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Journal of Social Work

DOI: 10.1177/14680173030032006 2003; 3; 211 Journal of Social Work

Kirsten Stalker Managing Risk and Uncertainty in Social Work: A Literature Review

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Managing Risk andUncertainty in Social WorkA Literature Review

K I R S T E N S TA L K E RUniversity of Stirling, Scotland

Abstract• Summary: This review, which draws mainly but not exclusively on UK

material, explores the social work literature on managing risk anduncertainty, with emphasis on community care. Risk has become amajor, if not over-arching, preoccupation in social work, reflected in ahuge upsurge of written material.

• Findings: The article briefly traces the historical development of theconcepts of risk and uncertainty and identifies a number of theoreticalframeworks, noting that the risk society is marked by change,uncertainty, and a reduced faith in experts. Some commentators havedrawn out the implications of these ideas for social work. At present,however, we lack a social model of risk. The article describes acontinuum of risk management, marked by controlling attitudes at oneend and more empowering approaches at the other. The former isevident in risk avoidance strategies, the latter in positive risk-taking; theliterature on each is reviewed.

• Applications: The views of service users are largely absent from theliterature but their role in taking and managing risks on an everydaybasis should not be overlooked, nor their potential to play a moresignificant role in the process. Pointers for future research are identified.

Keywords community care risk service users social model of riskuncertainty

Introduction

‘To be alive at all involves some risk.’ Harold Macmillan.

Risk is a complex and multifaceted concept (Ryan, 1996; Stevenson, 1999;Warner, 1992). There is a vast amount of literature on the topic, for example inmedicine, public health, engineering, economics, business studies, law and

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commercial insurance. A recent ESRC research programme entitled Risk andHuman Behaviour, involving 23 studies, claims to have provided ‘a vital focusand major stimulus for risk research in the UK’ (Loomes, 1997). Brearley(1982a, 1982b) is often cited as a pioneering thinker about risk in social work.Although the topic received little attention for some years after this early work,it has now become a major issue, reflected in the considerable amount that hasbeen written about risk and social work in the last five years or so. The ScottishExecutive Mental Health Reference Group (2000a) describes the literature aslargely ‘opinion-based: it is difficult to relate the issues of practice to a body ofauthoritative research data which is often descriptive rather than methodo-logically rigorous’ (2000a: 23).

The aim of this review is to explore the literature on managing risk anduncertainty in social work, to highlight key findings, issues and arguments, andto discuss points of consensus and dissent. It was decided to focus on themanagement rather than the assessment of risk because a good deal of atten-tion has already been paid to the latter. Carson (1995) argues that social workhas focused on risk assessment at the expense of risk management, althoughParsloe (1999), also noting the small number of studies on risk management,suggests this may be because it is a new term rather than a new activity. Thisarticle focuses more on community care, although it includes some genericsocial work literature. More has been written about risk in relation to offend-ers and children and families, with less synthesis of the research on communitycare.

The article draws mainly but not exclusively on UK literature, with theemphasis on theoretical work, think-pieces and published research rather thandetailed policy and practice documents. Within these broad parameters,relevant texts were identified through database searches (including the Insti-tute for Scientific Information Citation Indexes; ASSIA; National Institute forSocial Work; Caredata), university library catalogues, following up referencescited in bibliographies and discussion with colleagues.

Risk and Uncertainty: Developing ConceptsVarious claims are made in the literature for the origin of the term ‘risk’.According to Jaeger et al. (2001), the idea of risk management can be tracedback to the 18th-century BC code of Hammurabi. Luhmann (1993) states thatrisk first appeared in German literature in the mid-16th century, but that thiswas predated by the Renaissance Latin word riscum, a term which wasoriginally linked to maritime insurance, and referred to a means of calculatingthe probability of a range of disasters that might befall ships. This laterextended to insuring soldiers in the Napoleonic wars, decisions initially beingguided by personal knowledge and market forces rather than statistical calcu-lation (Kemshall, 2002). According to Douglas (1992) and Parton (1996),however, the concept of risk emerged in the 17th century in the context of

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gambling: here it referred to the probability of an event occurring and the sizeof the associated gains and losses. In short, there is little consensus about theorigin of risk, although clearly it has always been part of human experience insome form.

In the Middle Ages and up to the late 17th and early 18th centuries,harmful, destructive and dangerous events were not attributed to human failingbut to divine or supernatural intervention (Lupton, 1999). Such superstitionwas swept away during the Enlightenment when rational thought and objectiveknowledge were seen as central to progress and order. It was believed that boththe social and the natural world were subject to laws and forces which could bemeasured and predicted. This was the period when probability and statisticsemerged; norms and deviations from the norm could be calculated and riskbecame scientized. Lupton notes the distinction drawn between risk,‘conditions in which the probability estimates of an event are known orknowable’, and uncertainty, ‘when probabilities were inestimable’ (1999: 7).According to Lupton, no value was attached to risk itself at that time: it was aneutral concept, and did not imply that outcomes were likely to be either goodor bad.

During the course of the 19th century, however, risk was increasingly usedto refer to undesirable events or outcomes, and often retains that meaningtoday. Warner, in his introduction to the Royal Society’s second report on risk,defines it as ‘the probability that a particular adverse event occurs during astated period of time or results from a particular challenge’ (1992: 2). Jaeger etal. (2000: 17) offer an alternative definition: risk is ‘a situation or event in whichsomething of human value (including humans themselves) has been put at stakeand where the outcome is uncertain’. This definition is intended to capture whatthe authors call the ontological nature of the world: humans are embedded inuncertain environments, both natural and of their own making, containingdesirable and undesirable risks.

