Risk Management policy
Introduction:
Space 2B You is committed to the promotion of client welfare and the delivery of a high quality and safe clinical service. The purpose of this policy is to detail the arrangements for supporting the identification and management of risk. This includes the roles and responsibilities of all staff across the organisation and outlining the structure and systems that support the promotion of safety.
Staff must be aware of their role in contributing to the delivery of a safe service. There must be a framework for the development of competence and confidence in this role and appropriate support to achieve this.
Scope:
This policy sets out the key responsibilities and arrangements for all staff who have contact with clients (children and adults) during the delivery of services, employed by Space 2B You, in ensuring the safety of individuals we support. Space 2B You is not a crisis support service and works in conjunction with local agencies to provide support. However, it is possible that clients may approach Space 2B You employees if they are concerned about a referred client’s emotional wellbeing specifically in the instance of perceived deterioration in between sessions. Information pertaining to risk may also be disclosed within clinical sessions.
This document provides guidance for all Space 2B You employees and contractors, regardless of role, on how to minimise the likelihood of incurred harm via the process of assessing, responding to and reporting on possible risks.
Definitions:
Child:
A child is defined as “anyone who has not yet reached their 18th birthday. The fact that a child has reached 16 years of age, is living independently or is in further education, is a member of the Armed Forces, is in hospital or in custody in the secure estate, does not change his/her status or entitlements to services or protection. (HM Government 2013).
Risk:
The term ‘risk’ refers to the possibility of incurred harm by potentially self-injurious behaviour but also risk which might be associated with poor impulse control or limited self-regulatory skills. It also includes risks posed to others by the Client. Risks associated with safeguarding are not included within this document (See Space 2B You Safeguarding policy).
Power Diary:
Power is Space 2B You' internal electronic patient record system. All data stored in Power Diary is securely held and maintained by the Space 2B You Technical team. Annual penetration testing is carried out on both internal and external systems to ensure that Space 2B You complies with Cyber Essentials Plus and maintains the highest possible level of security for its clients data.
Duties:
The Risk Management Lead
The Risk Management Lead takes leadership responsibility at for the organisation’s safeguarding arrangements at board, operational and front line arranements;
Space 2B You Staff/Contractors
All members of staff that have contact with clients (children, young people and adults) have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about any aspect of a client’s safety.
Specific details:
Risk Assessment for families starting with Space 2B You
Clinicians should complete the Space 2B You risk screening tool (Appendix 2) in the first session with the referred client and/or their family irrespective of the reason for referral. This should be done collaboratively and saved within the referral record.
For any identified risks, a Level One Risk Assessment should be completed and accompanying Risk Management plan (Appendix 4).
All risk management plans should be reviewed within six months (maximum), following internal referral between Space 2B You services and when the identified Risk has changed.
Families should be advised, in Session 1, what to do if they are concerned about the wellbeing of the referred client at any time.
What to do if you are concerned about the safety of any client during a clinical session
There are resources available to staff to provide support or further information, should they have a concern about a child, young person, or adult at risk. Space 2B You clinicians can discuss their concerns with their Clinical Supervisor, Line Manager or Clinical Lead.
As a minimum requirement, if risk is disclosed during a session Space 2B You clinicians should:
1) Complete a clinical risk assessment (Risk Assessment Level One, Appendix 4) to ascertain the likelihood and severity of possible harm.
This includes asking about the nature and frequency of the behaviour which may cause harm, any protective factors and known strategies/ safety measures. For expressed suicidal ideation it includes attempting to ascertain whether the person has a plan or suicidal intent.
The clinician should explain their duty of care to keep the child or adult at risk safe and the necessity to share the disclosed information. Young people and adults at risk, as much as possible, should be invited to contribute to information sharing e.g. with family member/carer.
Clinicians should NOT assume that family/carers know about self-injurious behaviour or suicidal intent simply because the client says so.
N.B. Clinicians have a responsibility to make parents/carers aware if risks are identified for a child or young person under 18 years of age. However, this should be handled sensitively to preserve therapeutic relationship as much as possible.
If a young person or adult at risk is perceived as being at risk of immediate harm the clinician must stop the session and support the family to access emergency services (999/A&E).
For non-immediate harm, e.g. superficial self-injurious behaviour, the clinician, referred client and/or family/carers should develop a risk management plan which should be sensitively communicated on ‘need to know’ basis.
2) Risk management plans should include details of the risks, agreed strategies and crisis support plan. A risk management plan should reflect the local risk protocol from the referring team.
Not all mental health teams will have out of hours support and family should be signposted to A&E/999 during a crisis.
For non-urgent concerns families or clinicians may contact the local mental health team and ask to speak to the duty worker.
3) Recording risk
Information pertaining to the risk behaviour and associated management plan should be recorded within the session summary. This is automatically sent to the client and referring mental health team so should be written collaboratively and sensitively. It should provide a detailed description of any held discussion and agreed plan.
As sessions are recorded on Power Diary, they will be available to be viewed by the clinician to support them in documentation of Risk. Clinician and manager dashboards indicate when risk management actions are at risk of not meeting or have exceeded expected timescales.
4) Communicating risk
It is the clinicians’ responsibility to ensure risk information is handed over to the local mental health team via a courtesy call to the referring team and asking to speak to either the referred client’s lead practitioner, the team manager, or duty worker. This ensures timely handover of information to enable health records to be updated. Any additional input from the local mental health service, e.g. Psychiatry review will need to be negotiated via telephone consultation with the local team.
