A Model for Risk Assessment

1. Introduction

The aim of this framework is to provide a clear and standardised guidance in order that social workers feel confident and clear about their roles and responsibilities in the assessment and analysis of risk.

Risk is the possibility that an event will occur with harmful outcomes for a particular person or others with whom they come into contact. Risk factors are those things that are identified in the child's circumstances or environment that might constitute a risk, a hazard or a threat. The more risk factors present (or the more serious one single factor is) then the greater the risk of harm.

Our aim should be to:

• Reduce risk and make children safe;
• Empower children and parents;
• Understand an individual's strengths;
• Know what has worked or not worked in the past and understanding why;
• Be positive about potential risks;
• Develop a trusting working relationship;
• Work in partnership with parents and children;
• Help children and parents to access opportunities and take worthwhile chances, but realistic that it might not achieve the desired outcome;
• Make decisions based on all the choices available and accurate information.

Establishing an understanding and measure of risk is central to the work that is undertaken with children and their families. Robust assessment of risk and need is one of the cornerstones of high quality social work, delivery of effective services and good outcomes for children.

Measuring the level of risk is crucial to determining both the need for intervention, support and protection as well as shaping an appropriate response to identified needs within a timely manner. Professionals have to make difficult judgements in seeking the right balance between ensuring that responses are proportionate and enabling children and families to participate and have control over their lives whilst also ensuring that they are free from harm, exploitation and abuse. However, it is important that this does not mean agencies or professionals should become opposed to taking risks or only willing to take small risks.

Eileen Munro, in her work, 'Effective Child Protection' (2008) states that in order to manage risk, there is a need to identify:

• What has been happening?
• What is happening now?
• What might happen?
• How likely it is?
• How serious it would be?
• A combination of seriousness and likelihood leading to an overall judgement of risk.

It is important to acknowledge that risks cannot necessarily be eliminated, but they can be managed and reduced. Risk management should therefore be understood as risk reduction, with no situation considered entirely risk free. There is no definitive, fail-safe method of predicting risk of harm to children and young people. Risk assessment matrices and check lists can be helpful in guiding understanding but they cannot be absolutely relied upon to provide definitive answers to levels of risks faced by children.

Risk exists on a continuum rather than being a specific score on a checklist or matrix and it can and does change over time (be dynamic) dependent on a wide range of different factors. What is particularly important in the management of risk is that professionals, using their judgement, also analyse the impact associated with the intervention and balance those, with reasoned arguments, against the current risks to the child – e.g. a neglected child supported at home or be become Looked After.

It is essential, therefore, to work in a holistic way, one which recognises the balance between the known risk factors and protective factors, strengths and resilience.

2. All Assessments are Assessments of Risk

Assessment' is the purposeful gathering and analysis of available information. In the context of child protection, assessment should underpin professional judgements to inform and determine the level and type of intervention with vulnerable children and young people who may have been harmed or are at risk of harm.

In work with children and their families requires us to:

• Establish the goals (purpose) and objectives (target) – clarify objectives and areas where risks may occur;
• Identify risks – including how they may happen;
• Consider any cultural factors including language and religion;
• Analyse risks – determine likelihood and magnitude of consequences;
• Evaluate risks (e.g. low, medium, high) – which risks are acceptable, make a comparative assessment of all the benefits you anticipate from the behaviour or action as well as all the implications/costs and consider what the potential impact are resulting from it;
• Implement strategies to minimise and prevent risk – "SMART" actions to be taken and who is responsible;
• Review and revise risks and preventative measures – detect and manage new risks – e.g. An incident or change of circumstances. Remember, risks change as circumstances change and should be reviewed on a regular basis;
• Communicate and consult – to build commitment and increase ownership and compliance.

Traditionally, agencies have assessed risks to children's well-being in the context and prom the perspective of their own agency. Within this framework social work practitioners are encouraged to understand their work in the context of the whole child and family and use it as a principle to their approach to assessment and analysis of risks. The framework encourages the integration of gathered information to ensure that the effects and impact of risk in one dimension are linked with what is happening in the rest of the child's life. In other words, it demands an approach that is both developmental and ecological in its approach and is an approach that not only considers the risks in the short term but hypothesises on the impact of risks on children's well-being in the long term.

This framework also acknowledges the complexity of the social work task of assessing both risk and need and the impact on children whilst working with them and their families. This approach provides for the exercise of professional judgement.