Brearley’s (1982a: 82) definition, which has been influential in social work,framed risk itself in negative terms: ‘the relative variation in possible lossoutcomes’. However, it was part of a wider model, comprising various elements,including strengths, which were ‘the factors likely to reduce dangerousoutcomes’. Brearley distinguished between vulnerability, which he described as‘capable of being wounded or susceptible to danger’ (1982b: 26), and danger,which denoted ‘a feared outcome of a hazard which is either expected to be aloss outcome or is associated with loss in the expectation of the observer’(1982b: 4). When working with older people or those with learning difficulties,social workers may equate risk with vulnerability. In relation to offenders andsome users of mental health services, risk is more likely to be associated withthe idea of dangerousness, although that too is a socially constructed term(Moon, 2000). However, Link and Cullen (1986) suggest an inverse relation-ship between contact with people with mental health problems and theirperceived dangerousness. Statistically there is a much greater risk that a

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mentally disordered person will commit suicide than injure others (Parsloe,1999).

Risk itself is not a discrete legal concept, unlike negligence and recklessness(Carson, 1996). In the childcare field, professionals are likely to equate risk withthe concept of significant harm, central to the Children Act 1989 and theChildren (Scotland) Act 1995 (Sargent, 1999). What counts as significant harm,however, depends on the age and condition of the individual as well as currentsocial norms. These are constantly changing, and legal decisions and appeals setnew precedents. Thus social workers are constantly working with uncertainty(Parsloe, 1999).

Indeed, it has also been suggested that risk is now commonly used as if itwere synonymous with uncertainty. Lupton notes that ‘risk and uncertaintytend to be treated as conceptually the same thing’ (1999: 9), the earlier distinc-tion regarding the calculation of probability having disappeared. Macdonaldand Macdonald, who are critical of Brearley’s model for being obfuscatory,define uncertainty as ‘not knowing for sure what will happen (risk)’ (1999: 17).Many commentators (such as Parton, 1996; Lupton, 1999; Shaw and Shaw,2001) note that risk has become a widespread term in contemporary Westernsociety. Indeed, in some areas of life it has become a predominant preoccu-pation. To understand why this might be so, we need to turn to a number oftheoretical frameworks.

Theoretical DimensionsJaeger et al. (2001) propose a typology of approaches to studying risk: techni-cal, psychological, sociological, anthropological and geographical. As explainedabove, when risk was conceived in terms of calculating probability, its existencewas not questioned; it was taken as an objective fact. To a large extent, thisassumption remains the basis of contemporary scientific and technicalapproaches, as seen for example in the use of psychometric risk assessments,founded on rational behaviour theory (Lupton, 1999). Professionals are seen asexperts, and lay people may be limited or biased in their ability to assess andmanage risk, for example because they do not process information efficiently.Lupton senses epistemological uncertainty here, allowing room for subjectiveinterpretation within a realist paradigm. Perhaps this reflects the point madeabove regarding the relationship between risk and uncertainty, the latter beinga response to perceived risk. Scientific approaches to risk have been criticizedfor ignoring symbolic meanings and social signs, for isolating the individualfrom the social world and for separating a particular risk or risk behaviour fromthe context of associated risks and behaviour.

In the fields of sociology and anthropology, recent theoretical advanceshave challenged the idea that modernity is a time of continuing progress.Rather, it is portrayed as a period of change, dislocation and uncertainty: theconstantly changing nature of our world is undermining our accustomed


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traditions and sense of security (Giddens, 1990; Beck, 1992). As a result, we areconstantly re-evaluating our actions and our place in the world in order tounderstand what is going on around us and thus gain a greater sense of control.Paradoxically, however, the more we acquire this kind of knowledge, the moreuncertain we become.

These aspects of modernity, or late modernity’ in Giddens’s work, areassociated with many large-scale risks which lie outside the control of indi-viduals or organizations. Former markers of progress are now seen as a meansof self-destruction: ‘In advanced modernity, the social production of wealth issystematically accompanied by the social production of risks’ (Beck, 1992: 19).The globalization of risk, for example through the threat of nuclear war oraccident, changes in the global economy and labour market, and environmentalrisks such as widespread pollution and global warming, have far-reachingeffects on individuals’ lives. At the same time, people’s perception or experi-ence of risk has changed; we see risk as risk, which can no longer be trans-formed into certainty through religion or magic.

Although both Giddens and Beck identify these risks, the former does notportray late modernity as a riskier time than before: rather, it is the calculativeattitudes of individuals which create what he calls a risk culture, preoccupiedwith safety and what might happen in the future. Beck, who had no doubt thatrisks were increasing, used the term ‘the (industrial) risk society’. Jaeger et al.argue that risk, as we know it, is ‘a wholly new child of the late twentiethcentury’ (2001: 9).

Giddens, acknowledging increasing public uncertainty about who can betrusted, also argues that lay people (most of us on most subjects) have littlechoice but to trust experts. But Beck points out that many of the risks we faceresult from decisions taken by individual so-called experts or their organiz-ations. Experts often disagree with each other or are proved wrong in theirpredictions and pronouncements. Therefore, in Beck’s view, loss of faith inprofessional expertise is an appropriate response. Faced with this insecurity ona global level, in their private lives individuals have more options and autonomythan ever before. They must develop and take responsibility for their own lifecourses in a way that was not possible when personal biographies were prettymuch laid down from birth. Beck is critical of this individualization process, inthat it attributes failure to the individual rather than to changing socialprocesses.

Douglas (1982, 1986, 1992) portrays risk as a strategy for dealing withperceived danger. She is particularly interested in why some dangers are seenas presenting risks while others are not. This is partly related to shared valuesand beliefs, and partly to the need of individuals and organizations to maintainboundaries between themselves and others. Douglas also explores the differ-ences between lay and expert views of risk, which she attributes to differencesin cultural and political meaning. She views risk as closely linked to account-ability and blame: those who rightly point to the pervasiveness of uncertainty


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are only accused of trying to evade responsibility. Douglas is critical of thelanguage of risk, ‘which often makes a spurious claim to be scientific’ (1992:14), arguing that ‘anger, hope and fear are part of most risky situations’(1992: 12).

