Risk taking is part of daily life and does bring benefits, including wellbeing (see Promoting Wellbeing). The evaluation and management of risk, therefore, is an essential part of the assessment process and is a necessary for identifying an adult’s level of need and eligibility for services (see Assessment). Not all risks can be eradicated, but they can be managed to prevent or reduce the impact of harm.
Some risks are general and some specific, but in each case risk should be defined in relation to a specific situation, that is, what is the presenting risk and /or who or what is the risk. Undertaking a comprehensive risk assessment involves collating evidence based information, evaluating that information – balancing possible positives of a course of action against potential drawbacks – and using professional judgment to ascertain the potential for the occurrence of harm.
Adequate risk assessment can rarely be done by one person alone and a coordinated approach is required. Good relationships between professionals and the adult and their carers makes the assessment easier and more accurate, and may indeed reduce risk.
A risk assessment needs to identify and balance different perceptions of risk, including the adult, their carers and professionals; the adult’s right to make informed choices about taking risks should be safeguarded and encouraged. Decisions about risk, however, do need to balance any risk to the public and the needs and wishes of the adult.
If the adult lacks capacity to make decisions, the risk assessment must take account of the views of family members or friends important to the adult and who have an interest in their welfare or, where appointed, their Attorney or Independent Mental Capacity Advocate (see Independent Advocacy and Independent Mental Capacity Advocates).
The professional undertaking the assessment must be supported throughout the process by their manager, to ensure all aspects of the situation have been understood, evaluated and the views of the adult, their Attorney and / or Advocate where appointed and other agencies and service providers have been considered. The professional undertaking the assessment should ensure a referral for an IMCA is made, where appropriate, to protect an unsupported person who lacks capacity to make a decision.
Within Adult Social Care, lines of accountability with other agencies should be established for high risk areas, and a clear management reporting structure should be in place.
Staff undertaking risk assessments should be competent and able to evaluate and act upon a risk of danger, harm or abuse. Staff should therefore know how to reduce or remove risk. Ongoing risk management tasks include staff supervision.
In high risk situations staff should be debriefed on the outcomes of the assessment, enabling them to gain insight into their work, their personal stress, their decisions and the appropriate plan of action.
The adult should be involved as far as possible in the process and their independence should be the main focus. The adult’s Attorney and / or Advocate where appointed should also be involved. See Mental Capacity and Deprivation of Liberty Safeguards.
A multi-disciplinary approach should form the basis of the risk assessment process. Information should be collated from a variety of sources and agencies. Contributions from agencies such as the police, probation and the adult’s GP should always be considered at each stage in the process.
The professional/s undertaking the risk assessment should be aware of the different types of risk that may exist. These may include risks in four main areas:
Risk should be considered in terms of the likely risk to:
Types of risk may include the following:
Risks that involve the allegation or suspicion that an adult may be experiencing, or at risk of, abuse or neglect should be dealt with under the local Safeguarding Adults Procedures. For example in the immediate aftermath of an incident, or interpreting signs of distress which have built up over a period leading to a decision that serious concern is warranted.
In assessing the likelihood of the risk occurring, the professional should consider the:
It should be noted, risk assessment forms and screening checklists may vary between different service areas.
Other factors to be considered by the professional include:
Risk assessments should be subject to frequent review, as an adult – or their carer’s – circumstances may change. Interventions can increase risk as well as decrease it.
Recording of the risk assessment should be structured with the identification of each risk in order of priority, and the likelihood of the realisation of the risk and its impact. Each risk should have recommendations to control, reduce or remove the risk (see also Case Recording).
Multi-agency meetings may be required where:
The professional should conclude how serious the risk is, how specific it is and its immediacy.
Not every adult will require a risk management plan, but where there are concerns, a plan should be developed.
The risk management plan should:
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