3. When Can the Framework be Used?

The framework can be used by any practitioner in circumstances where agencies are trying to understand a child's needs any assessment of a child's circumstances should always consider the child's need to be safe and protected. Where the assessment process identifies concerns, the Framework can support practitioners to explore potential areas of risk in greater detail and can be used within the following circumstances:

• Single agency assessment of need – to assist identifying issues of concern which require to be addressed within a single service assessment;
• Child Protection investigation – to help obtain initial multi-agency understanding and agreement on the level of actual and potential risk(s) and the initial action(s) that may be necessary to support and protect the child;
• An accumulation of concerns – such as in cases of domestic abuse and neglect where practitioners require a better shared understanding of the multidimensional nature of the concerns, the level of risk and whether change is possible within the family context;
• Child Protection planning – where a comprehensive assessment of need and risk requires to be undertaken to inform the Child Protection Plan and risk management/reduction strategies.

Where circumstances have improved and services remain involved the framework can still usefully support on-going assessment and intervention, evidencing change.

4. Framework for Risk Assessment

Identified in the framework are five stages to be undertaken to ensure that assessment is holistic and continual, and outcomes are based on clear, evidence based rationales. These are:

• Stage 1 - Gather Information;
• Stage 2 - Assess Harm and Risk of Harm;
• Stage 3 - Decide the Response;
• Stage 4 - Decide the Outcome Stage;
• Stage 5 - Review Risk Assessments During On-Going Intervention.

The framework is cyclical, highlighting the need for continual review of all assessment and care plan outcomes through analysis of new information and evidence, while incorporating changes that have occurred for the child and family as a result of intervention or due to other factors.

Application of the framework should be supported by supervision processes and continued professional development opportunities and is to be used in conjunction with relevant legislation, policy, procedures and practice guidelines.

5. Application of the Risk Assessment Model

5.1 Stage 1 - Gather Information

To continually assess risk of harm along the Child Protection continuum, clear, factual information needs to be gathered in relation to:

• The alleged harm / risk of harm;
• The child;
• The parents;
• The family context;
• Any social, environmental, and cultural factors that may influence child and family functioning.

This information can be gathered by:

• Engaging with the referrer to gather information about their concerns for the child - the who / what / where / when;
• Critically reviewing all previous histories / case files; both electronic and paper based;
• Engaging with the child, siblings, parents, foster carers, relevant family and household members, significant people in the child's life and community; and relevant professionals, for example, teacher, GP, Health Visitor, School Nurse and other service providers in contact with the family;
• Direct observation and assessment of the quality of interactions between the child, parents, foster carers, and others within the environment.

Information gathering is a continual process, with new information needing to be incorporated with what is already known. The receipt of new information may require a review of decision-making and a re-assessment of harm and risk of harm.

Identify Risk and Protective Factors

Research evidence indicates harm to a child may be due to the interplay of multiple factors both within and outside the family. To understand this interplay, an analysis of risk and protective factors that may exist is required as part of the overall assessment.

1. Risk Factors

Risk factors are those aspects that are identified in the child's circumstances, care giving or environment that might constitute a risk, a hazard or a threat. Risk Factors need to be understood in relation to the potential for child abuse and neglect rather than accidental harm to children, although this possibility should not be overlooked since a predisposition to accidental harm may be relative to safe-caring issues, poor supervision or parental recklessness.

These risk factors may indicate a heightened likelihood that a child may be harmed in the future, however, as predictors of harm, individual/single risk factors should be considered in context. Critical analysis of all information gathered needs to occur, to determine each factor's significance for the on-going safety of the child. While acknowledging it is not possible to predict future behaviour of a person with any certainty, risk factors can be viewed as markers which require further consideration and analysis, using professional knowledge and judgement. It is the interactions between multiple factors that may combine to increase the probability of harm occurring.

2. Protective Factors

To complete a balanced assessment, risk factors cannot be considered in isolation - they must be assessed in conjunction with identifiable protective factors. These protective factors can influence the direction or strength of the interaction between risk factors and the decision as to the appropriate response or outcome.

However, where protective factors are identified within a family, they must be verified or checked before they can be assessed as mitigating or reducing the identified risks. Accepting what a parent or relative describes as a protective action without verification may result in a child being placed at further risk of harm.

In assessing protective factors there is a need to differentiate between:

1. Factors which may provide immediate safety for the child, but do not decrease the overall and on-going risk of harm (for example, the child staying elsewhere, away from the risk, temporarily);
2. Factors which reduce the overall risk of harm for the child and therefore influence the decision about intervention (for example, the continued and verified presence of a protective adult/parent/family member in the household).

Comprehensive information, and knowledge and understanding of both risk and protective factors is required to analyse what balance or interplay of risk and protective factors exists for a child. The interplay of these factors is analysed during the assessment stage.

