Personalisation and risk of harm
Might personalisation through self-directed support pose risk of harm to children? The answer to that question is, of course, a complicated one. It depends...on the child, on the family, on the community, and getting the right 'balance' between risk of harm and choice and control. Some areas of tension in that delicate balance are that:
- Children and parents may have different views about what might be unsafe or, indeed, 'beneficial' for a child.
- Most parents act in the best interests of children, but some, sometimes, do not. This could be for a range of reasons (e.g. mental health problems, physical illness). These kinds of difficulties, as well as problems such as unemployment and poverty, may compromise a parent's ability to, for example, take responsibility for making decisions about how to spend an individual budget to support their child.
- It is sometimes hard to separate out what is 'good' for a family and what is 'good' for a child. Supporting a child has potential benefits for the whole family, but there is a risk that a child's individual needs could become submerged when the family is the main focus for support - especially if different family members have conflicting needs.
And of course when we are thinking about risk, we also have to think about the risks of keeping the status quo - of not enabling people to benefit from taking greater control of and choice over their decision-making.
The next activity explores the question of risk of harm from the perspective of family members and paid carers, and asks how we can minimise the potential for harm.
Activity 4.5 Responding to risk of harm to children and young people
This activity provides an opportunity to consider how families and service providers, such as personal assistants, can respond to the potential for risk of harm when personalised services, such as self-directed support, are being discussed and provided. First, you will hear the parents of a young man, Cameron, who has autism, discussing questions about risk. Then you will hear one of Cameron's personal assistants, Kayleigh, who works for the organisation, Enable, explaining her role with Cameron in relation to risk assessment and management. After you have listened to the podcasts use your learning log to answer the following questions:
- What do Cameron's parents and his personal assistant have to say about responding to risk of harm?
- Do you think that personalisation through self-directed support increases or decreases the potential for risk of harm to children and young people?
Transcript: Mr and Mrs McKendrick
You have heard Cameron's parents and Kayleigh speaking about a number of ways of minimising possible risk. His mother, Betsy McKendrick refers to the importance of discussing possible risks with Cameron so that he can identify hazards for himself and understand the reasons for minimising some kinds of risks. However, his parents also emphasise the importance of Cameron having control over his life and, sometimes, of experiencing potentially risky situations so that he learns how to respond to danger. Assessing and managing risk is central to Kayleigh's work with Cameron but she also stresses that Enable, the organisation that she works for, aims to do everything they can to allow Cameron to do the things that matter to him. Kayleigh's work with Cameron, and the family's decision making about risk, is informed by an outcomes based approach ( Section 3 ).
Cameron's agreed outcomes provide a framework for identifying and managing risk, but, as Kayleigh explains, it is also important for the support provided to be as flexible and as responsive to changing circumstances as possible. In Control has argued that personalisation initiatives such as self-directed support can minimise the risk of harm and maximise opportunities for children and families to lead active, enjoyable and exciting lives. In Control suggests that:
- Self-directed support promotes participation and visibility in communities: this helps to protect children against harm, and means that communities play an increasing role in safeguarding their children.
- Drawing on the ' real wealth ' (or assets : see Section 2 ) of children and people close to them enables the development of a solution-focused approach to risk that meets the needs of the child as an individual.
- Vetting (e.g. of personal assistant s) and oversight of support arrangements for children (e.g. by social workers, nurses, teachers) are necessary elements of a comprehensive and positive approach to keeping children safe.
There is always likely to be tension between harm and benefit in any course of action we take. The difficult task for those involved in health, education, social care and other services, as users and/or providers of services, is finding the right balance between the two. This involves thinking about ways of reducing the likelihood of harm while not disproportionately impacting on personal choice. This is sometimes described as 'proportionality': weighing up the potential outcomes in terms of harms and benefits is a feature of many decisions. Practitioners are required to adhere to codes of practice in this respect. For example, social service workers are required to:
Promote the independence of service users while protecting them as far as possible from harm(SSSC Codes of Practice, 2009)