10. Asking difficult questions
and how to conduct a clinical and risk
formulation
Most qualified clinical and social care staff
have received little, if any, training on how to
complete risk assessments, risk formulations, or
risk management plans.
This discrepancy between a lack of training in
the risk assessment process, alongside the fact
that risk assessment is now perceived as a
central clinical skill for all staff, often
causes anxiety in staff and consequential
avoidance (or the lack of full commitment and
engagement) in the task of assessing and
managing risk.
There has frequently been an over-reliance on
‘paperwork’ (i.e. non-evidenced based risk
assessment tools that utilise simple tick-box
systems) as a way of managing this professional
anxiety. However, such tools do not bring about
effective risk assessment in the absence of good
clinical skills and, sometimes, actually prevent
the clinician thinking about issues in a
systematic manner and applying best practice.
The ‘difficult questions’ course aims to
· remedy the lack of skill-based
training that is currently present.
· improve basic clinical skills in risk
assessment and risk management and to train
clinicians how to complete a risk formulation
(which then directly feeds into a risk
management plan).
The course targets:
(a) the ability to ask the appropriate clinical
questions relating to risk issues and gather
sensitive information; and
(b) skills at clinical and risk formulation once
clinical information had been collected, which
should then link into risk management plans.
These clinical skills are seen as a foundation
for structured clinical risk assessment across
all levels of risk.
The ‘difficult questions’ course has the aim of
improving risk assessment, risk formulation and
risk management skills as broadly defined and is
relevant to a wide-range of risk areas
(including suicide, violence, sexual violence,
self-neglect, exploitation).
Thus the course covers both information relevant
to Unified Assessment as well as CPA and to
multi-disciplinary care plans. Specific efforts
have been made to ensure that the ‘difficult
questions’ course is relevant to a wide-range of
service-user populations (including Older Adults
and Learning Disabilities) and WARRN has
consulted with staff working in these areas to
ensure that the course materials are relevant to
these populations, as well as to General Adult
services.
Certain NHS Trusts and Local Authorities have
undertaken to train all their qualified clinical
staff on the ‘difficult questions and risk
formulation’ training course in order to improve
basic clinical skills in risk assessment and
risk management.
This training is frequently offered jointly to
NHS staff and staff from their associated Local
Authorities. The advantage of this joint
training across methods of risk assessment, risk
formulation and risk management is that it aids
understanding and communication of risk issues
both within and across these organisations.
Fees
Thanks to the sponsorship of the Welsh Assembly
Government we are able to offer these courses at
discount prices for those working within Welsh
Institutions
Full course - 2 day £300 per person (£400 for
those in Non-Welsh Institutions)
Lunch and refreshments are provided.
Further information and discussion of training
needs can be sought from
Charlotte Cox
WARRN
PO Box 5207
Cardiff CF5 9BR
phone number 029 20556300, ext 2149
email: -email-
