Child & Adolescent Risk Assessment

NICE Mental Health Self-harm Guidelines

In Autumn 2022, the National Institute for Care Excellence (NICE) published new guidelines relating to the assessment, management and recurrence prevention of self-harm.

The guidelines stipulated that risk assessment tools and scales (including global risk stratification into low, medium or high risk) should not be used to predict future suicide or self-harm, or determine who should and should not be offered treatment or be discharged – urging health and social care organisations to move towards more person-centred approaches to safety planning for people with mental health needs.

Imosphere welcomed these newly published guidelines – and are in full agreement as to how crucial it is that risk assessments are not used as a means to exclude people from services. We have always believed in the importance of using robust and evidence-based tools to support the process of assessing and managing risk – and that these tools should support good practice rather than be a gatekeeping method for access to services.

Tools and training

Imosphere’s FACE Risk Tools have been used by many health and care organisations across the UK and Ireland for almost 30 years – regularly evolving over this period to reflect changes in best practice and emerging national guidelines. The tools have been designed to use a Structured Professional Judgement (SPJ) approach and, therefore, are in concordance with the Department of Health and Social Care’s requirements for practitioners to use an SPJ approach for assessing and managing clinical risk.

A vital part of the SPJ approach taken by the FACE Risk Tools is the use of a robust “Formulation” for every Risk Profile completed, followed by a Strengths Assessment, consideration of Positive/Therapeutic Risk options, and supported with appropriate Contingency Planning as well as Crisis Planning for known or potential scenario(s) where appropriate.

Approach to risk assessment and compliance

In the training that is delivered by our partner consultants, the problems with using High/Medium/Low or Red/Amber/Green (RAG) ratings for clinical risk are specifically highlighted, and practitioners are actively advised to avoid such approaches. A multidisciplinary team approach to assessing and managing clinical risk is also encouraged within the training, including recommendations that practitioners do not assess and manage risk on their own.

On the subject of ‘scoring’, whilst the FACE Risk Profile tools do each have one section (the ‘Assessment Summary’ completed at the end) which involves numeric scoring, importantly this scoring is not predictive – it is completed at the final stage of filling-in the tool and is intended to very much be a reflection of the individual’s overall, personalised risk assessment and the plan/actions that have already been agreed for them as a result.

The purpose of this scoring (and the reason why it is on the front page despite being the last part of the form that is completed) is to:

(1) Allow for changes in levels of risk which now require a different level of risk-based intervention to be easily identified and measured; and

(2) Allow for quick identification and communication of areas where there is significant risk (for example, a score of 4 in the global risk scores section will enable the reader to quickly see that this is an area which requires proactive and immediate risk management).

In other words, the risk scores are completed at the end of the form to reflect the personalised action plans drawn up (such as the level of support offered and the type of management plan in place), not the other way around.

For these reasons, both Imosphere and our experienced partner consultants are fully confident that the FACE Risk Profile tools are already compliant with the new NICE guidelines – however we decided to apply some minor updates to the tools to ensure that their compliance is sufficiently and immediately clear – as we understand that organisations using the tools will want to be able to demonstrate this.

Firstly – a guidance note has been added to the ‘Current risk status’ section in the Assessment Summary on the first page:

“Important note: The numeric risk scores below must reflect the agreed personalised action plan(s) for the individual (including the level of support offered or the type of management plan in place), rather than the action plan(s) being based on the risk scores. Development of a personalised risk assessment/safety plan must always take precedence.”

Secondly – we have reviewed and updated the guidance document supplied with the Risk Profiles to ensure that it includes the NICE guidance and explains the points made in this article.

The new tools and accompanying materials were released in June 2023 – and licensed customers have been sent the new versions to enable them to upgrade at their earliest opportunity – and demonstrate full compliance with the NICE guidelines.