Clinicians should contact their supervisor, Team Manager or Clinical Lead at any point during this process for guidance and/or support.
N.B. if a client leaves the session without warning the clinician should follow the same process as in this section, keep the session open so you can continue to update the documentation. The clinician should contact the client by phone to continue the assessment and ensure a plan is in place to manage any risks identified. If the clinician is concerned about the welfare of the client and unable to contact the client the clinician has a duty of care to inform the relevant people. The clinician should then contact the family/carers and discuss the risks identified and agree a management plan. Risk guidance as above.
What to do if you are concerned about the safety of a young person or adult at risk outside of a clinical session
A parent, family member or carer may contact Space 2B You by telephone or email with concerns about a perceived deterioration in a referred client’s emotional wellbeing. In these instances, the first point of contact is likely to be a member of the office team rather than a clinician. Non-clinicians are not expected to complete comprehensive risk assessments or advise on risk management strategies but do have a role in capturing information pertaining to risk, notifying the appropriate staff and signposting families to the relevant local agency.
1) Gather information
During the telephone conversation, or follow-up call, explain to them that you need to know more about their concerns so that you can notify the appropriate person and ensure everyone’s safety. The aim of this conversation is to try to ascertain whether anyone is at risk of IMMEDIATE harm. If YES then confirm the current location of the person at risk and call 999.
If NO immediate risk: ask for more information about:
Open a contact record and click YES for risk identified, complete the details of concern / what happened / when / outcome - has anyone been hurt? history? is it a new behaviour, who else is aware? Does the environment need to be changed immediately? e.g. reducing access to sharp objects. Please see Appendix 2
This information should be recorded on the Space 2B You Risk Reporting form within a contact record.
Explain that you will share this information with the clinical team who will be in contact with them.
2) Advise
If a family member/carer is worried their child, young person or adult at risk might do something to hurt themselves or someone else then they should contact emergency services/ use A&E as Space 2B You is unable to provide a crisis service.
For non-immediate risks the family should contact their local mental health team and ask to speak to the duty worker. Space 2B You cannot agree to bring scheduled appointments forward in light of new information about risk.
3) Report
Complete a Risk Capture form (Appendix 2) on Panacea and make an entry in the client record under Contacts marked ‘Risk’. Please also alert the allocated clinician and the Team Manager / Risk Lead Manager via telephone that a new risk has been recorded to ensure timely handover of information.
For clinicians receiving information pertaining to risk outside of a session e.g. via email, follow process of risk assessment, risk management planning, recording and communicating concerns. Ensure this is captured on a Risk reporting form. Telephone conversations should be followed up with an email summarising the discussion and agreed actions. This should be emailed to the referred client and their connected family/carers, added to the referral record and marked as ‘risk’. It should be sent securely to the referring mental health team via NHS.Net.
4) Recording risk
Information pertaining to the risk behaviour and associated management plan should be recorded within a contact record. Open a contact record and click YES for risk identified, complete the details of concern / what happened / when / outcome. Explore whether anyone been hurt, history, is it a new behaviour, who else is aware? Document agreed management plan. Please complete risk capture form Appendix 2
Record keeping and documentation
All information relating to risk detection and reporting should be captured on Space 2B You’ approved client record management system and in accordance with the Space 2B You Information Governance Policy.
Protecting staff/ Family expectations
It is important that families are aware that Space 2B You works in partnership with their local referring mental health team and whilst providing a clinical service, cannot provide crisis support. Clinicians and office staff should ensure use of an Out of Office / automated reply message which includes guidance around risk / deterioration.
Training
All staff who may have contact with children as part of their work require a certain level of training to ensure they are competent in filling their duties and responsibilities.
In addition to Level 3 Safeguarding training, regular refresher training on responding to risk in line with Space 2B You’ policies and procedures will be provided by the Space 2B You management team on a yearly basis, any additional training needs should be identified and discussed during supervision.
Dissemination and Implementation:
All Staff members will be required to sign to say they have read and understand the Risk Management Policy and will be expected to complete periodic assessments of understanding of Space 2B You policies and procedures relating to Risk. Any additional support would be identified as part of supervision and an agreed plan would then be put into place to action the identified need.
Any updated to the Risk Management Policy will be disseminated through team/line managers to all staff.
Risk management and Safeguarding policies and contact details can be found in Space 2B You google drive.
Policy Governance:
The Directors of Space 2B You are responsible for the full implementation of this policy.
Review and Revision:
This policy will be reviewed as it is deemed appropriate, but no less frequently than every 12 months.
Information Governance:
Personal identifying Information for both clients and staff is confidential and must not be disclosed to unauthorised persons and will continue in perpetuity. This is a legal obligation; therefore, any breaches of personal confidential information or data may result in prosecution and/or an action for civil damages under the General Data Protection Regulations 2018.
Disciplinary Actions:
Breach of this Code of Conduct may result in disciplinary action.
Contact Details:
If staff members are concerned that there has been a breach of this Code of Conduct, they must inform Space 2B You directors Marie-Anne McKee and Alison Joyce.
Telephone:
020 3048 3331 (ext. 301)
Email:
barbara.johnston@space2byou.co.uk
marie-anne.mckee@space2byou.co.uk