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Vivienne Riches & Friederike GadowCentre for Disability Studies

50th Annual ASID ConferenceMaking it real together!

11-13th November 2015Crown Promenade Conference Centre, Southbank Melbourne

PERSON CENTRED CLINICAL RISK“Putting The Person First”

• Develop a PC clinical risk assessment Practice Guide

• For Behaviour Support clinicians and staff• To support vulnerable people with ID &

complex needs

AIMS …

To laugh is to risk appearing a fool,To weep is to risk appearing sentimental.To reach out to another is to risk involvement,To expose feelings is to risk exposing your true self.To place your ideas and dreams before a crowd is to risk their loss.To love is to risk not being loved in return,To live is to risk dying,To hope is to risk despair,To try is to risk failure.But risks must be taken because the greatest hazard in life is to risk nothing.The person who risks nothing, does nothing, has nothing, is nothing.He may avoid suffering and sorrow,But he cannot learn, feel, change, grow or live.Chained by his servitude he is a slave who has forfeited all freedom.Only a person who risks is free.The pessimist complains about the wind;The optimist expects it to change;And the realist adjusts the sails. By William Arthur Ward

The greatest hazard in life is to risk nothing

Overview: who is it for…

Target group Targeted

• People with Disability • Behaviour support clinicians

• Other specialised staff

• Review of contemporary research literature & resources– Person centredness– Safeguarding, risk assessment management– Clinical risk assessment

• Identification of key principles• Development of step-by-step assessment

process

METHOD…

Why did we develop the practice guide

Risk Assessment &

ManagementRisk Assessment

& Enablement

Person Centredness

Principles of person centred risk assessment

• Person centredness

• Sensible risk management

• Risk enablement culture

• Use of a multiple disciplinary approach

• Limiting and prioritising information

• Understanding the persons capacity to make decisions

Risk Assessment: A person centred approach

• Balanced approach

• Assumptions relate to happiness as much as safety

• Considers both risk and protective factors

• Considers risk management in a safeguarding framework

• Improves the basic system of risk management contained in the International Risk Management Standard

Risk Assessment: A person centred approach

“In the person centred context risk assessment focuses on expanding the choice and control people have in their

life, and [enable] people to try new things and develop their skills and competences”

(Methven 2012, p. 244).

The process (adapted from Sanderson & Lewis, 2012)

(5) Action PlanWhat shall we

do next?(2) Status QuoWhere are we

now?(3) Goals &

DreamsWhere do we want to be?

(1) The PersonWhat is important to and important for the person?

(4) HistoryWhat have we

tried and learned?

RISK ENABLEMENT CULTUREOrganisational Commitment: Statement of Intent

Existing and/or specialised tools that can assist in the process

PERSON CENTRED THINKING

MONITOR – REVIEW – EVALUATE

(1) The PersonWhat is important to and important for the person?

important to/for toolone page profilerelationship circle

(2) Status QuoWhere are we now?

working/not working happy/safe griddecision making agreement

(3) Goals & DreamsWhere do we want to be?

Success looks like...

(4) HistoryWhat have we tried and learned?

4+1 questions consequences of not taking the risk

(5) Action PlanWhat shall we do next?

blue sky thinking happy/safe griddecision making agreement agreed support strategies

Person centred risk assessment tools (Helen Sanderson Associates, 2007)

Graphics retrieved from http://www.helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/

Graphics retrieved from http://www.helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/

Graphics retrieved from http://www.helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/

Graphics retrieved from http://www.helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/

• Risk and protective factors considered• Begins by identifying what matters to the

person• Solution focused perspective to risk• Specialised forensic and/or mental health

assessments

Additional resources

• Sample report template• Forensic clinical risk assessment instruments• Mental health risk assessment instruments• Person centred tools

Conclusions

• A risk enablement culture supports staff in facilitating positive risk taking

• It focuses on expanding the choice and control vulnerable people have in their life

• Enables them to try new things and live a life of quality

ReferencesAgeing, Disability and Home Care (2007). Clinical Risk Assessment. Practice guide paper for

clinicians working in DADHC disability services. Ageing, Disability and Home Care (2012). Behaviour Support Policy. Version 4.0.

Department of Family and Community Services NSW. Retrieved from http://www.adhc.nsw.gov.au/__data/assets/file/0007/228364/Behaviour_Support_Policy_March2012_updated.pdf

Gadow, F., & Riches, V. (2014). Practice Guide to Person Centred Clinical Risk Assessment. Prepared for NSW Department of Family & Community Services, Ageing, Disability and Home Care. Centre for Disability Studies, University of Sydney.

Person-centred Thinking Tools. (n.d.). Retrieved November 3, 2015, from http://www.helensandersonassociates.co.uk/person-centred-practice/person-centred-thinking-tools/

Methven, S. (2012). Enabling risk. In: S. Stirk, S. & H. Sanderson, (Eds.), Creating person-centred organisations: Strategies and tools for managing change in health, social care and the voluntary sector (240-256). London: Jessica Kingsley Publishers.

Sanderson, H., & Lewis, J. (2012). A Practical Guide to Delivering Personalisation: Person-Centred Practice in Health and Social Care. Jessica Kingsley Publishers.