Explain ways in which risk is an integral part of everyday life,
Risk for most people is an accepted part of everyday life e.g. catching a bus or walking to the shop etc… will carry some element of risk. Risk is associated with our health, safety, security, well being, employment, education, daily activities, using resources and equipment and community participation. Some adults such as those who are disabled or who are older are usually discouraged from taking risks with their budgeting, planning, employment and their daily living skills usually because people fear for their limitations or that they might hurt themselves or others.
Everyone has the right to take risks and make decisions about their own lives, a balance should be found between service users participation in everyday activities and the carers duty of care. Social care and health policies are encouraging residents to increase their independence by being involved in the wider society such as leisure and work. It should be noted that it is impossible to eliminate risk completely, however minimising and being prepared for risk by preventative action.
Supporting people to live independently by taking part of their lives means accepting that there are risks that cant be avoided but can be prepared for.
Explain why individuals may have been discouraged or prevented from taking risks,
For some services, approaches to risk have been a problem because they have been concerned with avoiding potentially harmful situations for the service user and staff.
People need to take risk to achieve things on their own merit, but there are people who should support them but will discourage them from taking risks because of perceived perceptions of the persons limitations. Risk taking can have benefits for the individual as it will enable them to do things most people take for granted. Risk is beneficial, balancing levels or protection and preserving levels of choice and control. A balance will need to be achieved between the wishes of the individual and the law duty of care.
Described the links between risk taking and responsibilities, empowerment and social inclusion,
Personalised care is a right for everyone, however some people will need more support than others in helping to make choices of their own lives. Effective personalisation of care comes the need to manage risk for people to make decisions as safely as humanly possible. Making risks clear and understood is crucial to empowering residents and the carers, risk management does not eliminate risks. managing risk to maximise peoples choice and control of their own lives. If the outcomes are part of the support plan and all risks have been discussed and understood, this will lead to real choice and control and will offer a better quality of life for the individual. Positive risk taking will help the resident to gain self confidence, develop new skills knowledge and hopefully allow them take an active part within their community so that they don’t feel included.
Explain the process of developing a positive person centered approach to risk assessment,
The person centered approach will focus on the individuals rights to choose their own lifestyle, even if that includes making bad decisions. A person centered approach is about helping people and those involved, think in a positive way to achieve the changes they want whilst keeping risk at bay. Risk management is about finding the balance been positive risk taking based on autonomy and independence and a policy of protection for the person and the community based on reducing harm. Its been stated that for a positive person centered approach to a risk assessment should consist of the following, involvement of the service user and relatives in the risk assessment, positive and informed risk taking, proportionality, contextualising behavior, defensible decision making, a learning culture and tolerable risks.
Explain how to apply the principles and method of a person centered approach to each of the different stages of the process of risk assessment,
Working in a personalised way and developing a positive person centered approach means to know that risks cannot be avoided but however can be prepared for. Reasonable risk is about balancing empowering people who need help to make their own decisions, once they have all the information, that is tailored to their needs so that they make their best decisions.
Involvement of service users and relatives in risk assessment, to involve the resident, nearest and dearest is one of the most important parts of the person centered approach. The people involved with the resident will help gather information in framing of what the risk actually is, in thinking, generating ideas and solutions, by evaluating the solutions, in decisions making around the risk, in implementing the actions and by the learning that takes place during these actions. Staff must make note of the residents and others wants, their views on their owns risk and what responsibilities each person has in managing their own risk effectively. The person Centered Approach will meet this by asking for a clear picture of what the person is wanting to achieve, why it is important, what the outcome would look like, a history of the risk, the decision making agreement tools to look at staff roles and responsibilities and who will be responsible for the different decisions relating to the risk.
Positive and informed risk raking, This particular process is formed around the positive view of the person. This process is based on finding creative solutions rather than just saying no. Informed and positive risk taking is about quality of life being lived to the full whilst people in the community are kept safe, by meeting what is important to them, how they would keep themselves and others safe. Remember that positive and informed risk taking needs to touch on what the law says and allows i.e. legislation within The Human Rights Act.
Proportionality, The management of risk must match the potential harm that could be caused. Using a person centered approach means flexibility. The more serious the task the more time you would consider it in greater detail. Centered approach looks at the consequences of not doing the task that could have potential risks for the resident, family member etc… and being able to balance against the consequences that could happen of taking the risk.
Contextualising Behavior, asks why did the person behaved in a certain way? at this time? in this situation? Part of this process involves getting information regarding previous information about the person, including the history of the resident of the risk they are wanting to undertake from their own perspective, historical data from a variety of sources to look at what has worked in particular situations, and communication charts will help with a persons words and behaviors, seeking their meaning and what the best response should be. This will help to get a understanding of the persons behavior in different context, but also to build a picture of what has been learned about how to best support the resident.