Jaeger et al. (2001) place the concept of risk in a broader framework ofsocial theory. They argue that rationality, or Rational Actor Paradigm (RAP),which has dominated modern Western thought since the Enlightenment, is notable to help us fully understand and respond to the risk society. RAP’s under-lying premise, the expectation of progress and continual improvement, ischallenged by the risk society, which reveals what Beck called ‘the dark side ofprogress’. Risk threatens two fundamental aspects of Giddens’s ontologicalsecurity: the continuity of self-identity and the constancy of the social andmaterial world. Jaeger et al. argue that these developments cannot be fullyexplained by RAP, which fails to acknowledge the importance of macro-sociological and historical forces on the one hand, and non-rational, individualforces on the other. The authors consider the explanatory potential of othersocial theories, including reflexive modernization, critical theory, systemstheory and post-modernism.

Culpitt (1999) argues that neo-liberalism has used various aspects of risk toattack welfare dependency. Drawing on Foucault, he contends that a new moraldiscourse of welfare has emerged which is ‘almost totally pejorative’. A lessgloomy view of the implications of risk for politics and policy is presented byFranklin (1998), who sees risk society as having a potential for positive change,so long as we accept and work with it, rather than harking back to the oldcertainties, trying to resist the inevitable: ‘It encourages action built on realis-tic assumptions, pushes out the boundaries of consensus and opens up thedynamic of action and debate’ (1998: 8).

Lupton (1999) reminds us that social theories of risk include strong andweak constructionists. None of the theorists discussed above would deny theexistence of real risks (although Beck and Douglas emphasize them more thanGiddens) nor, in examining the relevance of these ideas to social work practice,should we. The theories do suggest, however, that social work theorists andpractitioners should adopt a critical approach in their understanding of andresponse to risk (Brownlie, personal communication).

Parton (1996) is one of several commentators to relate risk theories specific-ally to social work (see also Shaw and Shaw, 2001), adopting a strong construc-tionist position. The development of social work, particularly during thepostwar period, was based on optimistic ideas of improvement and rehabili-tation, but with the collapse of welfarism and the growth of neo-liberal beliefs,the notion of risk has superseded that of welfare. The impact of globalizationhas dislocated many areas of social and economic life, giving rise to uncertain-ties, fears and insecurities: more importance is now attached to the calculatingchoices of individuals. The increasing emphasis on risk in social work is both areflection of these heightened concerns and a way of trying to understand and


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respond to them. The growing public distrust of social work’s claims toexpertise, and the profession’s increasing reliance on complex systems of audit,monitoring and quality control reflect the increasing emergence of the risksociety. Parton suggests that: ‘risk is not a thing or a set of realities waiting tobe unearthed but a way of thinking. As a consequence, social work’s increasingobsession(s) with risk(s) point to important changes in both the way socialworkers think about and constitute their practices and the way social work isitself thought about and thereby constituted more widely’ (1996: 98).

Alaszewski and Manthorpe (1998), drawing on Douglas (1992), note thatuntil the 1980s little attention was paid to the way in which welfare institutionsmanage risk. These authors examine a number of classic works on organiz-ations, particularly welfare agencies, from a risk perspective. They concludethat traditional bureaucracies and agencies which are staff-centred rather thanuser-centred are likely to rely on expert advice, punish mistakes and try tocontrol the environment by anticipating and preventing risks. In contrast, user-centred agencies are more flexible, delegate decisions and value individualjudgement. They encourage wider participation in decision-making, learn frommistakes and may develop rapid response systems to deal with any problems,rather than use up a lot of energy trying to predict and prevent specific risks.

The regulation of risk by institutions in different policy domains is exploredby Hood et al. (2001). These authors challenge – indeed reject – many of theideas discussed above, concluding that ‘there is no such thing as risk society,only different risk regulation regimes’ (2001: 171). Their analysis of differentregimes reveals greater variation, they say, than risk society theories canexplain, with some policy areas engaging in no more than ‘half-heartedattempts at consciousness-raising’. They contend that regulation is not shapedby dramatic changes in the scale and nature of contemporary risk, but by factorsalready well known to influence policy, such as public opinion and marketforces. Hood et al. claim to have developed a systematic way of mapping howrisks are managed and regulated, pinpointing and, importantly, explaining simi-larities and differences, in a way which studies of single policy areas, like thatby Alaszewski and Manthorpe (1998), cannot achieve. However, the analysisof risk regulation regimes still has some way to go, and its policy implicationsfor social work are not, perhaps, immediately obvious.

A number of writers (Gurney, 2000a; Langan, 1999; Parsloe, 1999; Steven-son, 1999) have noted that at present we lack a well-developed social model ofrisk. During the 1990s attention was increasingly directed at the risks attachedto individual behaviour, rather than wider social, economic and political factors,or indeed risks emanating from medical treatment or social work intervention(Tanner, 1998). Gurney (2000b) points out that the responsibility for risk-takingand allocation of blame when things go wrong vary according to how far risk isseen as a consequence of social structures and conditions, and thus a sharedresponsibility, or is attributed to individual behaviour or shortcomings. Inrelation to children, Parsloe (1999) argues that poverty, poor housing and


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ill-health may be as harmful as abuse. In the mental health field, Langan (1999)points out that much research has been uncritical in accepting the concept ofmental illness; few studies have tried to understand the risks which some indi-viduals pose to others in the context of socio-economic conditions, youth orgender. For older people, many risks come from the environment (Wilson,1994). Parsloe (1999) calls for a social model of risk which takes account ofenvironmental factors and social networks.

