5th November 2015
As an assessor on the Leading Lights programme, I visit services all around the country to see how they work. It’s a real privilege to be welcomed into organisations, to speak to staff, and to look in detail at the work they do every day to help clients stay safe and recover from abuse. Everywhere I go I see innovative ideas, meet dedicated staff and read about the experiences of clients and the intensive support they receive.
A key area that we assess as part of Leading Lights is the use of risk assessment, and it is in this area that I have recently started to notice patterns in how services implement the risk-led model. At SafeLives we talk a lot about this risk-led response, but how should you use it in practice?
Worth the hassle?
The Leading Lights standard asks you to assess risk with the client during the intake process using an evidence-based tool (This might be the SafeLives Dash or Acpo Dash, Merit etc). We then recommend that you review risk every 6-8 weeks, as well as when circumstances change and at closure. Some services also use the severity of abuse grid to provide context to the risk score, but we recommend that this is in addition to the full Dash, not instead of it.
I do get feedback from front line workers questioning whether it’s always worth reviewing the risk formally. They highlight the fact that - due to historical risk factors - the review Dash may not show a reduction in risk even though all safety planning options have been put in place. Some also feel that completing a full review of the Dash is not helpful for the client and that clients themselves are resistant to it.
So, why do we recommend a full review is completed with the client?
- New risks can be identified and fed into the support & safety plan e.g. access to weapons, recent incidents, recent separation, pregnancy etc.
- To identify where risk has reduced and help with case management
- To provide evidence of defensible decision making in terms of scaling down support or case closure.
- It creates a dialogue with the client and helps them to understand the risk posed to them by the perpetrator.
- It will undoubtedly bring up other information that may otherwise be missed if those questions are not asked directly.
In cases where the service has tried to review the Dash but couldn’t contact the client or they declined, it should record this clearly on the case file and keep trying to make contact - but I have found that clients very rarely decline to answer the questions. Workers I have interviewed also say that a full review of the risk assessment empowers the client and allows them to feel in control of the risk they face. Where it can be shown that risk has reduced, it also helps them to see how far they have come on their journey.
Your client's safety - and yours
So what about those cases that some argue will always remain high-risk due to the static risk factors? Where the review still shows that the case is high-risk, even though all safety measures have been put in place?
In these cases, it is still important to have that information – and this is where the severity of abuse grid can help to provide context to the score. In cases where a client is ready for a longer term service but their risk assessment still shows they are high-risk, you can still refer them on. But you need to make clear on your case file the reasons for referral and tell the other agency what has been put in place to reduce the risk.
Sometimes workers tell me that they are constantly assessing risk on a daily basis and there is no need to formally review it. But if it is all in your head and not on your file, it is unsafe for you and unsafe for your client. We have to lead by example – if we want our midwives and police officers to be asking and acting, it is important that we are also comfortable to ask the questions.
It is worth noting that workers who feel most comfortable repeating the Dash have usually developed their own ways of conducting the assessment that are also comfortable for the client. For some the tool forms part of a wider conversation, whereas others find the direct approach works best for them – the appropriate technique to use will vary from client to client.
The final thing to remember in terms of risk assessment is that the checklist forms part of a whole risk-led response. What I love to see when I open a file is regular formal review of risk cross referenced in clear case notes, backed up by regular and robust case management with a supervisor and support plans that are SMART and kept up to date as the case progresses. Those three things a happy Leading Lights assessor makes.