Risk Definitions

Risk:

is the likelihood of an event happening with potentially harmful or beneficial outcomes for self and others. (Possible behaviours include suicide, self-harm, neglect, aggression and violence; with an additional range of other positive or negative service user experiences).

Risk Assessment:

is the gathering of information through processes of communication, investigation, observation and persistence; and analysis of the potential outcomes of identified behaviours. Identifying specific risk factors of relevance to an individual, and the circumstances in which they may occur. This process requires linking the context of historical information to current circumstances, to anticipate possible future change.

Risk Management:

is the statement of plans and the allocation of responsibilities for translating collective decisions into real actions. It is the activity of exercising a duty of care where risks (positive and negative) are identified. It entails a broad range of responses linked closely to the wider process of care planning. The activities may involve preventative, responsive and supportive measures to diminish the potential negative consequences of risk and to promote 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. It should also clearly identify the dates for reviewing the assessment and the management plans.

Positive Risk-Taking:

[From: Morgan, 2004]: 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. It involves using available resources and support to achieve the desired outcomes, and to minimise the potential harmful outcomes. It requires an agreement of the goals to be achieved, or a clear explanation of any differences of opinion regarding the goals or courses of action.

Morgan, S. (2004) Positive risk-taking: an idea whose time has come. Health Care Risk Report 10 (10) 18-19.

Morgan, S. (2007) Working with Risk Practitioner’s Manual. Brighton: Pavilion Publishing.

Strengths Leadership Programme

Developing your key staff

The managers of the teams who directly deliver services to service users and carers in health and social care organisations are in a pivotal role for influencing the success of an organisation. They are the people who manage the demands of the teams they are charged to lead, and the expectations of the organisation’s management structure. The quality of support and development offered to these people is critical to their morale and motivation in the job.

The Practice Based Evidence consultancy for mental health services has developed a programme based in a ‘Strengths Approach’ and the extensive strengths business research of the Gallup organisation, specifically focused on this group of key staff.

In discussion with the programme’s author, Hugh Griffiths (Deputy National Clinical Director for Mental Health, Department of Health) expressed the view that “it is very important to focus attention on developing the needs of the clinical team leaders and managers.”

This programme is now recognised through its inclusion on the CSIP ‘New Ways of Working’ website as a resource for organisation’s to consider as an option for the development of Team Managers/Leaders.

In an initial trial of the programme structure and content the following comments were made:

“This is a very practical programme that gives tools to help me understand and lead the team. It applies to the real situation I work in, and ties in closely to how I feel and what I need.” Sue Jugon (Assertive Outreach Team Manager).

“This is so different from any other management courses or approaches I have experienced. It is focused very much on personal reflection from a very positive perspective.” Geoffrey Smith (CMHT Manager).

“This programme meets the needs of team managers, and is full of very challenging exercises.” Kirt Hunte (CRHT Manager).

The following linked pages outline the structure, content, delivery and intended outcomes of the programme. Contact Steve Morgan if you wish to consider commissioning such a programme of development in your organisation.

Team Managers/Leaders Programme.

Responses to Questions.

Relevant C.V. for facilitating the programme

• Working with a ‘strengths approach’ since 1991
• Writing textbooks, articles and materials incorporating strengths working since 1993
• Training in strengths since 1995
• Strengths practice within team development since 2001
• Mentoring from a strengths perspective since 2001
• Conference presentations on aspects of strengths working since 2003
• Personal development through textbooks and online resources since 2003

Strengths Assessment Tools & Guidelines

Click below to download this form as a PDF.

PDF: Strengths Assessment tool: for developing working priorities and care/support planning

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Guidelines for developing strengths working

Click here to download these guidelines as a PDF document.

Purpose

To provide guidance for encouraging the identification of strengths as an essential part of all assessments in practice across the local services. Reflecting the need for a flexible approach that is individually tailored to service users needs on a case-by-case basis. It is intended to be a 'method of working' that supports client-led practice, not a service driven need for auditing standards. A strengths assessment tool may help the process, but is not considered essential for ensuring a unique picture of the person is being developed through a unique process. Strengths working forms a radically different basis with which to resolve problems and work with risk.

Who is it for?

• Everyone who comes into contact with all services should have a balanced assessment that includes recognition of their 'strengths and abilities', not just a summary of 'problems'.
• All service users should have an assessment of their strengths at least in a process of completion, documented in whatever way is most appropriate to ensuring they strongly influence the on-going work of the team.
• Wants, aims, and aspirations are important anchors to drive plans forward, to clarify what resources are needed from whom in order to achieve them, and to identify what barriers or difficulties may need to be overcome.