A Continuum of Risk ManagementThe Blackwell Encyclopaedia of Social Work defines risk management as ‘theprocesses devised by organizations to minimise negative outcomes which canarise in the delivery of welfare services’ (Gurney, 2000a: 300). As Gurney pointsout, explicit in the term is the assumption that risk can be managed. At the sametime, it is widely acknowledged that, as with assessing risk, managing it cannever be an exact science (Kemshall, 1996; Ryan, 1997). Gurney’s (2000a) defi-nition locates responsibility for managing risk within organizations but, as weshall see, service users can also take responsibility for managing the risks theyface, and sometimes those they pose to others.

Gurney (2000a) suggests that risk management moves along a continuumbetween control, legitimate authority and empowerment. Between theempowering and controlling ends of the continuum lie models of risk mini-mization which seek to reduce harms and maximize benefits (Manthorpe,2000). In this vein, the Scottish Executive Mental Health Reference Groupstates that ‘the proper management of risk cannot be separated from goodquality care and is integral to meeting the full needs of people with mentalhealth problems’ (2000a: 13).

Hood et al. (1992), writing on risk management for an influential reportproduced by the Royal Society, identify seven key areas of debate or doctrinalcontests. These areas are as follows:

• Proactive anticipation and avoidance of specific risks versus generalresilience to unexpected disasters

• The extent to which systems should be blame-oriented, as opposed tocreating a learning culture

• How far, and what kinds of, risk should be assessed by quantitative orqualitative means

• The feasibility of applying an orthodox engineering approach to the designof complex socio-technical systems

• The costs of risk reduction, which may need to be balanced against othergoals and other risks

• The degree of participation in risk decisions – the optimum size andcomposition of decision-making groups

• The appropriate regulatory target – should it be outcomes or processes?


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Alaszewski and Manthorpe (1998), drawing on these seven doctrinalcontests, suggest that in practice organizations may move up and down thecontrol/empowerment continuum by being controlling in some areas andempowering in others. These authors examined how 42 welfare agencies,working either with children or adults with learning difficulties, responded toand managed risk. For decision-making, some agencies had a broad partici-patory approach (for example, including service users wherever possible);others had a narrow participatory approach (only consulting otherprofessionals). In terms of internal management, some organizations had alearning policy (for example, encouraging staff to voice any concerns aboutagency policy so that practice could be improved), and others had a blamingone. Looking at the ways risk itself was managed, some organizations showedan anticipatory policy (for example, using reviews to identify potential hazardsand a process for dealing with them). Others had a rapid response policy whichidentified and investigated harmful situations (such as when a risk had alreadydeveloped into a harm).

The authors conclude that agencies varied considerably in their approachto risk management. Although some were highly sensitive to risk, overall fewagencies had well-developed risk strategies. Most were fairly encouraging ofparticipation in decision-making but defensive about managing the environ-ment. They were more evenly divided over the use of positive and negativesanctions for internal management. Childcare agencies were more likely to bedefensive and those working with people with learning difficulties were gener-ally more open. Although the reason for these differences was not known,Alaszewski and Manthorpe speculate, using Douglas’s (1992) work on risk, thatit was related to agencies’ overall sense of security. If an agency sees itself asunder attack, it may respond by reinforcing boundaries, either by creatingclearly defined systems which externalize blame or by allocating blame tomarginal individuals in the organization.

Risk AvoidanceDrawing on the work of Douglas (1986, 1992) and Beck (1992), Kemshall et al.(1997) argue that social work’s current concern with risk is tied up with a widerloss of faith in science, knowledge and traditional power hierarchies. Beckbelieved that the normative basis of the risk society was safety and that itsutopia was negative and defensive. Kemshall et al. argue that public policy isnow focused on the forensic rather than the predictive use of risk, that is, ‘as ameans of investigating situations that go wrong’ (1997: 223) and allocatingblame. At times risk management is characterized in the literature as little morethan social work watching its own back. Parton (1998) claims that making adefensible decision has become more important than making the right one(although these are not necessarily different). Reviewing the role of social work


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in the blaming society, he suggests that something like ‘a state of emergency isbeing introduced . . . It gives birth to a language that crawls with expressionslike “control”, “official approval”, “management responsibility” and so on’(1998: 112–13). His concern is echoed by Parsloe, who notes that the languageseems managerial rather than compassionate (1999: 8).

Tanner (1998) suggests that risk management, as the term implies, utilizessocial workers’ managerial rather than professional skills, reflecting a broadermovement from depth to surface in social work, a focus on task and process atthe expense of value. Surface methods, Tanner claims, follow set procedures,with the result that risk management is concerned to manage rather than treatsocial problems.

Another aspect of modernity which has encouraged a defensive reaction torisk by exaggerating specific hazards (although also sometimes minimizing risksjudged serious by experts) is the role of the mass media (Eldridge et al., 1997).High-profile cases of child deaths, child abuse (Parton, 1998) and homicide bypeople with severe mental health problems (Langan, 1999) have been spot-lighted in the press, causing public outcry. The rise of litigation in the US, whichmay also now be taking hold in the UK, is a further threat hanging overprofessionals (Carson, 1996). When things go wrong, courts and officialinquiries are increasingly expected to examine decision-making processes inretrospect (Carson, 1995). Steele is not alone in noting ‘that social workers aredamned if they do and damned if they don’t’ (1998: 9). The fear of being heldresponsible for an adverse outcome acts as a strong disincentive to risk-taking(Tanner, 1998).

