Assessing risk in services for people with intellectual disability
| Date | 16 November 2012 |
| Pages | 301-307 |
| Published date | 16 November 2012 |
| DOI | https://doi.org/10.1108/20441281211285946 |
| Author | Evan Yacoub,Richard Latham |
| Subject Matter | Education,Health & social care |
Assessing risk in services for people with
intellectual disability
Evan Yacoub and Richard Latham
Abstract
Purpose – The purpose of this paper is to make recommendations for practitioners on risk assessment
in relation to people with intellectual disability.
Design/methodology/approach – The authors summarise research in the area of risk assessment in
order to recommend a practical approach for practitioners working in the field of intellectual disability
psychiatry.
Findings – Risk assessment for the purpose of predicting risk in an individual is not likely to be of value
in clinical settings. The use of structured clinical judgement does however provide a comprehensive
structure for considering relevantrisk factors, developing an overall formulation relating to a specific risk
and devising a risk management plan.
Research limitations/implications – Much of the evidence is extrapolated from research with people
without an intellectual disability.
Practical implications – The use of structured clinical judgement is advocated as a useful tool for
developing a risk management plan for practitioners working with people with intellectual disability in
secure and community settings. The issues of training and the interface between community and
security settings are explored.
Originality/value – The paper provides more clarity about the use of such tools in this population.
Keywords Intellectual disability, Risk assessment, Community services, Secure, Forensic, Practical,
Learning disabilities, Risk analysis
Paper type General review
Introduction
Risk is the probability that an adverse event occurs within a specified time frame. The
capacity to predict adverse events is challenged on statistical grounds; high rates of
false-positives and high rates of missed cases. Challenges on ethical grounds relate to
these statistical criticisms and include the suggestion of unnecessary and stigmatising
classification of people as high risk.
The majority of risk assessment research relates to the predictive validity of risk assessment
yet there is a paucity of research suggesting that risk assessment has any overall impact on
the occurrence of adverse events. The likely consequence of an adverse event is now a
common component of risk assessment tools – it is not just the risk of violence that is
considered but the severity of that violence and the degree of harm.
This paper focuses on risk of violence or aggression. The adaptation of methods of risk
assessment in general terms to mental health (and intellectual disability) services
specifically is founded on a reasonable premise; that thorough assessment of risk of
violence or aggression and targeted interventions will reduce the incidence of violence.
There is no convincing evidence that this aim is achievable.
DOI 10.1108/20441281211285946 VOL. 6 NO. 6 2012, pp. 301-307, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 301
Evan Yacoub and
Richard Latham are based
at East London Foundation
Trust, London, UK.
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