When is it used?

• From the first point of referral, direct contact and thinking about a person determined to be in need of the local services.
• It is not a specialist assessment only to be drawn on in special cases.

How is it used?

• There is no single way of doing it, or documenting it; but the outcome should be a positive inventory of achievements, resources and aspirations individualised to the experience of the person themselves.
• In many cases a tool may simply act as the prompt for this aspect of assessment to take place, and to influence decisions in plans.
• 'Strengths working' is a continuous process that develops over time. It is not something that is done to someone, but rather an outcome of mutual dialogue. Circumstances change, as may the service user's aspirations; therefore the assessment is not fixed, and new facets of a person continuously emerge.
• The ultimate aim is for the assessment to be completed collaboratively, with or without an example of a form being introduced into the conversations. Paperwork in meetings can have a habit of formalising the situation, and thus getting in the way of the intended purpose.
• In rare instances, the whole process could be described to the service user, and where appropriate, a strengths assessment format left with them to ponder and complete in their own time. This may then form a basis for the service user to lead a subsequent discussion of their strengths and aspirations with the practitioner.
• The assessment is best conducted in an informal, conversational manner, rather than a structured interview. It is best conducted so far as is possible on the client's own 'territory' and in places where the user feels comfortable, rather than in formal service or institutional settings (e.g. the service user's home).
• It develops at each service user's pace and comfort level, and adapts to change.
• As 'strengths working' will be developed in response to the individual's circumstances, it is not relevant to set a standard time period for monitoring when it is completed and reviewed. Some assessments will be completed relatively quickly, and can reasonably be reviewed on a regular basis e.g. 6-monthly timescales. Some assessments will take many months or years to build up, and therefore do not fit a regular review cycle.

Structure of the process

• The assessment is focused on gathering information relevant to a range of 'life domains' e.g. housing, finance, health, occupation, social relationships, cultural and spiritual beliefs. Therefore, it should paint a holistic picture of the service user's life.
• It should be a positive, hopeful, and constructive process - the act of looking at strengths, possibilities and motivations is in itself constructive.
• It provides the essential positive information and resources needed to work constructively with risk.
• The format fits well with the local training on WRAP (Wellness Recovery Action Plan), and with Brief Solution Focused Therapy.

Strengths-Based Practice

The following article was first published in Openmind 126, Mar/Apr 2004) and is reproduced with their kind permission.

Steve Morgan goes beyond the alphabet of negativity

PDF: Strengths-based practice - OpenMind article

To read the report above you will need free software called Adobe Reader. This software can be downloaded here.

Models and Processes

A Working Model

Creative Capability through Practice Based Evidence (a working model)

David Juriansz and Steve Morgan

Creative Capability model	Focus	Core Components
Ethical practice	Individual practitioner capability	Essential values and 'humanity' of practice. Questioning assumptions and judgements. Respecting individual choices and human rights.
Process of care	Practitioner + client capability (the helping relationship)	Engaging a partnership with service users, not because the NSF says we should, but because it motivates their own capabilities to regain better mental health. Recognising service user strengths as well as needs, and promoting their capability to help themselves.
Team working	Practitioner + client + team capability (the team approach)	Promoting and maintaining clarity of team functions and goals. Efficient structures and systems that allow time for creative work. Effective partnerships between the team and the wider network of agencies.
Knowledge in practice	Practitioner + client + team + organisation capability.(the service approach)	The capability of the service to respond to the needs of individuals in a way that is flexible and creative. The sum total of the all the capabilities above, expressed as model or philosophy of the service. An approach to care that works in both theory and practice. A service that is influenced by the service user and pracctitioner experience.

A Working Process

Identifying a team to work with.

Engage the trust of team members (sceptical of external 'consultants').

Confidential 'Creative Capability' interviews (Parts 1 & 2) with all team members (including priorities for team away-day).

Produce a 'team' report of interviews.

'Team' away-day.

Report & summary of participant evaluations from away-day.

Identifying priorities for practice development 'implementation'.

Working with team in creative ways to implement their priorities and decisions for change.

Second 'team' away-day at approximately 6 months (completing Creative Capability Part 2).

Produce comparison of amalgamated team responses to Creative Capability Part 2, identifying positive changes.

Identify small number of local practitioners/team leaders to be mentored as a local 'Practice Development Team' (building up to working one day/week out of existing posts, to establish the local capability to continue the process in local services).