5.2 Stage 2 - Assess Harm and Risk of Harm

The assessment of harm and risk of harm is the dynamic process of gathering and analysing information to assess:

Past Harm	Harm previously experienced by a child which may have an on-going cumulative impact or may re-occur.
Current Harm	Being the level of harm that exists for the child in the present, including an assessment of the child's immediate safety.
Risk of Harm	The likelihood and level of harm that may occur to the child in the future.
Existing Protective Factors	Factors that may mitigate against risk of harm.

Incorporate Knowledge of Cumulative Harm

Cumulative harm is experienced by a child over a prolonged period of time due to the impacts of recurring incidents of harm. Not all incidents may meet the threshold for Social Care intervention however the resulting impact can accumulate.

Cumulative harm may be caused by an accumulation of a single recurring adverse circumstance or event, for example, on-going neglect, low levels of parental warmth and high levels of criticism, or by multiple different circumstances and events, such as a combination of persistent verbal abuse, harsh discipline and exposure to domestic violence.

Cumulative harm is understood within a framework rooted in the knowledge of child development - with harm impacting on a child's safety, well-being, stability and development. The impacts of cumulative harm can be profound, and have a greater impact than one off events, and have been widely associated with children experiencing complex trauma. Some developmental effects of cumulative harm include:

• Disruptions to early brain development, with permanent impacts on behavioural and emotional responses;
• Post-traumatic stress disorder;
• Disturbed patterns of attachment;
• Behavioural regression;
• Aggressive behaviour against self and others;
• Lack of awareness of danger or self-endangering behaviours;
• Self-hatred and self-blame;
• Chronic feelings of ineffectiveness.

If not alleviated, and the child's environment remains unaltered, stress and anxiety disorders, depression, and oppositional and conduct disorders may occur.

Assessment of Harm and Risk of Harm, Applying Analysis and Professional Judgement

When assessing harm and risk of harm, the focus is not on the specific incident that may have been notified, as this may lead to non-identification of cumulative harm. A holistic approach is required, with harm being considered along a continuum - with any cumulative harm from past experiences together with current harms and future risks being considered.

Integrating information obtained about child protection history, risk factors, protective factors, family strengths, and the family's access to services and resources inform the risk assessment.

Professional judgement, applying knowledge of a broad range of theoretical perspectives and appraising information, on multi-agency basis, to make a decision - is also an integral part of every child protection assessment.

Analysis

Analysis involves the process of breaking down what is known about the complexity of a child and family's circumstances into smaller parts, so as to acquire a better overall understanding of what is, or may be, going on. A multi-agency chronology can be an invaluable tool to assist with this process. Analysis critically draws on the information gathered, and the quality and nature of the information collated can shape how analysis is applied and some early conclusions reached.

Analysis is where information that the professional has gathered is then:

• Sorted;
• Weighted in terms of its significance; and
• Ultimately made sense of.

While separated out here as a distinct stage, analysis is a dynamic, continued process that is present in all aspects of risk considerations.

The analysis of harm and risk of harm is undertaken prior to identifying an appropriate response or intervention. This does not mean that the formulation of a care plan or interventions should wait until the end of the assessment.

Steps include:

• Gathering all available information;
• Summarising the harm characteristics known regarding:
  • Frequency of harm - the number of incidents that have occurred over time; any knowledge of prior unreported incidents; and whether there have been previous concerns for similar issues;
  • Type of harm - number of harm categories notified and whether there are indicators of other harm types in addition to those notified. For example, neglect may be the notified concern however further information gathered indicates regular incidents of domestic violence, resulting in physical and emotional harm to a child;
  • Severity - whether the alleged harm is significant, or is likely to cause significant harm if it were repeated over a prolonged period; and whether the impact of the harm on the child's development and well-being is, or will be, detrimental;
  • Source of harm - the number of people responsible for the harm; the significance of the relationship between the child and person(s) responsible (consider both intra - and extra-familial); and whether the child's current situation makes them more vulnerable to other perpetrators;
  • Duration - the period of time over which harm has occurred, including prior history that did not reach the threshold for a referral but where the impacts of harm may have accumulated over time.
• Integrating this information with all previous history;
• Reflecting on previous responses/assessments in light of this information;
• Social work reflection on and assessment of the experiences of any siblings.

It is essential that practitioners utilise formal supervision and case discussions with colleagues to assist in this process.

