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Version 1- 01/10/10

In Association With

Learning work book to contribute to the

achievement of the underpinning

knowledge for unit: LD 305

Understand Positive Risk

Taking for Individuals with

Disabilities

Credit value 3

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Q C F A C D i n H & S C L 3 L i c e n s e d u n t i l F e b 1 2 U n i t L D

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INTRODUCTION

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WHERE TO STUDY The best way to complete this workbook

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If you know anyone else doing the same programme as you, then

you might find it very useful to talk to them too.



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Certification When you complete your workbook, your

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your certificate. Your centre will send your certificate to you when

they receive it from your awarding organisation. Your tutor/assessor

will be able to tell you how long this might take.



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Unit LD 305: Understand positive risk taking for individuals

with disabilities

About this unit

This unit promotes a positive, person-centred approach to risk

taking for individuals with disabilities and emphasises the importance of working in partnership to support individuals to take

risks. It provides the opportunity to reflect on difficulties and

dilemmas commonly encountered when addressing issues of risk, in

the context of the legal and policy frameworks.

Learning outcomes

There are five learning outcomes to this unit. The learner will be

able to

1. Understand that individuals with disabilities have the same right as everyone else to take risks

2. Understand the importance of a positive, person-centred

approach to risk assessment

3. Understand the legal and policy framework underpinning an

individual with disabilities right to make decisions and take risks

4. Understand the importance of considering with an individual with

disabilities the risks associated with the choices they make

5. Understand the importance of a partnership approach to risk

taking

What is risk?

The experience of many people who have to rely on human services

for their support is that risk is the reason

given to them by services why they cannot do

the things that other people are doing every day. Risk is sometimes used as a verb: a

person ‘risks’ doing something, and

sometimes a noun: a person is labelled as

being a ‘risk to society’. Risk decision

making is often complicated by the fact that

the person or group taking the decision is not

always the person or group affected by the

risk.



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Risk is the probability that an event will occur with beneficial or

harmful outcomes for a particular person or others with whom they come into contact.

An event can occur because of:

� Risks associated with impairment or

disability such as falls

� Accidents, for example, whilst out in

the community or at a social care

service

� Risks associated with everyday

activities that might be increased by a

person’s impairment or disability

� The use of medication

� The misuse of drugs or alcohol

� Behaviours resulting in injury, neglect, abuse, and

exploitation by self or others

� Suicide or self-harm � Aggression and violence

The type of event depends on the nature of the person, their

relationships with others and the circumstances they find themselves in. Risk is often thought of in terms of danger, loss,

threat, damage or injury. But as well as potentially negative

characteristics, risk-taking can have positive benefits for individuals

and their communities.

The difference for many people with learning disabilities when they

take risks is that they will do so when being supported by personal

assistants or a support worker from a statutory service or an

independent agency. Also, there will be times

when a person might take risks on their own,

but a statutory service might be held

responsible if harm to them or others occurs.

A balance therefore has to be achieved between

the desire of person to do everyday activities,

the duty of care owed by services and

employers to their workers, the duty of care owed to users of services, and the legal duties

of statutory and community services and

independent providers. As well as considering the dangers

associated with risk, the potential benefits of risk-taking have to be

identified (‘nothing ventured, nothing gained’). This should involve

everyone affected – adults who use services, their families and

practitioners.



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Differences in power and status affect the extent to which people

influence risk decision making – the views of developers wishing to build a dam across a

river may well be given more weight than

those of people living nearby that river.

Where a person with less power and status might wish to take a risk, and the

consequences of that risk would affect more

powerful people, it is more likely that they

will be prevented from taking it. This is the

problem faced by people supported by

services and professionals, where those services and professionals

fear various real and imagined consequences to them of the risk

taking of the people they support.

What is risk taking?

For many people risk is an accepted part of life. But people with

learning disabilities and older people are often discouraged from taking risks. Either because of their perceived limitations or fear

that they or others might be harmed, resulting in criticism or

compensation claims against health, social care and other

community based services.