The process of individualization apparent in modern society encouragesagencies to seek out scapegoats rather than accept corporate responsibility(Kemshall et al., 1997). Following an independent inquiry into the death of athree-year-old child at the hands of her stepfather, it was reported thatDumfries and Galloway Council planned to remove the names of individualsocial workers before publishing the report. This decision was said to havecaused outrage among some council employees (Garavelli, 2001). While someauthorities have volumes of material on risk management, others haveproduced very little (Kemshall et al., 1997; Carson, 1996; Alaszewski andManthorpe, 1998). Where risk management is largely left to individual judge-ment, the practitioner rather than the manager may be blamed if things gowrong (Carson, 1996). Gummer (1998) discusses the difficulties workers facewhen rules are either absent or ambiguous.

A policy of risk avoidance can, perversely, create new risks (Parton, 1996).It can reinforce workers’ uncertainties and vulnerabilities, both about their ownculpability and about their personal safety (Kemshall et al., 1997). In addition,examples can be found in the literature of social workers identifying new areasof perceived risk (for instance, Hicks 1997, about adoption by lesbians and gaymen), interpreting unconventional behaviour as risky (such as George, 1996,about an individual with learning difficulties staying up all night) and/or


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adopting unnecessarily controlling policy and practice (Herring and Thom,1997, concerning older people and alcohol).

Furedi (1997) argues that the exaggeration of risk and the diminishedimportance attached to subjectivity mean that any form of human interventionis now viewed as potentially suspect, any stranger as potentially dangerous. Themistaken belief that abuse is endemic has led to the rediscovery of people ‘assad and damaged individuals in need of professional guidance’ (1997: 147). Theworship of safety and the avoidance of risk make up the new moral order, anorder which, Furedi argues, is prescriptive, intrusive and deeply anti-humanis-tic. From this perspective, social work is at fault for its over-zealous policing ofindividuals’ lives, while seeking to justify its actions on the basis that the safetyof children is at risk from ‘the threat posed by millions of abusing parents’(1997: 47).

As the literature repeatedly reminds us, risk management is based on along-standing tension in social work between autonomy and protection. Theseare both important values but can be hard to reconcile. In criminal justice,national standards and legislation leave little doubt that the rights of victimsand the public take precedence over those of offenders (Kemshall andPritchard, 1997). As these authors point out, the balance of self-determinationand protection is often determined by ideas about worthiness. Who shouldprovide care and who should receive it? Who is a worthy citizen and whojeopardizes his or her citizenship rights because of perceived riskiness ordependent status?

Less attention has been paid to risk management in community care,although concerns about safety feature prominently in work on elder abuse(Pritchard, 2002) and people with severe mental illness (Waterson, 1999).Recent community care legislation established a duty of care of adults on thepart of social work and health authorities. Kemshall and Pritchard describe thisas ‘a principle of protection within which the assessment of need, vulnerabilityand risk are essential’ (1997: 10). The 1980s saw growing interest in the rightsof older people, but during the 1990s risk guidance and adult protectionprocedures became more dominant (Littlechild and Blakeney, 1996). Olderpeople may be prevented from taking risks purely on the grounds of age, theemphasis being on their perceived limitations rather than their abilities orpotential (Littlechild and Blakeney, 1996). Similarly, those with learning diffi-culties may be seen as unable to make decisions for themselves, in which caseit is not always clear whether family members or social workers should do so(Mapp, 1996). Kemshall (2002) predicts that mental health policies in the 21stcentury will revolve around compulsory treatment and surveillance in thecommunity for those deemed high-risk, and isolation and invisibility, amount-ing to segregation, for those deemed low-risk.

Waterson (1999) is one of several writers who warn that the identificationof need, central to the community care reforms, is being overtaken by theidentification of risk (although identifying need is not necessarily the neutral or


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value-free exercise she perhaps implies). Thus, Tindall (1997) writing aboutpeople with learning difficulties, proposes that the gap between a person’spresent circumstances and their future aspirations should be filled by means ofa risk assessment. The legislation encourages social workers to assess the needsof anyone who appears to be in need of services, but offers little guidance aboutprioritizing them (Kemshall and Pritchard, 1997). Local authorities have devel-oped eligibility criteria which set out hierarchies of need in terms of risk, thosedeemed to be at greatest risk having the first claim to services (Parton, 1996).Containing risks has become a means of rationing scarce resources while alsoreducing the potential for preventive work (Waterson, 1999). Waterson (1997:277) writes: ‘risk management may in the end only be risk distribution, creatingfurther hazards for vulnerable users, such as older people who pose no immedi-ate risk and whose vulnerability is of little social concern’. One way round this,identified by Richards (2000), is for social workers to emphasize possible risksin order to have low-level cases prioritized.

Kemshall (2002) argues that risk is replacing need not just in communitycare but also in health and welfare policy and provision. She locates this trendwithin a wider political context associated with (but not confined to) the policiesof New Labour. Kemshall describes a process which she inelegantly calls‘responsibilization’:

This restructuring of welfare provision within a largely economic discourse has alsoresulted in a relocation of need to individual failings and away from the social sphere,paralleled by a growing delegitimisation of even residual needs. The ‘third way’emphasis on labour market rather than welfare solutions to inequality and socialexclusion . . . has also challenged traditional social insurance responses to need. Riskand insecurity are increasingly replacing the concepts of need and security in welfareprovision. (2002: 30)

The increasing residualism of this approach, characterized by checking eligi-bility and harsh gatekeeping, inevitably reduces the scope for preventiveand/or long-term work. Parton (1998), focusing on children’s services, arguesthat social work operates in the twilight zone between the private family andpublic worlds, and that this is inherently ambiguous, uncertain and contestedterritory. Recent childcare legislation in the UK is based on the dual, butconflicting, principles of partnership with families/family support, and protec-tion of children/prevention of significant harm. In the context of poorer andsocially excluded families and decreased social work resources, Parton argues,it is increasingly difficult to focus on preventive work. Effort is directed atidentifying high-risk cases, using legalistic criteria and forensic evidence. Audithas replaced trust in social work. Partly quoting Lash et al. (1996), Partonwrites:

