Orange Earth

Thats too risky.. OR is it just your opinion?A R.E.A.L Conference PresentationAmanda Wood, DefinitionA situation involving exposure to danger.

The possibility of suffering harm or loss

Hazardous

Endangered

RISK - defineda hazardous or dangerous chance

risk concerns expected value of one or more results of one or more future events wikipedia

a hazard that is incompletely understood, and thus whose occurrence can be forecast only with uncertainty(Boer et al, 1997)What are the risks associated with getting to the conference today?Why measure riskIdentify situations where harm could occur

Minimise likelihood of harm to worker and clients.

Prevent situations that cause harm.

Duty of Care prevent foreseeable harm without breaching a persons rights too much.

Identify the RiskWhat Might happen NOT What Could Happen

John likes to sit on the driveway to the house without his t-shirt on laying on the concrete.

What are the risks?

Brainstorm the risksOutline all the risks to John from this Behaviour.

Some will be more likely than others and the level of seriousness of each will be different.

Need to decide how serious these are

Need to determine the likelihood of these occurring.

Risk Classification

Example.Risk CategoryRisk behaviours/ ConditionsIndicators/ TriggersPreventionResponseFurther InformationVERBAL THREATS OF HARM:Joe will verbally threaten to cause harm to himself and othersOther people are receiving attention from staff whilst Joe is not; Joe is hearing voicesStaff to interact with Joe on a regular basis, redirection to another activity/task - Staff are to follow the IPRP. Joe is verbally encouraged to participate in another activity (redirection). Staff should make sure Joe has taken medication. Staff should carry a mobile phone with them at all times A familiar staff member should accompany Joe at all times.Subjectivity and Bias RISK ASSSESSMENT RESEARCH:Clinicians/ Professionals are poor at judging probability of risk, biases.Better off flipping a coin to predict risk.

Optimism Bias:Causes a person to believe that they are less at risk of experiencing a negative event compared to others.10Risk Aversive vs Risk AcceptingRisk AversiveWanting to avoid risk unless adequately compensated for it

Risk Accepting/TolerantRisk tolerance affects how psychologically receptive an individual is to decisions involving risk.Four types of risk tolerance: physical, social, ethical and financial.People behave consistently within type not BETWEEN types.

What happens when we make judgements about risk for others?Research suggests the more we see the person as being Similar to us the more we judge their risk to be the same as ours*.

When person has different values to the judger they showed greater risk aversion for the decision made for themselves than the other person*.

Suggesting that our belief about the persons values impact on our decision making for them and hence our judgement of risk.

*Harvey, Twyman & Harries (2006), Making Decisions for Other People: The Problem of Judging Acceptable Levels of Risk

Know your own Values and beliefsOur own beliefs, values can impact on how we classify a risk.

How do you classify possible sunburn?

Life threatening or inconvenience requiring first aid??

Is it very Likely or unlikely?

Classifying Risk and Making a Decision of whether to act or not act is a balancing act of:

Rights and need of individual

Safety of person and/or others

Need to have an understanding of persons CAPACITYBalancing ActInherent vs Residual RiskInherent Risk: The risk of something if no controls or other mitigating factors were in place (risk before controls).

For example the risk a persons behaviour poses if there is no Support Plan or Reactive Strategies.

Residual Risk: The risk that remains after controls are taken into account (risk after controls).

For example the risk a persons behaviours pose when the support plan. Reactive strategies and other factors to minimise risk are put in place

Common MistakeMUST compare the Inherent risk with the residual risk.

Comparing risk before and after:

You can see the key controls that need to be monitored and enforced to ensure the environment remains safe.

Behaviour SupportBehaviour Support Plans should address risk associated with Behaviours of Concern

Through the IPRP

Strategies that clearly aim to reduce the risk should be outlined clearly

ExampleJohn is more likely to hit outWhen there is a lot of noiseIn crowded placesWhen he is being told what to do.

Minimise RiskReduce the noise and amount of people around John.Avoid telling John what to do, insteadredirect John to what he can do.

Common MistakePeople Confuse Risk Classification and Risk Assessment.

Violence Risk Assessmentthe process of evaluating individuals to (1) characterize the risk they will commit acts of violence and (2) develop interventions to manage or reduce that risk (Hart, 2000)The goal is violence prevention. To minimize the likelihood of and negative consequences stemming from future violence (Douglas et al, 2001)

Violence Risk AssessmentUse of clinical toolIdentify a person likelihood to continue to engage in violent or challenging BehavioursMeasured against evidence based risk factorsAble to target interventions at these factors to reduce persons likelihood of engaging in behaviours in the futureExample evidence based risk factorsLack of insightEmployment statusPresence of mental illnessAge of first violent behaviourSubstance useImpulsivityResponsiveness to treatmentNegative attitudesExampleJohn first displayed behaviours of concern at age 10.John has a moderate intellectual disability and schizophrenia.He often acts without thinking he is impulsive.John has low self esteem and has negative thoughts about himself and his abilities.John takes his medication everyday but will often refuse to attend day program and some weekend activities.Example cont.Ensure treatment for schizophrenia are regularly reviewed a and he is receiving good psychiatric care.Help his to understand what his diagnosis means for him.Provide some counselling or behavioural support to assist John to reduce his impulsivity.Provide some counselling and behavioural support to assist John to improve his self esteem.Review Johns day program options and why he is not attending and address this in a person centred manner.SummaryRisk Classification is a useful and necessary tool.

Best completed with a number of viewpoints.

Can be subjective to bias and opinion.

Often assess risk differently for someone else than ourselves.SummaryBehaviour Support Plan can address risk as identified through a risk classification AND a risk assessment.

Always review the inherent AND The residual risk.

Risk Classification is NOT risk assessment.

If you want to reduce a persons risk of engaging in significant challenging behaviour than you may need a clinician to conduct a risk assessment.

Amanda Woodinfo@awcommunityservices.comwww.awcommunityservices.com