Changes in disability, social care and health policy now mean that

people are being actively encouraged to increase their

independence by, for example, travelling independently, and by

being fully involved in mainstream society through education, work

and leisure. For people with disabilities, moves away from a

medical model to a social model of disability

now means there is an emphasis on the

discrimination and exclusion created by social

and cultural barriers. This contrasts with a

prior emphasis on the problems resulting

from people’s impaired bodies or minds or

learning ability.

At various times those working in health and

social care can be faced with a legal requirement, such as

organisations have a duty of care, whilst at another point they are told they have to empower people with learning disabilities and to

also afford them the dignity of risk. Whilst such concepts do not

necessarily have to be in conflict there can be confusion and tension

about how to approach either, especially when considering their

meeting.



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Times have changed, different philosophies of

care and changing public attitudes have rightly brought about the potential for a

better and more inclusive lifestyle for

individuals with a learning disability than they

would have experienced just a couple of generations ago. At the same time we are

also faced with changes regarding over-bureaucratisation of care

and an emerging blame culture, arising from an increasingly

litigious society. The worst thing for staff and services supporting

individuals with a learning disability would be to see the scenario as

a potential minefield not willingly entered. With sound policies and

appropriate safeguards, individuals with a learning disability can be

supported to embrace reasonable and responsible risk taking.

Every opportunity contains risks – a life without risk is a life without

opportunities, often without quality and without change. Traditional

methods of risk assessment are full of charts and scoring systems,

but the person, their objectives, dreams and life seem to get lost somewhere in the pages of tick boxes and statistics.

A person centred approach seeks to focus on people's rights to have

the lifestyle that they chose, including the right to make 'bad' decisions. The approach described here uses person centred

thinking tools, to help people and those who care about them most

think in a positive and productive way about how to ensure that

they can achieve the changes they want to see while keeping the

issue of risk in its place.

This in essence is a process to gather, in partnership with the

person, the fullest information and evidence to demonstrate that we

have thought deeply about all the issues involved. Decisions are

then guided by what is important to the person, what

is needed to keep them healthy and safe and on what

the law says.

Person Centred Approaches, with their focus on the

person and strategy of building an alliance of

supporters around the person can often cut across

this entrenchment and generate new and creative ways forward, providing that services are prepared to face this challenge. This is

now being recognised by government departments, the Department

of Health publication ‘Independence Choice and Risk’

wholeheartedly commends person centred approaches for everyone

because they identify what is important to a person from his or her

own perspective and find appropriate solutions.



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Regulators too want to see the balance of risk decision making

shifting toward supporting individuals who choose to take informed risks in order to improve the quality of their lives.

For some services, approaches to risk have in the past been

concerned with avoiding potentially harmful situations to adults who use services and staff. Now to support people to travel

independently or take part in everyday activities means accepting

there are risks that cannot be avoided but can be minimised and

prepared for.

DID YOU KNOW?

The longest word in the English language

according to the Oxford English Dictionary is

Pneumonoultramicroscopicsilicovolcanoconiosis.

The only other word with the same amount of

letters is

Pneumonoultramicroscopicsilicovolcanoconioses,

its plural.

ACTIVITY ONE

Circle the words or phrases you would associate with risk

taking

Harm Egypt Approach

Israel Changes Situations

Independence Morocco Culture

What is positive risk-taking?

Positive risk-taking is: weighing up the

potential benefits and harms of exercising one

choice of action over another. Identifying the

potential risks involved, and developing plans

and actions that reflect the positive potentials

and stated priorities of the service user.



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It involves using available resources and support to achieve the

desired outcomes, and to minimise the potential harmful outcomes. It is not negligent ignorance of the potential

risks it is usually a very carefully thought out

strategy for managing a specific situation or

set of circumstances.