Our contemporary conceptualisations of risk have predominantly assumed that theworld can be subjected to prediction and control, and that rational systems of account-ability should be constructed if things go wrong. Such notions of risk have rationalised


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and scientised areas of social life which I would suggest are much more appropriatelyconceived of in terms of uncertainty. (1998: 22)

Reverting to an old distinction (discussed above), Parton uses the word ‘risk’to mean the calculable, and ‘uncertainty’ to mean that which cannot be calcu-lated. Most of social work’s terrain, he argues, falls into the latter category, andwe should respond by employing ‘artistic, situated judgements’ (1998: 23),developing mutual trust and respecting other people’s viewpoints. Notions ofambiguity, uncertainty and complexity lie at the heart of social work andworking with, rather than against this, will produce more creative and inno-vative responses.

Risk-takingRisk-taking in social work is based on a view of the service user as an activecitizen with rights and responsibilities and it values the individual’s own exper-tise, rather than seeing professionals as the only experts (Gurney, 2000b). TheBlackwell Encyclopaedia describes risk-taking as ‘the belief that risk and theright to take risks is a normal part of everyday living’ (Gurney, 2000b: 303),challenging defensive practices. Tindall (1997) describes risk-taking as a meansof empowering the individual and assisting personal development. In much ofthe literature risk-taking is generally accepted as reasonable and indeed a right(Brearley, 1982a, 1982b; Kemshall et al., 1997; Waterson, 1999). Carsonenthuses: ‘risk-taking involves the most exciting, the most intellectual andprofessional parts of the job, although also the most anxiety provoking parts’(1995: 3). At policy level, the Social Services Inspectorate (1998) has high-lighted the benefits of taking reasonable risks. Guidance issued by the SocialWork Services Inspectorate (2000), however, stresses the concept of a defens-ible decision.

Alongside the duty of care and protection in community care, discussedabove, there is considerable emphasis on promoting user choice and control.The White Paper, Caring for People: Community Care in the Next Decade andBeyond (Secretaries of State, 1989: 1.8), stated that ‘promoting choice and inde-pendence underlies all the Government’s proposals’. The paper went so far asto say that rather than users’ wishes being subordinate to those of serviceproviders, ‘the roles will be progressively adjusted’ (1989, 1.7). This emphasison individuals gaining more control over their lives and setting their ownagendas, rather than responding to those laid down by professionals, echoes atradition of self-determination which has a long history in social work. Peoplewith physical impairments have argued powerfully for the right to self-determi-nation (see, for example, Oliver, 1990; Swain et al., 1994). In the learningdisability field, the value of risk-taking has achieved more recognition overrecent years (Browning et al., 1998). This is reflected in UK national policy bythe recent reviews of services to people with learning disabilities (Scottish


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Executive, 2000b; DoH, 2001). However, Alaszewski et al. (1999) note a failureof service agencies to develop effective strategies.

Stevenson (1999), writing about older people, discusses the difficulty ofknowing where to draw the line between acceptable and unacceptable risk, andwhen to intervene. Since life is inherently risky, she argues, social workersshould focus on unacceptable risk. Lawson (1996) takes the view that all usersshould be assumed to be capable of making informed choices unless multi-disciplinary assessment shows otherwise. Individuals have the right not to havetheir independence unnecessarily restricted due to other people’s anxietiesabout them: imposing restrictions may well compromise their quality of life(Lawson, 1996). But Stevenson (1999) warns that social workers can use theprimacy given to choice and autonomy as an excuse to do nothing, reflectingthe low value attached to older people in our society. Lawson (1996) sets out auseful framework for assessing risk for older people, allowing for positive risk-taking. This poses a number of questions such as: Why is the older personthinking about taking the risk at all? What are their hopes and anxieties? Therange of possible outcomes must be identified and those that are likely to bebeneficial weighed against those that may be harmful or undesirable. If certainoutcomes may benefit one person but disadvantage another, choices have to bemade about which outcome and whose aspirations are more important. Thegrounds for making a particular decision must be clear to everyone involvedand should be recorded.

Morgan (2000), discussing assertive outreach as a positive service model forpeople with severe mental illness who are difficult to engage, sets out thebenefits of well-managed risk-taking. He argues that traditional responses torisk, which he describes as negative and restrictive, only serve to confirm users’suspicions, and increase their distance from professionals and thus the chanceof risks occurring. Most people who are hard to reach do engage when servicesare offered in more flexible and client-centred ways. Morgan describes positiverisk-taking as involving ‘collaborative working, based on the establishment oftrusting working relationships, whereby service users can learn from theirmistakes based on taking chances, just like anyone else’ (2000: 17). It should beadded that Ryan et al. (1999, quoted in Kemshall, 2002), found that the successof assertive outreach projects depended, not surprisingly, on the level ofresources available: given that costs were usually high, benefits in some areaswere marginal.

The Role of Service UsersMuch has been written in psychology about risk avoidance and risk-taking fromthe individual’s perspective, particularly in relation to gambling. It may beinappropriate, however, to generalize from behaviour in that context to widerrisk behaviours. Many people choose to indulge in activities which yieldimmediate benefits or rewards, while the harms, although potentially very


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serious, are likely to be far off: examples include smoking and drinking anddriving (McKenna and Horswill, 1997). Although the reasons people avoidrisks are fairly well-established, less is known about why some individualsactively seek out risk (McKenna and Horswill, 1997). The very act of risk-takingmay bring its own rewards. Lupton (1999) suggests that in our highly regulatedand self-contained society, taking part in risky activities is one way to escapethe routine of everyday life.

