SCIE Report 36: Enabling risk, ensuring safety: Self-directed support and personal budgets

Practice

'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' (Neill, Allen, Woodhead et al, 2009)

Principles for person-centred practice

Some core principles which foster person-centred, positive risk taking while maintaining safety are:

• Involvement of people who use services and those who are important to them – this includes people who form the individual's informal 'circle of support', who are involved from the beginning to gather information, define what the risks are from the individual's point of view and to discuss ways to enable and manage these risks.
• Positive and informed risk-taking – this is built on a strengths-based approach to the person and looks at creative ways for people to be able to do things rather than ruling them out.
• Proportionality – this means that the time and effort spent on managing a risk should match the severity of that risk. The approach should also explore the consequence of not taking the risk in question, such as loss of autonomy or restriction of choice.
• Contextualising behaviour – this means knowing about the person's history and social environment, their previous experience of risk, what has and has not worked in previous situations.
• Defensible decision making – this means recording a clear rationale for all the decisions made and the discussions that led to the decisions, including reference to relevant legislation such as the Mental Capacity Act or the Human Rights Act.
• A learning culture – this require a commitment to ongoing learning and the use of reflective practice for people working at the frontline.
• Tolerable risks – this involves negotiating and balancing issues of risk and safety to identify what is acceptable for everyone concerned (the individual and others including the community) on a case by case basis.

The following practice points have been identified for local authorities and social care providers:

• Make explicit encouragement of staff to explore what's important to the people they are paid to support, and to take managed risks to make progress. Make it clear in risk management policies that staff engaged in reasonable risk taking are acting under their employer's instructions
• Provide sincere, swift and whole-hearted support for staff when positive risk-taking results in injury or harm.

Finally, any positive approach to risk must include the basic principles of person-centred approaches:

• keeping the person at the centre
• treating the family and friends as partners
• focusing on what is important to the person
• an intent to build connections with the community
• being prepared to go beyond conventional service options
• continuing to listen and learn with the person.

Further reading

• Neill M, Allen J, Woodhead N, Sanderson H, Reid S & Erwin L (2009) Feature: A positive approach to risk requires person-centred thinking Tizard Learning Disability Review 14 (4)