For services, this means:

� Being empowering

� Working in partnership with adults who use services, family

carers and advocates

� Developing an understanding of the responsibilities of each

party

� Helping people to access opportunities and take worthwhile

chances

� Developing trusting working relationships

� Helping adults who use services to learn from their

experiences � Understanding the consequences of different actions

� Making decisions based on all the choices available and

accurate information

� Being positive about potential risks � Understanding a person’s strengths

� Knowing what has worked or not in the past where problems

have arisen, understanding why

� Ensuring support and advocacy is available to disabled adults and older people, particularly if things begin to go wrong for

someone

� Sometimes tolerating short-term risks for long-term gains

� Through regular reviews gradually withdrawing inappropriate

services that create dependency

� Having an understanding of the different perspectives of

people, family carers, practitioners, advocates and services

� Developing person-centred and

transition planning for adults to

support their involvement and that

of their families in decision-making

alongside practitioners

� Ensuring staff use the guidance, procedures and risk assessment /

management tools adopted by their service, and receive

appropriate support and supervision from their immediate line

manager



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Information Sharing

Information gathering and sharing is important. It is not just an

essential part of risk assessment and

management, but also key to identifying a

risk in the first place. However, the use and sharing of information must respect the

principles outlined in the Data Protection Act

1998. When collecting new data or

information, it is important to tell the person

or family affected the purpose of the data collection, why

information gathering is necessary and whom it will be shared with.

Numerous methods can be used to gather information:

� Access to past records

� Self-reports during assessment or reviews

� Reports from significant others eg. carers, relatives or friends,

other team members / other teams, advocates, other statutory or voluntary agencies or the police, probation

services or courts, or external companies providing services.

� Observing discrepancies between verbal and non-verbal cues

� Rating scales or other actuarial methods � Clinical judgement based on evidence based practice

� Predictive indicators derived from research

Because decisions may need to be defended, during the

identification, assessment and management of risk, practitioners

must ensure that information shared or gathered is properly

recorded to be able to evidence the:

� Formulation of a logical, informed opinion as to the severity of

risk.

� Organisation of discussions with the

adult, their family and any health,

social care, advocacy or independent

sector professional involved.

� Inclusion of the person and their

family in decision-making.

� Identification of conflicting opinions and interests.

� Clarification of lines of accountability.

� Justification of actions.



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Risk identification

Identification of a risk should involve a balanced approach, which

looks at what is and is not an acceptable risk. It should be a view

based on a person’s aspirations that aims to

support them to get the best out of life. The views of adults who use services and their

families are equally as important as those of

practitioners.

Not every situation or activity will entail a risk

that needs to be assessed or managed. The

risk may be minimal and no greater for the person concerned than

it would be for any other ordinary person. For example, if a person

with learning disabilities living in residential care is used to

travelling independently, taking a train trip to London where family

meets them at Kings Cross might not necessarily entail a risk that

needs to be assessed or managed. Or a disabled parent and their

children might be facing the same risks as those faced by any other family; therefore the involvement of workers might be inappropriate

or even discriminatory.

Risk Assessment

� Risk assessment is the activity of collecting information

through observation, communication and investigation. It is

an ongoing process that involves considerable persistence and

skill to assemble and manage relevant information in ways

that become meaningful for the users of services (and

significant other people) as well as the practitioners involved

in delivering services and support.

� To be effective it needs people, their

families, carers, advocates and

practitioners to interact and talk to each

other about decisions that have been

taken and their appropriateness in the

light of experience.

� Each assessment should identify a review

date and include the signatures of everyone involved in the

assessment. � If anyone involved in the care plan or the provision of support

does not agree with the assessment, they should be asked to

document their concerns and reasons.

� The influence of historical information in any assessment

should be concerned with understanding what happened if

risk-taking resulted in harm rather than the stigma of the

events themselves.



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Where a risk assessment is needed, a decision then has to be taken

about whether or not positive risk-taking is necessary to achieve certain outcomes for the person concerned. It will not always be

appropriate to take positive risks but this

has to be determined in partnership with

the person affected, and their family where appropriate. It is a professional judgement

that should not be influenced by an overly

cautious approach to risk. At the same

time though, positive risk-taking is not

negligent ignorance of the potential risks – nobody benefits from

allowing risks to play their course through to disaster.

During risk assessment, the following should be considered:

� People should not simply be seen as the source of risk – their

view of risk and that of their families and carers have a

prominent place in the identification, assessment and

management of risk. � When gathering information from adults, or family carers,

workers need to emphasise the importance of information

that is both accurate and identifies any concerns or issues

that may increase the probability of an event occurring. � There should be a focus on a person’s strengths to give a

positive base from which to develop plans that will support

positive risk-taking. Consider the strengths and abilities of

the adult, their wider social and family networks, and the

diverse support and advocacy services available to them.