5.3 Stage 3 - Decide the Response

As part of the assessment a determination is required as to the level of harm experienced by the child. It is important to establish:

• Whether the child has been harmed and/or is likely to be harmed in the future;
• Whether the child is at risk of immediate significant harm, with their immediate safety threatened;
• The level or degree of harm experienced previously, currently, and likely to be experienced in the future, giving consideration to the child's vulnerability and any protective factors;
• Whether there has been a detrimental impact of a significant nature on the child's well-being, or there is an unacceptable risk of this occurring in the future;
• Whether there is a parent both able and motivated to protect the child from harm.

By this stage practitioners will begin to form a professional judgement as to the level of risk that may be present for each individual child which will then enable them to form a professional view about grading the identified risk factors as either high, medium or low.

To ascertain the on-going safety of a child is it also necessary to integrate into the assessment evidence of the parent's ability to recognise identified risks, their ability to protect and their ability to affect change.

Determine the Swindon Social Work Led Multi-Agency Response

The decision as to the appropriate response once harm or risk of harm has been identified should be informed and guided by:

• Working together to Safeguard Children;
• Swindon Safeguarding Board Procedures and these Children's Services procedures.

5.4 Stage 4 - Decide the Outcome

Determine the Level of Intervention Necessary

If it has been assessed that on-going intervention is required to ensure that the child's protection and care needs are met, the level, type and timeliness of the response/intervention needs to be determined. This decision incorporates the assessment of the parent's ability and willingness to protect - will the child be safe and protected within the household with intervention occurring with the parent's agreement, can this be achieved on a "Child in Need" basis or is there a need to seek a plan of protection via a child protection conference? Consideration also needs to be made with regard to the Public Law Outline and meeting the legal threshold to seek appropriate orders from Court to ensure the child's protective and care needs are met?

Identify Child and Parent Strengths and Needs to Help Develop Effective Plans

In deciding the level of on-going intervention, an assessment of the strengths and needs of both the child and parent is required. Assessment outcomes will direct and guide case planning decisions by identifying outcomes targeted at improving the child's physical, psychological and emotional well-being.

Strengths

Research has identified characteristics within a child and parent that interact together to assist the development of positive coping mechanisms and relationships. These characteristics, or strengths, can then be supported through effective case planning strategies. Strengths do not always translate as protective factors with regards to the specific risks identified, as they do not mitigate against risk of harm but can be supported and built on during on-going intervention to achieve positive outcomes in the family.

Strength and resilience characteristics in parents are identified by the ability to:

• Have knowledge of, and a sense of competence in parenting - requiring knowledge of developmental phases in childhood, and associated needs of the child and incorporating this knowledge into skills to respond effectively to a child;
• Have secure supportive relationships with significant others - characterised by affection, warmth, support for autonomy, sharing of responsibilities and an identified support network;
• Have well developed positive coping strategies and problem solving skills - requiring emotional stability, and an ability to reflect on past traumatic experiences and incorporate new strategies to counteract any prior harm;
• Have effective conflict management skills - communicating openly, with mutual respect;
• Lead a healthy lifestyle - actively making and promoting healthy choices, having a positive attitude and setting goals.

By addressing needs and supporting and building on protective factors and strengths, a child and parent's ability to respond and interact more effectively will be enhanced, building resilience in the future. This will assist in decreasing the likelihood of future harm and its long-term effects.

5.5 Stage 5 - Review Risk Assessments During On-Going Intervention

Holistic and dynamic assessments of the child and family are required throughout intervention as part of the case management cycle of assessment, planning, implementation and review of a child's safety and protection and care needs. Each assessment will provide a snapshot in time of the child's experiences of harm, the impact of identified harms, the likelihood of future harm, and their vulnerability and resilience to future harm. As snapshots, risk assessments must be collated, analysed and integrated with the family's previous history and current functioning to determine service delivery responses.

During on-going intervention, a review and update of previous risk assessments is integral to a broader assessment, and is particularly important when:

• The child remains at home during the period of intervention;
• There are plans to work towards reunification;
• Significant changes occur within the family and/or household;
• Considering the ceasing or stepping down of intervention.

By revisiting previous assessments and incorporating new information, any changes both positive and negative can be analysed. Changes that heighten the level of risk may require a change in the type of intervention required to meet the child's needs.

6. Useful Tools and Pitfalls of Risk Assessment

A number of tools are available to help practitioners identify the extent of risk to a child. As stated these approaches to risk identification are helpful as long as their limitations are understood. The completion of questionnaires may help practitioners identify the details of a child's experience and where specific areas of risk lie – what they are unable to do is quantify that risk and lead to defined responses. That requires professional judgement, in a multi-agency context, in discussion with the child where appropriate, parents and other family members. However, these tools are helpful in being clear what the experiences of children and their parents are. Their use will ensure that all areas are considered and may often ensure that areas are explored that not have ordinarily been considered. The tools include:

• Swindon LSCB has developed the Professional's Handbook for Tackling CSE - this has been designed to support professionals in the identification and assessment of CSE and also outlines Swindon's approach to tackling exploitation.
  