Defensible Decision making, Following the person centered approach generates a clear trail of written and recorded records of what has been discussed, the different perspectives, the problems and solutions that have been considered, alongside any legal issues, such as the Human rights act or that of the mental health act that could effect the risk decision. All paperwork generated during the process provides a clear rationale for the decisions that will emerge during the processes that have been taken, and why other options have been declined. The rationale for decision making is also more clearly expounded and recorded than in traditional risk assessment forms in common usage.
A learning Culture, The positive and productive approach to risk has a deep emphasis within its on going learning, using learning and reflective tools such as questions such as whats working? whats not working etc… by defining staff their core duties and their own judgement and creativity in relation to the risk.
Tolerable Risks is a key aspect for the Person Centred Approach in using this process it enables participants to have a more balanced and rational approach to risk, finding ways to enable the person to achieve what is important to them while considering what keeps that person and the community safe in a way the individual understands.
Explain how a service focused approach to risk assessment would differ from a person centred approach
A risk assessment only identifies the probability of harm, assess the impact on the individual, and interventions that will help to diminish the risk or to reduce the harm. Assessments cannot prevent risk. Risk is a normal and enables learning and understanding.
Risk assessments are full of charts and scoring systems. A service focused approach seeks to avoid all risks. Risk assessments have no flexibility and is not a responsive approach to meet peoples changing circumstances. A service centred approach to risk assessment would be guided by a standard procedure and can compromise individuals rights to make choices and take risks. A person centred approach to risk taking will find the balance between what is important to the person, their aspirations and the supports that they require.
Identify the consequences for individuals of a service focused approach to risk-assessment.
Risk taking will usually often have positive benefits for individuals, enabling them to do things that most will take for granted. The problem with a service focused approach to risk assessment, is that it reduces the individual’s independence which in turn could reduce the positive benefits for the individual in question. A service focused approach to risk taking usually tends to have a negative focus on what the individual is not able to do or what they cannot achieve and has a limited outlook on identifying the benefits of positive, person-centred risk assessment. It does not empower the individual or encourage independence.
Explain how legislation, national and local policies and guidance provide a framework for decision making which can support an individual to have control over their own lives,
There are many different legislations and policies in place to promote human rights, in relation to support the individuals right to make up his or her own mind and to take risk.
The equality Act 2010, is a law that bans any unfair treatment and help to get equal opportunities in the workplace and society. This Act covers nine protected characteristics, which cannot be used as a reason to treat people unfairly they are,
marriage and civil partnership
pregnancy and maternity
religion or belief
The Human rights Act 1998, This Act states that are able to seek help from courts if their Human rights have been infringed. The Human Right Act guarantees the following rights;
The Right to life
The right to freedom from torture and inhuman or degrading punishment
The right to freedom from slavery, servitude and forced or compulsory labour
The right to liberty and security of person
The right to a fair and public trial within a reasonable time
The right to freedom from retrospective criminal law and no punishment without law
The right to respect for private and family life, home and correspondence
The right to freedom of thought, conscience and religion
The right to freedom of expression
The right to freedom of assembly and association
The right to marry and found a family
The prohibition of discrimination in the enjoyment of convention rights The right to peaceful enjoyment of possessions and protection of property The right to access to an education
The right to free elections
The right not to be subjected to the death penalty
Mental Capacity Act 2005, is to promote and safeguard decision making within a legal framework. It does this in two ways: By empowering people to make decisions for themselves wherever possible and by protecting people who lack capacity by providing a flexible framework that allows them to be part of the decision making process By allowing people to plan ahead for a time in the future when they might lack the capacity for any number of reasons
Mental Health Act 2007 – amends the Mental Health Act 1983 and the Mental Capacity Act 2005. It introduces significant changes which include: Introduction of Supervised Community Treatment. This replaced supervised discharge with a power to return the patient to hospital, where the person may be forcibly medicated, if the medication regime is not being complied with in the community. Redefining professional roles: broadening the range of mental health professionals who can be responsible for the treatment of patients without their consent. Nearest relative: making it possible for some patients to appoint a civil partner as nearest relative. Definition of mental disorder: introduce a new definition of mental disorder throughout the Act. Criteria for Involuntary commitment: introduce a requirement that someone cannot be detained for treatment unless appropriate treatment is available. Introduction of independent mental health advocates for qualifying patients.
Safeguarding Vulnerable Groups Act 2006 This act is intended to prevent unsuitable people from working with vulnerable people and to reform current vetting and barring practices. The act sets out a legal framework for the Independent Safeguarding Authority.
