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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.


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

Nicola Gray
PO Box 5207
Cardiff CF5 9BR
phone number  02920 874937