Risk Assessment and Risk Management of a Case

Introduction

This assignment will focus on a case study produced from a serious case review. In the first instance, the assignment shall identify the vulnerable people within the case and subsequently assess the needs, risk and strengths of those individuals, with integration of the complexity, uncertainty and ambiguity theory. Secondly, shall explore; inter-professional, multi-agency and service user involvement models which are relevant to the vulnerable individuals identified in the case study. Lastly, this assignment will endeavour to critically reflect upon the contemporary social work practices used in supporting families with challenges relating to ‘toxic trio’.

The Needs, Risk and Strengths of the Vulnerable People in the Family

Child S shall take precedence as the vulnerable person within the family whilst considering that the Children Act 1989 section 1 (1) states that the welfare of a child is to be of paramount consideration. Secondary to Child S, Ms M identifies as having her own vulnerabilities due to challenges with depression and alleged domestic abuse between herself, Mr N and Mr W, however it is noted here that Ms M does not meet the threshold for interventions as a vulnerable adult under the Safeguarding of Vulnerable Adults guidelines, (Safeguarding Adults, 2017). Mr W and Mr N may additionally be considered to have vulnerabilities due to lack of clarification around ‘victim’ and ‘perpetrator’ status of domestic abuse and Mr N previously being ‘looked after’, however these two individuals will not be discussed as they have not been a consistent member within Child S’ household.

The basic needs of Child S include; physical care, affection, security, stimulation and innate potential, guidance and control, responsibility and potential as stated by Cooper (1985), with the additional view that these needs are directed towards achieving and/or sustaining good health, safety and enjoying and achieving as outlined in Every Child Matters 2003 policy (Every child matters, 2003). Furthermore, exploration into the adequacy of Ms M’s parenting capacity in meeting Child S’ needs may have been identified through the common assessment framework triangle. Alongside an approach derived from the complexity theory may have ensured Child S’s needs were identified in a non-linear manner and assessed with mirrored complexity to that of each situation of concern within the family, (Sanger and Giddings, 2012).

In the case of Child S, it appears that Ms M was able to ensure a proportion of his basic needs were met which were confirmed by professional observations during unannounced visits, for example; positive interaction between Child S and Ms M and Child S appearing well-fed. Despite this, it may be fair to suggest that Ms M was not consistently able to ensure Child S’ basic need primarily of protection from a likelihood of significant harm. There were both substantiated and non-substantiated concerns around Ms M’s substance misuse and her capacity in managing risk within her relationships, thus arguably neglecting Child S’s need of protection from emotional abuse and ensuring Child S’ safety, (Basarab-Horwath, 2007).

To further ensure the needs of Child S are met, it may be beneficial to convene a family group conference. The conference would act as a method of crisis prevention in addition to providing a form of prevention and contingency planning, if Ms M was unable to provide a safe environment for Child S and additionally would allow the local authority to identify protective factors and risk assess appropriate individuals of their capacity to temporarily care for Child S safely, (Connolly and Morris, 2012). Ms M’s needs may be best established through assessment under section 9 of the Care Act 2014. The case study indicates that Ms M had experienced trauma as a child and as an adolescent, research suggests that ‘Childhood trauma is a potent risk factor for developing depression in adulthood, particularly in response to additional stress’, (Heim, D. Newport, Mletzko, H. Miller & B. Nemerof, 2007, pg. 695), although it is noted here that not all depression types are inclusive of childhood trauma. Considering this point, it may be beneficial for Ms M’s mental health needs to be referred to IAPT programme for talking therapies alongside the practical interventions already implemented, being; SIAS and The Bridge, this dual service approach is known as the ‘golden combination’ and may further aid in understanding the reasoning behind Ms M’s substance misuse and abilities in making positive lifestyle choices, (Best practice in managing risk, 2007).

On the other hand, a complexity approach, (Renn, Klinke and Asselt, 2011), suggests that professionals should seek to observe inter-relationships and further challenges the idea that every cause has an effect, thus Ms M’s ‘need’ for interventions regarding mental health and substance misuse, may not necessarily have an identifiable cause. Critically, identifying her needs may lie within observing Ms M’s internal and external variables interacting with one another in relation to Ms M’s environment, relationships, lifestyle, and by understanding the impact of a ‘butterfly’ effect on Ms M’s needs and her child’s, (Sanger and Giddings, 2012). Risk in these circumstances is a term understood in relation to complexity, uncertainty, ambiguity and ‘the possibility of beneficial and harmful outcomes, and the likelihood of their occurrence in a stated timescale’ (Alberg et al cited in Titterton, 2005). Subsequently, prevention and management of risk have compiled into frameworks through means of legislation with the overall aim of reducing the probability of risk occurring, this is reflected through such legislations; Care Act 2014 and Children Act 1989. Moreover, it is thought within contemporary social care that risk assessment and management are fundamental concepts in promoting the welfare of vulnerable individuals parallel with a growing non-paternalistic society, (Parton, 1998). The case study of Ms M and Child S reflect ‘risk’ through different means, the actuarial risks within the case may be evidential through professional’s uncertainty around claims of Ms M’s substance misuse in front of Child S in addition to the local authority, at present, not making statutory checks of Mr N and Mr W despite reports of domestic abuse. An additional actuarial risk presents itself through the lack of professional attendance at the information sharing meeting and the subsequent lack of intended action by police.