� A person-centred approach should be used to identify, assess

and manage risk. This depends on the willingness of

practitioners to work in this way and for some may present a

challenge to traditional ways of working.

� ‘Positive risk-taking’ may sometimes need to

distinguish between the short-term, and long-

term position. Short-term heightened risk

may need to be tolerated and managed for

longer-term positive gains.

� Taking risks can give people confidence and enables them to manage their involvement in

community activities better. � An assessment needs to be clear if it is to

protect the individual or others.

� Every individual or agency directly affected should be involved in the development of a positive risk management plan that

agrees on the approach to risk and how identified risks will be

supported. Consensus helps to support positive risk-taking

and promotes a person-centred response.



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DID YOU KNOW?

The reason firehouses have circular stairways is from the days of yore when

the engines were pulled by horses. The

horses were stabled on the ground floor

and figured out how to walk up straight staircases.

ACTIVITY TWO


assessment

Whale Approach Manage

Strengths Dolphin Protect

Positives Advocacy Shark

Risk Management

Risk management is the activity of exercising a duty of care where risks (positive and negative) are identified. It entails a broad range

of responses that are often linked closely to the wider process of

care planning. The activities may involve

preventative, responsive and supportive

measures to reduce the potential negative

consequences of risk and to promote the

potential benefits of taking appropriate risks. These will occasionally involve more

restrictive measures and crisis responses

where the identified risks have an increased

potential for harmful outcomes. Decisions though need to be negotiated and agreed between all parties, and clearly understood.



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When carrying out risk management, the following must be

considered:

� Decision making in relation to risk must be clearly evidenced

on relevant documentation.

� High quality supervision and support are essential to provide an

opportunity to discuss concerns

and refine ideas, as well as review

the progress of the implementation

of risk assessments.

� Managers / supervisors need to

recognise that there is joint

accountability / ownership for risk decisions. Practitioners

need to know that support is available if things begin to go

wrong.

� Risk-taking is further enhanced by limiting the duration of the

decision i.e. working to shorter timescales and with smaller

goals broken down. This is supported by having mechanisms in place to check on progress; and an ability to quickly change

previous decisions when needed, including intervening in a

more restrictive way where necessary.

� Risk management should become part of a practitioner’s ongoing work with an adult and events should be reflected in

people’s case notes where appropriate.

� Individual practitioners can reasonably be expected to accept responsibility for the professional standards of conduct set out

by their professional body. But it is the collective

responsibility of the team to share information, make

decisions and plan.

� Issues of confidentiality need to be considered by

practitioners, officers and their

managers / supervisors to ensure client

and public safety.

� This approach supports the recognition of an individual’s right to make

informed decisions about the care or

support they receive. It recognises the

concept of empowerment when working

with vulnerable people. � The rights of adult users of services and family carers to make

decisions are acknowledged. In certain circumstances these

can be overruled, particularly when the individual is regarded

as lacking in ‘mental capacity’ in relation to a specific decision.

Where someone lacks mental capacity, anything done for or

on their behalf must be in their ‘best interests’.



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� Where this happens, practitioners should refer to guidance on

best practice in dealing with decision-making and incapacity, and on the principle of best interests of the person who lacks

capacity.

� The assessment and management of

risk should be, as far as possible, a multi-disciplinary exercise.

� Positive risk-taking needs to be

underpinned by contingency planning

for the fears and possibilities of failure.

This will help to prevent some harmful

outcomes, and minimise others. Risk-

taking should be pursued in a context of promoting

opportunities and safety not negligence. Therefore, adult

users of services, their families and practitioners should be

encouraged to learn to think about ‘what ifs’ and

contingencies as part of their day-to-day thinking.

� Where people are behaving recklessly, risk management may

include the setting of explicit boundaries to contain situations that are developing into potentially dangerous circumstances

for all involved. If a person or their carer makes a decision to

continue behaviour that is reckless, a record should be made

of their decision and when it was taken. If workers are affected by this decision, any support service being provided

will be reviewed to ensure that how it is delivered guarantees

the safety of any worker involved.