Valuing People (Department of Health, 2001) This states the importance of Person Centred Planning can play in helping people with learning difficulties take charge of their own lives. The Guidance (Department of Health, 2002) stressed that Person Centred Planning is not a professional activity done to people; instead people themselves and their friends, families or other allies, must lead it.
Putting People First, stated that person centred planning must become mainstream. Putting People First recognises that person-centred planning and self-directed support are central to delivering personalisation and maximising choice and control. It recognises that to achieve real change, users and carers must participate at every stage.
These areas are:
universal services – transport, leisure, health, education, housing and access to information and advice; choice and control – shaping services to meet people’s needs, rather than shaping people to fit in with the services on offer; social capital – care and support that individuals and their carers can get from their local community (friends, family, neighbours or community groups); and early intervention and prevention – support that is available for people who need help to stay independent for as long as possible, to keep their home or garden tidy, or to start taking regular exercise.
Describe how a human rights based approach supports an individual to make decisions and take risks;
A human rights based approach to risk management means to make sure individuals know their rights and that they are being supported to participate in making their own choices and decisions. A human rights based approach to risk assessment will balance the human rights of service users, carers, and other members of their communities. This is done so risks can be managed more positively and effectively. A human rights based approach looks at risk with ‘Human Rights’ in mind, it identifies the relevant equality and diversity issues, and maximises service user participation and empowerment. A human rights based approach to risk, means ensuring service users are as involved as they can possibly be in their own risk assessment process.
support an individual to recognise potential risk in different areas of their life, and support the individual to balance choices with their own and others’ health, safety and Wellbeing;
Positive risk taking is the process which will identify the potential benefit or harm. Positive Risk taking is to encourage and support people in positive risk taking so that they can achieve personal change or growth. Risks can be in many different areas of their life including, risks relating to their own health, their social life and also their finances and it is important to support the individual to recognise all of these potential risks. The risk assessment looks at four areas of risk; risks to self, risks to others and risks from other and risks to property. It is important that whilst improving on their quality of life they need to maintain their safety, responsibilities to themselves and others.
Supporting an individual to recognise potential risks whilst balancing the choices with their own and others health, safety and well-being involves:
Empowering people to access opportunities and take worthwhile chances. Understanding the person’s perspective of what they will gain from taking risks and understanding what they will lose if they are not allowed to take the risk. Ensuring the individual understanding the consequences of different actions to understand what the reasonably expected consequences may be of making that choice. Helping the individual to make decisions based on all the choices available and accurate information. Being positive about risk taking.
Understanding a person’s strengths and finding creative ways for people to be able to do things rather than ruling them out. Knowing what has worked or not in the past and where problems have arisen, understanding why supporting people who use services to learn from their experiences. ensuring support and advocacy is available
sometimes supporting short term risks for long-term gains. ensuring that services provided promote independence not dependence assuming that people can make their own decisions (in line with the Mental Capacity Act) and supporting people to do so
working in partnership with adults who use services, family carers and advocates and recognise their different perspectives and views developing an understanding of the responsibilities of each party promoting trusting working relationships.
Describe how own values, belief systems and experiences may affect working practice when supporting an individual to take risks
Encouraging risk taking can put people in a difficult position as trying to balance someones own personalisation through risk taking with your own values and beliefs and the duty to keep people safe. Peoples past experiences may make them feel that the risks involved, will result in problems, however they should not let this interfere with the individual’s wishes. At some point everyone will have had a bad experience following a course of action this does not necessarily mean this will happen to other people. Your beliefs and experiences should not cloud the issue. It is key that you feel confident and equipped to support people to assess and evaluate their own risks. Advice is readily available when facing difficult cases in the form of risk enablement panels.
Record all discussions and decisions made relating to supporting the individual to take risks,
It is very important to ensure that all discussions and decisions made relating to supporting the individual to take risks are recorded within their support plan. Records will need to be eligible and understandable to all the members that work with the individual. The aim of record keeping is to ensure that the right people have the right information at the right time to provide the best care for the person in question. Recording information will provide a record of what has been discussed and decided in regards of risk taking. The records should also record any incidents which have taken place.
