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Positive Risk Taking in Practice 

Research shows that a risk-averse attitude among practitioners can lead to generalisations about certain service user groups.The responsibility for encouraging risk-taking can make practitioner feel trapped in the invidious position of trying to balance personalisation with their duty to keep people safe.The Positive Risk Taking In Practice course aims to give practitioners the tools and the confidence to support the people that they care for to assess and evaluate their own risks. 

Good Practice Means Understanding That: 

• Risk is a normal everyday experience 
• Risk is dynamic, constantly changing in response to changing circumstances 
• Each person’s perceptions of risk depends on their individual circumstances such as their values, aspirations, cultural background 
• Identification of risk carries a duty to do something about it, that is, risk assessment and management 
• Assessment of risk is enhanced by accessing multiple sources of information 
• Risk-taking is an integral component of good risk management 
• Decision-making can be enhanced through a multi-agency approach 
• Risk can be minimised, but not eliminated. 
 
Source: Positive Risk Taking and Risk Management Guidance 
 
(Source Positive Risk Taking and Risk Management Guidance, London Borough of Camden - Adult Social Care (v.1 2016) 

It is Characterised by: 

• An understanding of the person’s strengths. It is very much based in the here and now, but will be clearly influenced by knowledge that support is available if things begin to go wrong 
• Depending on the circumstance, tolerating short-term heightened risk for longer term positive gains 
• Collaborative working and a clear understanding of responsibilities that people and services/networks can reasonably hold in specific situations 
• Supporting people to access opportunities for personal change and growth 
• Establishing trusting working relationships, whereby the person can learn from their experiences, based on taking chances just like anyone else 
• Understanding the consequences of different courses of action, and making decisions based on a range of choices available, and supported by adequate and accurate information 
• Explicit setting of boundaries, to contain situations that are developing into potentially dangerous circumstances for all involved. 
• 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. 
 
(Source Positive Risk Taking and Risk Management Guidance, London Borough of Camden - Adult Social Care (v.1 2016) 
 
This document help to balance safeguarding with the principles of personalisation, stressing that safety planning must recognise and compliment a persons strenghts and resources 
This document from ADASS, West Midlands Joint Improvement Partnership and NHS West Midlands is a helpful and informative guide to Risk Assessment and Management in the Personalisation and Enablement Context. 
You can review the powerpoint content of the Positive Risk Taking in Pract video here. 

Focus on Success through SMART Planning 

The SMART model is a wayl to help people set and reach their goals.Goals convey what it is that is to be achieved, and the desired outcome for the or gain for the service user, i.e. a person centred outcome.  Specific Specific and significant Well defined Clear to anyone that has a basic knowledge of the situation   

Start by describing this particular person's needs as precisely as possible. Avoid clichés or describing needs using ‘universal’ terms eg “X needs to reach his full potential”. We all need the opportunity and occasional support to do that. Do not describe needs in ‘service terms’ eg ‘X. to be referred to CMHT’ is inadequate. This is an action and not a need. If the purpose of the referral isn’t clear the support plan will fail. The need might be ‘everyone to understand why X hurts herself when upset by cutting her arms and for X to be helped to deal with upsets without hurting herself’. Action would be, refer to CMHTS. Use plain language not jargon. 

Measurable 

 
Meaning and motivational 
Know if the goal is obtainable and how far away completion is 
Know when it has been achieved 
 
Establish concrete criteria for measuring progress toward the attainment of each goal you set. This will enable you and the service user to measure progress and stay on track, reach target dates, and feel positive about what has been achieved. achieved. 

Achievable and Realistic 

Attainable, acceptable and action-oriented 
Agreement with the service user of what the goals should be 
Relevant, reasonable, rewarding and results-oriented 
Within the availability of resources, knowledge and time 
 
When we identify goals that are most important to us,we begin to figure out ways to fulfill them. It is therefore important that we don't simply "give" a plan to a service user, it will be more meaningful if it reflects their genuine wishes and feelings and the person's strengths abilities and resources. 
To be realistic, a goal must represent an objective toward which the person and their support network are willing and able to work. A goal can be both high and realistic; y A high goal is frequently easier to reach than a low one because a low goal exerts low motivational force. A goal is realistic if it can be accomplished. 

Timely 

Respect deadlines and factor in sensible review dates. These might represent helpful milestones at which progress can be explicitely identified and recorded but be flexible, bring review dates forward and re-evaluate the plan if problems are occurring. 

Abraham Maslow and a Theory of Motivation 

Maslow's (1943, 1954) hierarchy of needs is a motivational theory in psychology comprising a five tier model of human needs, often depicted as hierarchical levels within a pyramid. Maslow stated that people are motivated to achieve certain needs and that some needs take precedence over others. Our most basic need is for physical survival, and this will be the first thing that motivates our behaviour. Once level is fulfilled the next level up is what motivates us, and so on. 
This five stage model can be divided into deficiency needs and growth needs. The first four levels are often referred to as deficiency needs (D-needs), and the top level is known as growth or being needs (B-needs). 
The deficiency needs are said to motivate people when they are unmet. Also, the need to fulfil such needs will become stronger the longer the duration they are denied. For example, the longer a person goes without food, the more hungry they will become. 
 
One must satisfy lower level deficit needs before progressing on to meet higher level growth needs. When a deficit 
need has been satisfied it will go away, and our activities become habitually directed towards meeting the next set of 
needs that we have yet to satisfy. These then become our salient needs. However, growth needs continue to be felt 
and may even become stronger once they have been engaged. Once these growth needs have been reasonably 
satisfied, one may be able to reach the highest level called self-actualization. 
 
