Social Care, Risk, COVID and True Uncertainty

The understanding and assessment of risk for social workers is as important as it is challenging.

The current COVID pandemic has brought risk into the public spotlight with social care (and everyone else) facing an array of risk-based judgment calls.

One example from my Connected Carers team is should the children of a 70 year old carer (with underlying conditions) continue to go to school; is it better to harm their education or harm the health of their main carer, what is the probability risk of these outcomes? What is their severity?

Stephen Webb offers a theoretical ladder to climb up with his adoption of the concept of irreducible uncertainty.

This is the acceptance that the risk of a certain outcome will carry with it a level of probability that can’t be assessed, can’t be worked on and that will stubbornly remain regardless of our approach and level of intervention.

“No one can say with certainty whether child abuse will occur, when it will occur (if it does), to what extent it will occur (if it does) or whether it is likely to happen again (if it did occur). Nor is there agreement on the degree of uncertainty involved in child abuse cases. These kinds of uncertainty will remain whatever mode of organisation is undertaken in child protection at a national level”
Stephen Webb (Decision making in social work Lecture (2014).

Importantly this unknown element is not in of its self-bad or dangerous it is just a representation of human complexity and the work we do as social workers.

A basic but useful definition would be

Risk = Assessed/measured uncertainty of a future outcome

Irreducible uncertainty = Risk that can’t be measured or quantified

To give another COVID example – we know many risk factors, age, weight, job role, post code, diabetes, racial background. Crucially thou we cannot say with certainty who will get it, who will die if they get, or, inversely, who wont and who will only have mild symptoms.

However, from a risk perspective it is valid to talk about the risk to 90-year olds being a 1 % chance of death and the risk for under 20’s being 1 in 10,000. This immense range is further confused by media reporting the shocking and very sad tiny number of cases of children who have died, it becomes part of our consciousness, so we feel it is more likely than it is.

A social care example would be cases likely Baby P or Victoria Climbe which have led a sea change in child protection. But their story is only representative of an absolutely tiny percentage of all cases open to social care.  The point being that considering the most extreme forms of child death and torture are not useful when supporting families that are struggling with parenting, ADHD or poor standards of physical care. Undoubtedly fear of a terrible outcome will always be part of human nature and we have to be aware of this in our practice, to quote her Majesties professor of risk Dr Speigelhalther

“I am as prone to irrational statistical judgements as anybody else”

The messages for practice I feel are,

  • A risk assessment does not cover all the picture some of which cannot be quantified through social work intervention.
  • Using extremes as a measuring tool is not useful and can skew practice towards defensive decision making
  • Whilst we fear the worst-case scenario, we must be aware of how this can alter thinking and allow ourselves as professionals to develop an accurate, case specific judgement, on future outcomes.

George Bull

George is a Social Worker at the Connected Carers Team South Tyneside. He has been a social worker for 10 years working mainly in child protection and Early Help. He has lectured with Jamie Scorer at New College Durham, University of Sunderland and University of Northumbria in solution focused practice.

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