Furthermore, exaggerated risks may be identifiable within the case study, for example; Ms M’s substance misuse itself may heighten the risk in probability of domestic abuse between herself, her previous and present partners Mr N and Mr W. Lastly, anticipated risks are important to consider, historically the information from the case suggests that Ms M has been unable to consistently commit to remission, in addition to a pronounced history of drug related offences and theft. Historically, Ms M’s behaviour presents as unpredictable and her choices in term of priorities may pose the anticipated and heightened risk of neglect for Child S, Basarab-Horwath (2013) highlights that neglect can occur over a lengthy period, is difficult to detect and often will fall short of meeting the threshold of immediate CP intervention. However, the latter is arguable, given that risk is a concept derived from social construction and associated with the ideology of a ‘blame society’, it is thereby argued that, ‘risk is not a thing or a set of realities waiting to be unearthed but a way of thinking’, (Parton cited in Cree, 2011).

It is necessary to consider Ms M’s right to self-determination through ‘positive risk taking. Relevantly here, within the care and services provided to Ms M it is important for such rights to be acknowledge as a guiding value in maximising Ms M’s goal of making independent choices, this notion may be reflected through such actions as, Ms M deciding to visit another country in desire of spending time with Mr W, despite the proposed risks involved, (Best practice in managing risk, 2007).

Amidst assessing the needs and risks of the vulnerable individuals within the family, it is additionally important within social work to practice through a holistic lens, and identify strengths of the individuals, (Cleaver, 2007). Ms M has several identifiable strengths as highlighted within the case: Ms M demonstrated inner strength in participating in a detoxification programme, which demonstrated her ability to prioritise self-care, the needs of unborn Child S, as well as minimalizing a likelihood of risks for Child S. We should note that Child S was observed as well-fed and positively interacting with Ms M, arguably this illustrates Ms M’s protective behaviours and regard towards Child S’s development. Lastly, Ms M had made a positive contribution towards Child S’s educational needs through means of accessing pre-school services on his behalf. The strengths approach and motivational interviewing are tools that trained professionals have to their disposal, such approaches may empower Ms M to identify these strengths from her own accord which is suggested to encourage positive and sustainable changes, (Trevithick, 2012).

The innate strengths of Child S are difficult to determine considering his age. However, as outlined in the case study Child S is thought to have spent several weeks away from his mother whilst staying with his maternal grandmother, it may be fair to suggest that Child S has had the opportunity to build relationships with wider family members which in turn could contribute to Child S’s development of independence, emotional regulation and prospective resilience, (Heim, D. Newport, Mletzko, H. Miller & B. Nemerof, 2007). Moreover, if we observe Child S’ external subsystem through an ecological approach, this may further suggest that Child S derives strength in being valued and belonging within a secondary socialisation setting (nursery school), (Germaine and Gitterman, 1985).

Apply relevant theories and models related to service user involvement, inter-professional collaboration and multi-agency working to safeguard vulnerable people and the family:

Social work practice is imbedded with the ethic of empowerment, it therefore may be beneficial to explore the level of service user involvement within the case of Ms M and Child S. Arnstein’s (1969) ladder of participation provides a theory for assessing and understanding the level of service user participation and how the ethic and model of empowerment is integrated within interventions. The case study conveys an image of Ms M being told which services she needs to access and the actions she must take, for example; to engage with The Bridge, SIAS and midwifery, which are enforced via the CIN plan and later the CP plan. This may evidence that Ms M can be found at Arnstein’s (1969) level of ‘non-participation’ or ‘tokenism’, referring to an oppressed service user involvement of; informing, placation and consultation, (Arnstein, 1969). To ensure optimum service user involvement and to promote empowerment as well as anti-oppression, the local authority may wish to signpost Ms M to a community advocate service for example; POhWER advocacy. An advocate would see that Ms M’s wishes are heard and further ensure that she is involved within decision-making processes, (POhWER, 2016).