The reason for keeping the records are:
To show that you have offered the individual choices
To show that you have agreed the desired outcomes
To show that the individual has given their consent.
complete a risk assessment with an individual following agreed ways of working,
Risk assessment is the activity of collecting information through observation, communication and investigation. It is an ongoing process that involves considerable persistence and skill to assemble and manage relevant information in ways that become meaningful for the users of services (and significant other people) as well as the practitioners involved in delivering services and support. An effective risk assessment will need the person in question, their families, carers, advocates and practitioners to speak with one another to decide on decision and course of action.
communicate the content of the risk assessment to others
It is important to communicate and work in a consistent way with all those whom are supporting the individual. Gathering information and sharing is important. It is not just an essential part of risk assessment and management, but also key in identifying risks. Its important to communicate the relevant information of the risk assessment to all relevant staff. It will also be important to discuss and explain the risk assessment with the individual’s carer and family, so that they are kept in the loop. The individual’s goals and targets should be discussed too, so that they can aid understanding regarding the risk assessment and to ensure all those involved are aware of the desired outcomes.
support the individual to take the risk for which the assessment has been
One way of supporting the individual to take the risk, could involve having a trial run. An example could be where the individual wants to make an independent trip in to town using public transport. On the first trip you could accompany the individual on each step of the journey. On the second trip, you could accompany them to the town and then arrange to meet with them later in the day. On the third trip, you may just accompany them to the bus stop.
Gradually you can reduce the amount of support you provide. It is also important that the individual knows what to do if things do go wrong. You can support them to take risks by ensuring they have clear information and advice about what to do if they have any concerns.
Review and revise the risk assessment with the individual;
After each risk assessment has been agreed it will be important that to monitor and review in case any revisions are necessary. Risks may change as circumstances change, so they should be reviewed regularly. Risk assessments should be reviewed periodically and whenever circumstances change to ensure they remain current. i.e. Resident Baths on the own accord, but due to a fall now need assistance getting in and out of the bath.
evaluate with the individual how taking the identified risk has contributed to their well-being.
Well-being describes the way we think and feel about ourselves and others, our confidence, and our ability to control things in our life.
When evaluating you will need to speak, with the individual, how taking the identified risks has helped their well-being and their quality of life. This will involve looking at the positive /negative consequences and outcomes of their choices they have made. Looking at whether taking the risks have met the individual’s needs and achieved their desired outcome. Taking an identified risk will hopefully make the individual feel empowered and to have a greater feel of independence, control and normality.
In supporting the individual to take positive risks, it should help them to evaluate other courses of action and can build confidence. The experience of failure, as a result of risk taking in a safe environment, can help to manage the identified risk better in the future.
explain how the principle of duty of care can be maintained while supporting individuals to take risks,
Everyone has a duty of care and a responsibility not to agree to a support plan if there are any serious concerns that it will not meet the individual’s needs or if it places an individual in a dangerous situation. Whilst an individual can choose to live with a level of risk and is allowed to do so through law, the local authority does not have to fund it. When you support individuals so that they can have more choice and control within their lives through positive risk taking, things may go wrong from time to time. A defensible decision is one where those involved in the risk assessing process: Used reliable assessment methods
Acted responsibly in relation to their duty of care
Were not negligent
Assessed and took steps to manage and minimise foreseeable risks Recorded decisions and subsequently checked they were carried out Followed policies, procedures and guidance
Involved the person and other relevant people in the process Supported people to make informed decisions
Identification of positive and negative risks
Involvement of people who use services and those who are important to them – this includes people who form the individual’s informal ‘circle of support’, who are involved from the beginning to gather information, define what the risks are from the individual’s point of view and to discuss ways to enable and manage these risks. Positive and informed risk-taking – this is built on a strengths-based approach to the person and looks at creative ways for people to be able to do things rather than ruling them out. Proportionality – this means that the time and effort spent on managing a risk should match the severity of that risk. The approach should also explore the consequence of not taking the risk in question, such as loss of autonomy or restriction of choice.
Contextualising behaviour – this means knowing about the person’s history and social environment, their previous experience of risk, what has and has not worked in previous situations. Defensible decision making – this means recording a clear rationale for all the decisions made and the discussions that led to the decisions, including reference to relevant legislation such as the Mental Capacity Act or the Human Rights Act. A learning culture – this require a commitment to ongoing learning and the use of reflective practice for people working at the frontline. Tolerable risks – this involves negotiating and balancing issues of risk and safety to identify what is acceptable for everyone concerned (the individual and others including the community) on a case by case basis.
Describe what action to take if an individual decides to take an unplanned risk that places him/herself or others in immediate or imminent danger,
When looking after someone if you believe that he or she is about to take an unplanned risk which could potentially place them or others in immediate or imminent danger it is very important to take appropriate corrective and preventative action and stop the activity immediately. Risk assessments should include contingency plans that address risks from unplanned events. Physical intervention may only be the course of action. Staff should be trained with a range of skills to deal with any potentially violent situations, as well as a range of restraint techniques that will help them use the minimum level of force possible. Physical intervention is only used in response to challenging behaviour.