  Swindon LSCB has developed a number of resources to support practitioners in understanding and addressing neglect;
• Swindon LSCB Neglect Framework and Practice Guidance;
• The Family Pack of Questionnaires and Scales produced by the Department of Health, that can be used to support evidenced based practice and assessments. Although developed in 2000, they can still be a helpful tool for practitioners to use to support evidence based practice when undertaking assessments. The pack includes:
  • Strengths and Difficulties Questionnaires;
  • The Parenting Daily Hassle Scale;
  • Home conditions Scale;
  • Adult Well Being Scale.
• Assessing children in need and their families practice guidance;
• The Family Pack of Questionnaires and Scales;
• Swindon Borough Council Risk Management Record (see Appendix 1: Swindon Borough Council Risk Management Record).

Top Tips and Pitfalls in Risk Assessment (Including Lessons form Serious Case Reviews)

1. Rule of optimism – comes as a result of not properly understanding the risks children face and results in leaving children in places of danger; many Serious Case Reviews have illustrated that practitioners' views can be strongly influenced by factors such as seeing indicators of progress or disguised compliance and co-operation. This does not, however, always mean that the child or young person is safe and such factors need to be balanced against the overall balance of evidence and actual risks;
2. Respectful uncertainty, applying critical evaluation to any information Social Workers receive and maintaining an open mind. Lord Laming (2003);
3. Rule of hopelessness – a sense that no change can be arrived at and staff give up seeking positive changes. This can result in avoidable interventions or children left at risk;
4. Incident-led responses – seeing only the presenting issue and not the history or context;
5. Assessment Paralysis / a focus on the adults – staff aligning themselves with and seeking to assist adults and losing sight of the child. An accurate assessment of risk well managed ensures the needs of children are kept at the heart of the work;
6. Assessment Distortion – a position adopted by a multi-agency network that is led by one agency to such an extent that other and potentially opposing views are not voiced or heard;
7. Inter-Agency communication failures – key information not being shared either at all or in a timely manner;
8. Procedural Compliance – a view in child protection work that risk cannot only be managed but be eliminated through an increasing adherence to and reliance upon procedures. Inherent within this approach is a focus on maximising compliance – from staff and from systems – such that all risk is effectively managed out of the system;
9. Waiting until the assessment is completed - Interventions should not be delayed until the completion of an assessment, but they have to be carried out in accordance with what is required to ensure the child or young person's safety, taking account of any indications of accelerated risks and warning signs. The type and level of intervention, irrespective of when it is made, must always be proportionate to the circumstances and risks faced by the child;
10. Lack of professional curiosity - Workers should adopt an enquiring and investigative approach to risk assessment and not rely on parents or carers statements alone. Further corroboration of statements and challenging of parental views and perceptions is essential if to effectively determine the risk to the child or young person;
11. Not seeing or speaking alone with the child - A number of Serious Case Reviews have highlighted that children and young people may be hidden from view; are "unavailable" when professionals visit the family or are prevented from attending school or nursery. These incidents should act as potential indicators that children and young people are at risk of serious harm and stress the importance of seeing and speaking to the child.

Being aware of the above pitfalls is useful in developing assessments that are balanced and balance is essential to the effective management of risk. A degree of optimism is important in working with vulnerable families, so is a degree of scepticism; engaging with adults is absolutely unavoidable and an adherence to set procedures is necessary to ensure a consistent and systematic response. The views of all agencies, particularly where they diverge, should be heard and balanced to arrive at an informed and collective position. The key is that these, and other considerations, are well balanced and that the development of assessments, the gathering of information and the exploration of new hypotheses allows for the respective balance between these themes to be managed and amended as required.

Remember that this guidance and the supporting tools helps us understand risk ONLY at a given point in time and with the information that we have at that stage. Further information will demand a re-evaluation of the assessment and overall analysis. 

Effective Child Protection, 2nd edn, Eileen Munro, London, Sage, 2008.

Tilbury, C, Osmond, J, Wilson, S and Clark, J 2007, Good practice in child protection, Pearson Education Australia, Frenchs Forest.

Appendices

Appendix 1: Swindon Borough Council Risk Management Record.

Appendix 2: Swindon LSCB Neglect Framework Guidance.