� Positive risk-taking should be ingrained into the working

culture and be reflected in the content of team training. It is

not a one-off experiment, but the natural first line of thinking.

DID YOU KNOW?

The first known contraceptive was

crocodile dung, used by Egyptians in 2000

B.C.



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ACTIVITY THREE


management

Sandal Working Team

Training Flip-flop Culture

Assessment Guidance Plimsoll

Person-Centred Planning

An approach based on the principles of rights, independence, choice and inclusion used to help disabled people work out what they want

to do with their lives, and then determine how services and support

in the wider community can fit the needs of the individual so that

they are supported to achieve their aspirations. It is accepted that

both an individual’s priorities and aspirations, and the services they

need to fulfil these can and will change. As such, planning is a

continual process.

Person Centred Planning is a way of helping people to think about

what they want now and in the future. It is about supporting people

to plan their lives, work towards their goals and get the right

support. It is a collection of tools and approaches based upon a set

of shared values that can be used to plan with a person - not for them. Planning

should build the person's circle of support

and involve all the people who are important

in that person's life.

Person Centred Planning is built on the

values of inclusion and looks at what support

a person needs to be included and involved

in their community. Person centred approaches offer an alternative

to traditional types of planning which are based upon the medical

model of disability and which are set up to assess need, allocate services and make decisions for people.



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The key features of person-centred planning are:

� The person is at the centre and is in control � Family members and friends are full partners.

� Planning reflects a person’s capacities, what is important to

them, and identifies the support they need to be full citizens.

� Planning builds a shared commitment to

action that uphold a person’s rights.

� Planning leads to continual listening,

learning and action and helps a person

get what they want from life.

Medical Model of Disability

An approach to disability that says disabled people (because of their

impairment/s, mental health or learning disability) are unable to do

everyday activities that non-disabled people can take for granted.

The consequence of this approach is the emphasis placed on the individual’s ability to adapt to the world around them or the need

for people to limit their expectations and ambitions.

Social Model of Disability

An approach to disability that says the disadvantage and

inequalities experienced by people with disabilities are not caused

by their impaired body, mind or learning ability but by the society in

which they live. The way in which buildings and transport are

designed or education, hospitals, councils and government are run

or how people think about disability can create barriers and lead to

discrimination, exclusion and

prejudice if deaf and disabled

people’s needs are ignored. The

consequence of this approach is

the emphasis on the need to

remove physical barriers to

buildings and wider society,

change attitudes and

expectations, and use the law to stop disability discrimination.

Legislation and Legal Principles

When approaching the identification, assessment and management

of risk, a knowledge of key legal principles and legislation will help

practitioners to make informed decisions that promote both the

involvement and interests of disabled adults and older people, and

their families.



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It will also support and promote best practice for professional staff

involved in supporting positive-risk-taking. An understanding of the following legislation and legal principles is important.

Human Rights

These are rights and freedom to which every

human being is entitled. The Human Rights Act

1998 brought the European Convention on

Human Rights into domestic law for the whole

of the UK on 2 October 2000.

The Act:

� Makes it clear that as far as possible United Kingdom courts

should interpret the law in a way that is compatible with

Convention rights.

� Places an obligation on public authorities, including local

authorities, to act compatibly with Convention rights, ie workers need to be aware of the human rights of those adults

to whom they provide support.

� Gives people the right to take court proceedings if they think

that their Convention rights have been breached or are going to be.

Of the 13 Convention rights included in the Act, the following are of

particular concern to workers who work with adults and older

people: the right to liberty and security; the right to respect for

private and family life; the freedom of thought, conscience and

religion; the right to freedom of expression; the right to marry and

found a family; and the prohibition on discrimination.

Mental Capacity

The Mental Capacity Act 2005 provides a

statutory framework to empower and

protect vulnerable people who are not

able to make their own decisions. It

makes it clear who can take decisions, in

which situations, and how they should go about this. It enables people to plan

ahead for a time when they may lose

capacity.



