risk that remains after controls are taken into account (risk
after controls).
For example the risk a persons behaviours pose when the
support plan. Reactive strategies and other factors to minimise
risk are put in place
Common Mistake
MUST compare the Inherent risk with the residual risk.
Comparing risk before and after:
You can see the key controls that need to be monitored and
enforced to ensure the environment remains safe.
Behaviour Support
• Behaviour Support Plans
should address risk
associated with Behaviours
of Concern
• Through the IPRP
• Strategies that clearly aim to
reduce the risk should be
outlined clearly
Example
John is more likely to hit out
• When there is a lot of noise
• In crowded places
• When he is being told what to do.
Minimise Risk
• Reduce the noise and amount of people
around John.
• Avoid telling John what to do, instead
redirect John to what he can do.
Common Mistake
People Confuse Risk Classification
and Risk Assessment.
Violence Risk Assessment
“the process of evaluating individuals to (1)
characterize the risk they will commit acts
of violence and (2) develop interventions
to manage or reduce that risk (Hart, 2000)
“The goal is violence prevention…. To
minimize the likelihood of and negative
consequences stemming from future
violence” (Douglas et al, 2001)
Violence Risk Assessment
• Use of clinical tool
• Identify a person likelihood to
continue to engage in violent or
“challenging Behaviours”
• Measured against evidence based
risk factors
• Able to target interventions at
these factors to reduce persons
likelihood of engaging in
behaviours in the future
Example evidence based risk
factors
•
•
•
•
•
•
•
•
Lack of insight
Employment status
Presence of mental illness
Age of first violent behaviour
Substance use
Impulsivity
Responsiveness to treatment
Negative attitudes
Example
• John first displayed behaviours of concern at
age 10.
• John has a moderate intellectual disability and
schizophrenia.
• He often acts without thinking he is impulsive.
• John has low self esteem and has negative
thoughts about himself and his abilities.
• John takes his medication everyday but will
often refuse to attend day program and some
weekend activities.
Example cont.
• Ensure treatment for schizophrenia are
regularly reviewed a and he is receiving good
psychiatric care.
• Help his to understand what his diagnosis
means for him.
• Provide some counselling or behavioural
support to assist John to reduce his
impulsivity.
• Provide some counselling and behavioural
support to assist John to improve his self
esteem.
• Review John’s day program options and why
he is not attending and address this in a
person centred manner.
Summary
• Risk Classification is a useful and
necessary tool.
• Best completed with a number of
viewpoints.
• Can be subjective to bias and opinion.
• Often assess risk differently for
someone else than ourselves.
Summary
Behaviour Support Plan can address risk as identified through a
risk classification AND a risk assessment.
Always review the inherent AND The residual risk.
Risk Classification is NOT risk assessment.
If you want to reduce a persons risk of engaging in significant
challenging behaviour than you may need a clinician to conduct
a risk assessment.
Amanda Wood
[email protected]
www.awcommunityservices.com