IRAMP
Research type
Research Study
Full title
IRAMP: Investigating risk assessment and management processes
IRAS ID
215889
Contact name
Brian Gillatt
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde
Duration of Study in the UK
2 years, 11 months, 29 days
Research summary
Summary of Research: This study aims to investigate risk assessment and management processes across a health board in the context of the implementation of a new risk screening tool and risk policy. This is a mixed method study adopting qualitative measures of observations and focus groups to investigate how multi-disciplinary teams discuss and make decisions related to risk. In addition various baseline and follow-up measures will be taken pre and post the implementation of a new risk screening tool (the ‘Clinical Risk Assessment Framework for Teams’, or ‘CRAFT’) in NHSGG&C Mental Health Services.
Summary of results: The IRAMP study sought to understand how risk assessment tools were used by mental health clinical teams across one health board area. Overall the study found, primarily from direct observation of clinical team meetings, that risk was being discussed and assessed appropriately. Team discussions focussed on a variety of risks ranging from risk of suicide, harm to others, social disadvantage and risk of absconding.
However from across the range of observations the study found the CRAFT risk assessment tool (the standard risk tool recommended by the Health Board) did not inform decision making around risk management. The staff survey showed only 12% of staff consulted the CRAFT risk tool at every patient contact, and 35% of staff found the CRAFT aided decision making, with 43% of staff suggesting it aided decision making ‘sometimes’.
Open text questions in the staff survey provided more detail on the approach to risk assessment, with respondents reporting the tool was ‘non evidence based’, ‘not helpful and does not aid decision making’ and that it was ‘lengthy, repetitive’.
Focus groups with staff highlighted risk assessment is a dynamic, ongoing process and a complex issue where risks are hard to define in a mental health population. The staff group did report the CRAFT could be used to support communication between teams but also felt it lacked clinical utility.
From the staff survey, focus groups and case note audit patients were not always involved in risk assessment discussions, the staff survey showing only 46% of staff consulted the patient ‘most of the time’ or ‘always’. Family and carers were much more rarely consulted, with respondents to the staff survey suggesting family or carers were consulted ‘seldom’ or ‘never’ 75% of the time.
In the carer focus group this theme was echoed with carers stating they were ‘not aware of having seen risk assessment reports’, or they ‘don’t feel listened to’.The study concluded that risk is being discussed and managed appropriately by clinical teams, although the risk tool is not being used to inform decisions about risk, or to involve service users and carers in discussions about risk.
This poses challenges for risk research as there is a need to have a high quality risk tool that can be used by busy clinical teams which allows for discussion about risk with service users and carers in a way that is meaningful.REC name
South Central - Hampshire A Research Ethics Committee
REC reference
17/SC/0214
Date of REC Opinion
11 May 2017
REC opinion
Further Information Favourable Opinion