Every person is capable and has the desire to move up the hierarchy toward a level of self-actualization. Unfortunately, progress is often disrupted by a failure to meet lower level needs. Life experiences, including divorce and loss of a job may cause an individual to fluctuate between levels of the hierarchy. Therefore, not everyone will move through the hierarchy in a uni-directional manner but may move back and forth between the different types of needs. 
(Source: Saul McLeod 2007, updated 2016. Retrieved from simplypsychology.org/maslow.html 20/06/2017). 
Download Saul McLeod's informative article HERE 
 

Safety Planning: Scenario Building 

What is Scenario Building? 

Scenario building, also called scenario thinking or scenario analysis, is a strategic planning method used to make flexible long-term plans. 
It involves aspects of systems thinking, specifically the recognition that many factors may combine in complex ways to create outcomes (due to non-linear feedback loops). The method also allows the inclusion of dynamic, as well as static factors. Systems thinking used in conjunction with scenario planning leads to plausible scenario narratives because the causal relationship between factors can be demonstrated. 
What Are We Worried About? 
Nature 
• What kind of Harm is likely to occur? 
• Who is likely to be harmed? 
• What is the likely motivation — that is, what is the person trying to accomplish? 
It is important to explicitly state what kind of harm is likely to occur (Danger Statements) and who is most likely to be harmed. 
Behaviour never occurs out of the blue, there is always a reason for it and it is here that the motivation for the harmful behaviour, the decisions to act can be articulated. 
Severity 
• What would be the psychological or physical harm to victims? 
• Is there a chance that the harm might escalate to serious or life-threatening levels? 
Having established the likelihood and nature of the harmt, this section requires the assessor to articulate the degree of physical and psychological harm that might be caused . The age, development, health and resilience of the likely victim(s) need to be taken into account and this may vary between between people involved in the risk nscenarion.. 
Imminence 
• How soon might the harmful behaviour occur? 
• Are there any warning signs that might signal that the risk is increasing or imminent? 
This section draws on patterns of past behaviour and the identification of acute dynamic risk factors such as exposure to destabilisers. If there is current stability, there may be no imminent risk but the importance of this section is to alert professionals to warning signs that may indicate the need for urgent reassessment or corrective intervention. 
Frequency/Duration 
• How often might the harmful behaviour occur — once, several times, frequently? 
• Is the risk chronic or acute (i.e., time-limited)?. 
Based upon previous patterns of harmful behaviour, the assessor should be able to make an informed judgement about not just the likelihood of relapsing into harmful behaviour but the frequency with which harm may occur. A history of high density incidents and diversity of maltreatment would indicate greater likelihood of frequent abuse over a period of time. 
In some cases, harm may be directly associated with mental health state, sobriety or stability of relationships and therefore easier to make realistic predictions in terms of type, frequency and duration of potential maltreatment. 
Cases characterised by impulsive and spontaneous acts of abuse, reckless disregard for welfare of self or others or volatile relationships may make it harder to make specific predictions with regard to frequency. However, such a case history would indicate chronicity of risk. 
Likelihood 
• In general, how frequent or common is this type of harmful behaviour? 
• Based on this family’s history, how likely is it that this type of harmful behaviour will occur?. 
This section draws on research and knowledge about the prevalence of such harmful behaviour within the general population. The second question draws specifically on static risk factors and the presence or absence of protective factors. 

What's Working Well?  

• What strengths are demonstrated as protection over time? 
• What are the assets, resources and capacities within the family? 
• What research based protective factors are present? 
Based on the Signs of Safety approach, it is important to identify and make explicit that which is working well for the family and where there are signs of resilience (Turnell, 2012). This set of questions refers to items identified as present within the Strengths / protectors (Resilience) Domain) 
Monitoring 
• What is the best way to monitor warning signs that the risks posed may be increasing? 
• What events, occurrences, or circumstances should trigger a re-assessment of risk? 
Monitoring, or repeated assessment is a crucial part of risk management. The goal is to evaluate changes (positive and negative) in risk over time so that safety plans can be adjusted as needed (Webster, et al., 1997). Monitoring strategies may include contacts with the person, their family as well as other professionals and agencies. Plans for monitoring should include specification of the kind and frequency of contacts.. 
Intervention 
• What Intervention strategies could be implemented to manage the risks posed? 
• Which Concerns are high priorities for intervention? 
Intervention is likely to involve the provision of rehabilitative services. Targets for intervention may be addressing psycho-social adjustment of family members, treatment of mental health problems and substance use disorders, reduction of life stresses e.g. physical illness, interpersonal conflict, unemployment, legal problems etc. 
Supervision 
• What supervision strategies could be implemented to manage the risks posed? 
• What restrictions on activity, movement, association, or communication are indicated? 
Supervision involves the restriction of a person’s rights and freedoms. The goal of supervision is to make it more difficult to engage in behaviour that causes harm toself or others and may require input from legal services and law enforcement departments. 
 
In general, supervision should be commensurate with the risks posed by the individual (Webster, et al., 1997). 
Safety Planning 
• What steps could be taken to enhance the safety and security of the child(ren)? 
• How might the child(ren)’s physical security or self-protective skills be improved? 
Safety planning involves improving the person's dynamic ( a function of the social environment) and static (function of the physical environment) security resources and developing resilience. If harm or maltreatment occurs despite all the efforts to manage and monitor the situation, any harmful impact on the person)’s psychological and physical well being and development is minimised. 

Download a Positive Risk Taking  Worksheet for Scenario Building HERE