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The whole Act is underpinned by 5 key legal principles:

� A presumption of capacity - every adult has the right to make

his or her own decisions and must be assumed to have

capacity to do so unless it is proved

otherwise; � The right for individuals to be

supported to make their own

decisions - people must be given

all appropriate help before anyone

concludes that they cannot make

their own decisions;

� That individuals must retain the right to make what might be

seen as eccentric or unwise decisions;

� Best interests – anything done for or on behalf of people

without capacity must be in their best interests; and

� Least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive of

their basic rights and freedoms.

Duty of Care

This is a requirement that a person acts towards others and the public with the watchfulness, attention, caution and prudence that a

reasonable person in the circumstances would use. If a person's

actions do not meet this standard of care, then the acts may be

considered negligent, and any damages resulting may be claimed in

a lawsuit for negligence. Professional workers owe a specific duty of

care to the people they work with. The standard of conduct and

behaviour expected of people in their professional role is higher

than for an ordinary person because of the professional training

they have received and the level of responsibility they assume.

Negligence

Negligence is carelessness amounting to

the culpable breach of a duty, ie failure

to do something that a reasonable

person (ie an average citizen in that

same situation) would do, or doing something that a reasonable person

would not do. In cases of professional

negligence, involving someone with a special skill, that person is

expected to show the skill of an average member of his or her

profession.



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Safety at Work

Every employer has a common-law duty to take reasonable care for

their employees’ health, safety, and

welfare at work, and must insure

against their liability for employees’ injuries and diseases sustained or

contracted at work. The Health and

Safety at Work Act 1974 further

requires employers to ensure, as far

as is reasonably practicable, that

their working methods, equipment,

premises, and environment are safe

and to give such training, information, and supervision that will

ensure their employees' health and safety. Employees also have a

duty to take reasonable care for their own health and safety, for

example by complying with safety regulations and using protective

equipment supplied to them.

UNIT LD 305: SIGN-OFF

Assessor’s Name: _________________________________

Assessor’s

Signature:_________________________Date:___________

Learner’s Name: __________________________________

Learner’s Signature:_________________Date:___________

Mentor’s Name: ________________________________

Mentor’s Signature: _________________Date:___________



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UNIT LD 305: ASSESSMENT

ASSESSMENT ONE

Explain ways in which risk is an integral part of everyday life

ASSESSMENT TWO

Explain why, traditionally, people with disabilities have been discouraged or prevented from taking risks



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ASSESSMENT THREE

Describe the links between risk-taking and responsibility,

empowerment and social inclusion

ASSESSMENT FOUR

Explain the process of developing a positive person-centred

approach to risk assessment



3 0 5

ASSESSMENT FIVE

Explain how to apply the principles and methods of a person-

centred approach to each of the different stages of the process of risk assessment

ASSESSMENT SIX

Explain how a service focused approach to risk assessment would differ from a person-centred approach



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ASSESSMENT SEVEN

Identify the consequences for the individual of a service

focused approach to risk-assessment

ASSESSMENT EIGHT

Explain how legislation, national and local policies and

guidance provide a framework for decision making which can support an individual to have control over their own lives



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ASSESSMENT NINE

Analyse why individuals with disabilities may be at risk of

different forms of abuse, exploitation and harm in different areas of their lives

ASSESSMENT TEN

Explain how to support individuals to recognise and manage potential risk in different areas of their lives



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ASSESSMENT ELEVEN

Explain the importance of balancing the choices of the

individual with their own and others’ health and safety

ASSESSMENT TWELVE

Describe how own values, belief systems and experiences

may affect working practice when supporting individuals to take risks



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ASSESSMENT THIRTEEN

Explain the importance of recording all discussions and

decisions made

ASSESSMENT FOURTEEN

Explain the importance of a person-centred partnership

approach



3 0 5

ASSESSMENT FIFTEEN

Describe ways of handling conflict when discussing and

making decisions about risk

UNIT LD 305: ASSESSMENT SIGN-OFF

Assessor’s Name: _________________________________

Assessor’s Signature:________________Date:___________

Learner’s Name: __________________________________

Learner’s

Signature:_________________________Date:___________

Mentor’s Name: ___________________________________

Mentor’s Signature:_________________Date:___________



3 0 5

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