Although Child S is of a young age and limited in verbal communication, it may be possible for professionals to ensure his right in service user involvement. The Children Act 1989 states that LA’s should, ‘give due regard to a child’s wishes when determining what services to provide’, (HM Government, 2018). Wishes and feelings work adopts age-appropriate strategies in collaboratively capturing a child’s experiences through resources such as; games, visual aids, pictures and music. One such model of inter-professional collaboration and multi-agency working in aid of safeguarding vulnerable people may be demonstrated through the working together policy (2018). The policy places a statutory duty upon services to collaboratively share information where a child’s welfare is of concern or other-wise practice within a ‘multi-agency’ context, for Child S these services included; children’s services, police, health, drug and alcohol services, education. As highlighted within the case study, there was a poor attendance to the strategy discussion, in hindsight, this may have lead to the lack of necessary action from police services which in turn impacted on the future management of reported incidents at Ms M’s address. This suggest there was, ‘missed opportunities to record, understand the significance of and share information in a timely manner’, (Working together to safeguard children, 2018, pg. 18). However, it is noted that the policy outlines social workers have a specific role and responsibility to lead such statutory roles and thereby begs the question as to whether it is therefore children’s services responsibility to follow up a lack in collaborative working and take appropriate action to ensure accuracy and efficiency in Child S’ service provided, (Working together to safeguard children, 2018).

Critical Reflection

‘Toxic trio’ refers to the co-existence of mental health, substance misuse and domestic abuse. The Working Together Policy (2018) notes that these variables rarely exist in isolation and interactions between the three reflect complex systems, (Staffordshire County Council, 2011), this has been evidenced through the case of Ms M. The Common Assessment Framework (2009) suggests that children associated with ‘toxic trio’ are likely to present complexity in needs, thereby in need of statutory interventions.

Hertfordshire county council launched a contemporary innovation in 2015 through means of a ‘MASH’ team. The hub performs as a triage service and a gateway in accessing social care services across the continuum of need’s spectrum, included here is the family safeguarding team categorised within specialist services, (Continuum of need, 2016). The team is designed to support families with ‘toxic trio’ challenges through specialist domestic abuse, substance misuse and mental health workers. Additionally, HCC suggest this service can support in; strengthening relationships between service users and social workers, building resilience, and addressing the impacts of ‘toxic trio’ through contemporary practices such as motivational interviewing, (Coles, n.d.). HCC have prided themselves in their ability to evidence the difference made to children and families lives. Subsequently, this was reflected through DfE’s evaluation report of HCC’s family safeguarding which suggests; specialist workers support encouraged service users to make positive changes and service users thereby rated themselves on a life scale at 6/10 as opposed to 3/10 for families without support from a specialist worker, (Forrester et al,. 2017). Contrastingly, the DfE report additionally recommends in specific relation to workers of ‘toxic trio’ that Hertfordshire family safeguarding should, ‘increase the skills and knowledge of workers’ and ‘increase engagement with families, thereby increasing the help they receive’, (Forrester et al,. 2017), this may suggest that the family safeguarding team has not maximised their potential in support families challenged with ‘toxic trio’.

Critically, the family safeguarding team solely support families who have met the threshold for statutory interventions, (Continuum of need, 2016), this may suggest that the support families with ‘toxic trio’ receive is conditional to possessing issues with all three components and subsequently a progress within one component may jeopardise support within the other two. For example; Ms M engages in direct work of motivational interviewing and decides to end her relationship with Mr M, thus greatly reducing the risk of domestic abuse with the consequence of the threshold lacking justification, Ms M is stepped down to universal services. With understanding to the challenges ‘toxic trio’ pose, it is important to highlight the risks involved for professionals working within such environments.

Conclusion

This assignment has endeavoured to address three key questions in relation to the case study information. Consequently; the needs, risks and strengths of Ms M and Child S have been assessed, in addition to exploration of models and theories relating to inter-professional collaboration, service user involvement and multi-agency working. Lastly, this assignment has critically reflected upon an example of contemporary social work practice which supports families in relation to ‘toxic trio’ challenges, whilst importantly recognising the risks to social workers themselves.