Langan (1999) notes that service users’ views are largely missing from therisk literature. The extent to which risk assessments are shared with serviceusers is unclear (Manthorpe, 2000). Goodwin (1997), Heilbrun et al. (1999) andStanley and Manthorpe (1997) argue that service users should be more closelyinvolved in risk assessment and management. Parsloe (1999) goes further,describing risk assessment as a huge invasion of privacy, for which socialworkers should seek the person’s informed consent. The users should be seenas the expert on issues affecting them, while the social workers bring skills indecision-making (Waterson, 1999). In practice, however, it is usually socialworkers who make the final decision about whether or not a certain risk isacceptable (George, 1996).

There is some evidence that service users are less likely to identify risksthan professionals or relatives. They may, however, feel under pressure as aresult of other people’s anxieties about them (Littlechild and Blakeney,1996). Problems can also arise when service users see a risk but professionalsdo not, or the perceived risk does not meet eligibility criteria for a service(Tanner, 1998). If users are really to be empowered, Tanner argues, they mustbe allowed to identify the factors that present them with risks, as well as therisks they are prepared to take. Users’ views of risk will also vary accordingto how much choice and control they think they have in relation to it (Ryan,1997).

Users’ attitudes to risk may also conflict with those of their carers orrelatives. Kemshall and Pritchard (1997) cite the example of a dependent adultwhose mother feels she needs regular short breaks. She believes that suchsupport will help reduce the stress associated with looking after her son: withoutit, her stress will increase and her son’s quality of care could be compromised.The latter, however, does not wish to have a respite and refuses to go. Whilerecognizing that users and carers may have differing needs and perceptions,neither the community care legislation nor the guidance makes clear whoseview should take precedence. Kelley et al. (1998) found that both parents andchildren tended to externalize risk as being away from the home, locating it inthe outside world. Although most children accepted some degree of adultprotection, they resented rules and practices which were experienced asrestricting their autonomy.

It has been suggested that individuals can face risks as a result of beingsocial work clients. This may be due to stigma and enforced intervention(Gurney, 2000a) or the risk of abuse or loss of autonomy in residential care


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(Stevenson, 1999). Users of mental health services face risks from medicationand other forms of treatment (Ryan, 1997), from policies of surveillance andconfinement (Goodwin, 1997; Moon 2000) and from services which fail toengage them effectively, leaving risks unaddressed (Morgan, 2000).

Richards (2000) believes that older people manage and take risks on a dailybasis, although this process may not always be visible to social workers. Olderpeople may go to great lengths to maintain their independence, drawing onlessons learnt over a lifetime. Many struggle to manage increasing impairmentand show considerable resourcefulness, analysing problems and identifyingsolutions, an essential element of coping (Richards, 2000). Wilson (1994)identified risk avoidance, for example, choosing to limit or give up certainactivities, as one of three forms of self-care developed by older people. She alsonotes that greater recognition is being given to the role of older people as volun-teers and carers. Parents have strategies for protecting their children fromharm, as do carers of vulnerable adults (Parsloe, 1999). Kelley et al. (1998)explored the ways in which children and their parents perceived and managedrisk in and around the home. They found that children were not passive recip-ients of their parents’ risk-controlling behaviour: they played an active part innegotiating risk-related decisions and they adopted strategies for managing andreducing risks. Lee and Charm (2002) report encouraging findings from aproject promoting user participation in working with high-risk youth in HongKong. Many users of mental health services develop ways of avoiding the risksthey are prone to: some of them, as well as some parents, are aware of whenthey may become a danger to others (Davis, 1996). Yet users’ experiences ofbeing violent, their knowledge of what triggers and what reduces violent behav-iour, has received little attention (Langan, 1999).

Recently, there has been growing interest within social work in the conceptof resilience. Jackson (2000: 296) defines resilience as ‘an interaction betweenrisk and protective factors within a person’s background, which can interruptand reverse what might otherwise be damaging processes’. Miller (1996: 255)uses the term to refer to ‘individuals having some measure of success eventhough coming from situations where success is not predicted’. Fraser et al.(1999) suggest resilience can take the form of individual characteristics, familyfactors or extra-familial circumstances.

Social workers can enhance resilience by building on existing strengthsand reducing risk factors (Jackson, 2000). Research exploring the nature ofthese protective factors is still at an early stage. However, there is someevidence about the ways in which risk and protective factors differ accordingto gender, race and ethnicity (Fraser et al., 1999). Werner (1990), quoted inFraser et al., reports that resilience is fostered differentially in boys and girls.Just as risks can have a cumulative effect, so cumulative protection is thoughtto reduce and act as a buffer against risk in relation to many social and healthproblems.


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Summary

The concept of risk originally related to the probability of an event occurringand the gains and losses associated with it. Its meaning has changed over thecenturies, and it is now generally used to denote adverse outcomes or, some-times, as synonymous with uncertainty.

On a theoretical level, scientific and technical approaches, broadlyspeaking, see risk as an objective knowable fact which can be calculated andmeasured. In sociology and anthropology, the main interest lies in the culturaland political dimensions of risk, although the existence of real risk is not denied.Modernity is seen as an era of change and uncertainty, in which people facerisks on an unprecedented scale. These factors, along with a corresponding lossof faith in experts, have contributed to the emergence of individualization andheightened reflexivity in contemporary Western society. These ideas have hada significant impact on the way social work is perceived and interpreted, whichin turn can lead to changes of policy and practice. A number of commentatorsargue that risk has replaced welfare as social work’s raison d’être.

The last five or six years have seen a proliferation of written material onrisk and social work. A significant amount of this literature takes the form ofthink-pieces: little empirical research has been conducted, particularly on riskmanagement. The development of policy and practice guidelines has not beenconsistent throughout the country: some agencies have hefty tomes, and othersapparently have little or nothing.

