Part 4: Putting it into Practice – Enabling Positive Risk Taking

Positive risk taking relies heavily on a strengths-based approach.  This means we need to see people in terms of their strengths, their personal qualities, abilities, capabilities, desires, motivations and wishes.  This requires drawing on their past as well as their current situation, and future priorities.  It is ultimately about enabling people to live with as much dignity as possible.  Understanding that their identity is ‘who they are ‘and ‘what they can do’, NOT ‘what they are’ and ‘what they can no longer do’. 

A shared decision-making approach to positive risk taking should be:

• Balanced – recognizing the potential benefit as well as risk of harm.
• Defensible – well-founded, justifiable and recorded proportionately, and not driven by the need to protect ourselves and our agencies.
• Collaborative – with the person, their families and other professionals, to achieve outcomes that matter most to people.

How can we enable Positive Risk Taking? 

Being proactive in terms of risk management is essential to avoid an overly cautious, or risk averse approach compared to a defensible decision.  A defensible decision is one where:

• All reasonable steps have been taken to avoid harm
• A person’s mental capacity has been taken into consideration
• Reliable assessment methods have been used and information has been thoroughly evaluated
• Decisions are recorded succinctly and in line with organisational policy, with all related actions and outcomes communicated to all parties
• Practitioners and their managers adopt an approach that is proactive, investigative, and holistic
• All appropriate services are arranged to mitigate identified risk and meet the assessed needs of the individual concerned.
• Any occurrence of a risk event will lead to a review of the plan in relation that risk
• Policies and procedures have been followed and due adherence to statute, government and professional guidance is maintained. 

Positive Risk Taking Requires:

• Helping people, and the others around them, to weigh up the pros and cons of their choices in a particular decision.  Do the benefits outweigh the risks for one choice rather than another?
• Everyone reasonably affected by the decision to be involved, in varying capacities.
• Information and detailed thinking throughout, with a plan to manage the likely risks of any option that is chosen.
• Clear knowledge of the person’s abilities and understanding of the risks.
• Understanding of the benefits in terms of positive outcomes from the specific risk.
• A good plan, with support in place so that the person taking a risk feels as safe as possible.
• Anticipation of how things could go wrong, with a reasonable contingency plan in place.

Things will occasionally go wrong.  All of us – family, friends, services and media need to acknowledge that this happens in all of our lives.  Fear and blame are not helpful, particularly if the original decision and subsequent actions were reasonable.

Meaningful Care Matters has developed a Risk Framework Tool for People with Impaired Decision-Making Capacity.  This is a good practice guide, using evidence from research on risk and ideas about current best practice and is subject to further review.  It is based on identifying and balancing the positive benefits of taking risks against the risks of an adverse event occurring.  This framework starts by looking at the benefits for people of doing an activity, and then looks at the risks involved.  It also explores the emotional consequences of people not being permitted to do the things which bring love, comfort and joy into their lives.  In this way, the best results for the person with impaired decision making will be achieved.  It is the responsibility of any services or individuals to ensure they meet both statutory and organisational requirements. 

In the next and final section we put what we have learnt into practice through examining 2 case scenarios.  Here you will have an opportunity to use MCM’s Risk Framework Tool and debrief your findings.  Take some time now to read and respond to the case scenarios and debriefing questions included with this package.