That’s too risky.. OR is it just your opinion?

1. That’s too risky.. OR is it just your opinion? A R.E.A.L Conference Presentation Amanda Wood,

2. Definition • A situation involving exposure to danger. • The possibility of suffering harm or loss • Hazardous • Endangered

3. RISK - defined • “a 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)

4. What are the risks associated with getting to the conference today?

5. Why measure risk • Identify 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.

6. Identify the Risk • What 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?

7. Brainstorm the risks Outline 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.

8. Risk Classification

9. Example .

10. 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.

11. Risk Aversive vs Risk Accepting • Risk Aversive • Wanting to avoid risk unless adequately compensated for it • Risk Accepting/Tolerant • Risk 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.

12. 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

13. Know your own Values and beliefs • Our 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?

14. Balancing Act • 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 CAPACITY

15. Inherent vs Residual Risk • Inherent 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

16. Common Mistake MUST 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.

17. Behaviour Support • Behaviour 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

18. Example • John is more likely to hit out • When there is a lot of noise • In crowded places • When he is being told what to do. • Minimise Risk • Reduce the noise and amount of people • around John. • Avoid telling John what to do, instead • redirect John to what he can do.

19. Common Mistake People Confuse Risk Classification and Risk Assessment.

20. Violence Risk Assessment “the 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)

21. Violence Risk Assessment • Use of clinical tool • Identify a person likelihood to continue to engage in violent or “challenging Behaviours” • Measured against evidence based risk factors • Able to target interventions at these factors to reduce persons likelihood of engaging in behaviours in the future

22. Example evidence based risk factors • Lack of insight • Employment status • Presence of mental illness • Age of first violent behaviour • Substance use • Impulsivity • Responsiveness to treatment • Negative attitudes

23. Example • John 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.

24. 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 John’s day program options and why he is not attending and address this in a person centred manner.

25. Summary • Risk 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.

26. Summary • Behaviour 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.

27. Amanda Wood info@awcommunityservices.com www.awcommunityservices.com