References

1. Arnstein, S. (1969). A Ladder of Citizen Participation. Journal of the American Institute of Planners, [online] 35(4), pp. 216-224. Available at: https://doi.org/10.1080/01944366908977225 [Accessed 5 January 2019].
2. Basarab-Horwath, J. (2006). Child neglect (1st ed.). Basingstoke: Palgrave Macmillan.
3. Basarab-Horwath, J. (2013). Child neglect (1st ed.). Basingstoke: Palgrave Macmillan.
4. Children's Workforce Developmental Council. (2009). The common assessment framework for children and young people [PDF] (1st ed.). Leeds. Retrieved from http://greatermanchesterscb.proceduresonline.com/pdfs/caf_guidance_practitioners.pdf [Accessed 2 January 2019].
5. Coles, J. (n.d.). Family Safeguarding in Hertfordshire. Available at: http://www.local.gov.uk/documents/10180/7544064/Safeguarding+and+domestic+abuse/51956b3f- 7a69-4a53-9658-81177e0f5e8f [Accessed: 4 January 2019]
6. Cleaver, H. (2007). Child protection, domestic violence and parental substance misuse (1st ed.). London, UK: J. Kingsley.
7. Cooper, Christine (1985) ‘Good-enough’, border-line and ‘bad-enough’ parenting. In: Adcock, M. and White, R. (eds.) Good-enough parenting: a framework for assessment. London: British Association for Adoption and Fostering (BAAF) pp.60-1.
8. Connolly, M., & Morris, K. (2012). Understanding child and family welfare: Statutory responses to children at risk. Basingstoke: Palgrave Macmillan.
9. Cree, V. (2011). Social work: A reader (1st ed., p. 35). London: Routledge.
10. Germain, C.B and Gitterman, A. (1995) Ecological Perspective, in R.L Edwards (ed.) Encyclopaedia of Social Work,19th edn., Vol. 1. Washington, DC: National Association of Social Workers.
11. Forrester, D., Lynch, A., Bostock, L., Newlands, F., Preston, B., & Cary, A. (2017). Family Safeguarding Hertfordshire [Ebook] (1st ed., p. 11). Hertfordshire: Department of Education. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/625400/Family_Safeguarding_Hertfordshire.pdf [Accessed: 6 January 2019]
12. Hertfordshire Safeguarding Children Board. (2016). Continuum of need [Ebook] (2nd ed., p. 2). Hertfordshire. Retrieved from http://www.hertfordshirefamiliesfirst.org.uk/assets/1/meeting_the_needs_infographic_v3.pdf [Accessed: 6 January 2019]
13. Heim, C., D. Newport, J., Mletzko, T., H. Miller, A., & B. Nemerof, C. (2007). The link between childhood trauma and depression: Insights from HPA axis studies in humans (1st ed., p. 695). Atlanta: Elsevier.
14. Hill, M., Stafford, A., Seaman, P., Ross, N., & Daniel, B. (2007). Parenting and resilience [Ebook] (1st ed.). York: Joseph Rowntree Foundation. Retrieved from https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/parenting-resilience-children.pdf [Accessed 1 January 2019].
15. Michael Sanger & Martha M. Giddings (2012) A Simple Approach to Complexity Theory, Journal of Social Work Education, 48:2, 369-376, DOI: 10.5175/JSWE.2012.201000025 [Accessed 3 January 2019].
16. National risk management programme. (2007). Best Practice in Managing Risk [Ebook] (1st ed.). London. Retrieved from https://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_076512.pdf [Accessed: 2 January 2019].
17. NHS England. Safeguarding Adults [PDF] (pp. 1-29). NHS England. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2017/02/adult-pocket-guide.pdf [Accessed 2 January 2019].
18. Parton. N. Risk, Advanced Liberalism and Child Welfare: The Need to Rediscover Uncertainty and Ambiguity, The British Journal of Social Work, Volume 28, Issue 1, 1 February 1998, Pages 5–27, https://doi.org/10.1093/oxfordjournals.bjsw.a011317 [Accessed 2 January 2019].
19. Pioneering changes to child protection services - Hertfordshire County Council. (2018). Retrieved from https://www.local.gov.uk/pioneering-changes-child-protection-services-hertfordshire-county-council [Accessed 2 January 2019].
20. POHWER advocacy making your voice heard, what we do (2016). Available at: https://www.pohwer.net/what-we-do [Accessed: 5 January 2019].
21. Renn, O., Klinke, A., & van Asselt, M. (2011). Coping with Complexity, Uncertainty and Ambiguity in Risk Governance: A Synthesis. AMBIO, 40(2), 231-246. doi: 10.1007/s13280-010-0134-0 [Accessed: 4 January 2019].
22. Staffordshire county council service development team. (2011). Identifying and working with the 'toxic trio' [Ebook] (1st ed.). Staffordshire. Retrieved from https://www.staffsscb.org.uk/Professionals/Resources-Tools/Good-Practice-Guidance/Good-Practice-Guide---Identifying--Working-with-the-Toxic-Trio.pdf [Accessed: 4 January. 2019]
23. Stationery Office. (2003). Every child matters (1st ed.). [London].
24. Titterton, M. (2005) Risk and risk taking in health and social welfare, London: Jessica Kingsley.
25. Trevithick, P. (2012) Social work skills and knowledge. Maidenhead: Open University Press.
26. Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children. (2018). Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729914/Working_Together_to_Safeguard_Children-2018.pdf [Accessed 3 January 2019].
27. Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children. (2018). Pg. 18. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729914/Working_Together_to_Safeguard_Children-2018.pdf [Accessed 3 January 2019].