Risk management can be described as a process designed to minimizenegative outcomes and maximize potential benefits. It can refer to a broadrange of activities, and is open to different interpretations, as reflected in theseven doctrinal contests (see above). It has been suggested that different stylesof risk management are located along a continuum ranging from control at oneend to empowerment at the other, with legitimate authority occupying themiddle ground. Many commentators argue that risk management is increasinglytaking the form of risk avoidance, located at the controlling end of thecontinuum. This approach uses risk as a forensic rather than predictive device,a means of allocating blame once something has gone wrong. The increasingtrend towards individualization in modern society is reflected in the fact thatculpability is often placed with individuals rather than corporate bodies. Fearof being blamed is heightened by adverse media coverage, the threat of litiga-tion or public inquiries.

Paradoxically, risk avoidance carries the danger of creating new risks, bothby heightening social workers’ anxiety and vulnerability, and by promptingthem to identify new areas of risk in users’ lives, which can lead them to adopta more controlling approach. As this indicates, a policy of risk avoidance raisesfundamental questions about the nature of and balance between protection andautonomy within social work. It has been claimed that decisions about whoserights and freedom should be protected, and whose should be curtailed, rest on


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judgements about the relative worth of different groups and individuals insociety. From this perspective, concern about identifying risk is becoming moredominant than concern about identifying need in assessment and resource allo-cation, even though the end result may be little more than a redistribution ofrisks from dangerous to vulnerable groups.

Another perspective is that social work inevitably deals with ambiguity anduncertainty. Avoiding risk is a complex and difficult business which cannot bereduced to scientized but simplistic methods. Rather than try to calculate theincalculable, social workers need to regain their former status as experts inuncertainty. They should develop mutually trusting, respectful relationshipswith their clients, make fine judgements about risk, and dare to work creativelyand innovatively.

This leads to the other end of the continuum, where risk management isconceptualized as positive risk-taking with the potential to empower. Drawingon a long tradition of self-determination in social work, and on community carelegislation incorporating choice and control, taking risks is seen as a part ofordinary everyday life. However, it should not become an excuse for socialworkers to do nothing. Different options should be identified and weighedagainst each other, with decisions taken and the reasons for doing so clearlyrecorded.

Several writers argue for users to be more closely involved in managing risk.They have valuable knowledge and experience of their own situation, and therole they play in taking and managing risks in their lives should be acknow-ledged. There is a growing interest in the concept of resilience and in the protec-tive factors and practices from which users and their carers may benefit.Evidence suggests that users differ from social workers in their estimation ofthe risks they face or pose others: users’ views may also depart from those ofcarers or relatives. It has been suggested that people face certain risks as a resultof being social work clients.

Implications for Future ResearchThis review has thrown up many unanswered questions and identified a numberof areas that need further investigation. At the theoretical level it has beenargued that a new paradigm is needed to fully explain risk, drawing on insightsfrom a range of social theories. Jaeger et al. (2001) have made a start on this,but say that more needs to be done.

Although much has been written about risk, little empirical research hasbeen conducted. Macdonald and Macdonald (1999) suggest that research onrisk to date has taken an over-simplistic approach and that more studies areneeded which address the complex nature of risk, using methods which can capture its propensity for a variety of outcomes. Risk management increas-ingly requires social workers to follow procedures and guidelines, but there islittle evidence about the relationship between procedures and professional


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judgement, nor how managers can promote good judgement within – orperhaps in spite of – a bureaucratic framework (Parsloe, 1999).

The lessons of cognitive psychology have been little explored in social work.It is known that people generally use a limited number of heuristic principleswhen making decisions in conditions of uncertainty (Tversky and Kahneman,1982). Although heuristics are generally helpful in assessing probabilities andpredicting values, they can lead to serious errors of judgement. Many people,including trained professionals, commonly fall for the gambler’s fallacy (thatchance is a self-correcting process and a run of ‘tails’ will lead to a run of‘heads’). They fail to expect regression towards the mean in many contextswhere it is certain to occur, and do not appreciate the effect of sample size onsampling variability (Tversky and Kahneman, 1982). Research examining theimplications for decision-making in social work, and specifically for managingrisk, would be useful. Titterton (1999) also points to the lack of research on theeffectiveness of training professionals about risk.

The literature also raises interesting questions about how people usingservices or potential users manage risk in their everyday lives. There is littleevidence available about positive risk-taking, and we need to know more aboutprotective factors, for example, what protects most people, even when they arementally ill, from potentially dangerous situations (Parsloe, 1999). We lack asocial model of risk which takes account of cultural, economic and materialfactors. Finally, but related to these points, a glaring omission from much of theresearch to date are the voices of people using services, those who are perceivedby professionals as being at risk, or as posing a risk to others. The inclusion oftheir perspectives must be a priority for future work.

AcknowledgementsThis review was carried out as part of a wider research programme, funded by theScottish Executive, at the Social Work Research Centre, University of Stirling. I amgrateful to Dr Julie Brownlie, of the Department of Applied Social Science, and to theanonymous reviewers of the article for their helpful comments.

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K I R S T E N S TA L K E R is a senior research fellow at the Social Work ResearchCentre, University of Stirling, where she is responsible for a programme ofresearch in community care. Her main research interests relate to social models ofdisability and user choice and participation. Publications include (with CarolRobinson) Growing Up with Disability (Jessica Kingsley, 1998) andReconceptualisng Work With ‘Carers’: New Directions for Policy and Practice(Jessica Kingsley, 2003); and (with Clare Connors) The Views and Experiences ofDisabled Children and their Siblings: A Positive Outlook (Jessica Kingsley, 2003).Address: Social Work Research Centre, University of Stirling, Stirling FK9 4LA,UK. [email: [email protected]]


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