Pointers for Practice: Eliciting information during the screening and initial evaluation - the challenges

The overview of adult practice reviews, homicide reviews and mental homicide reviews found key issues relating to eliciting information and assessments, these included:

‘The assessments conducted by practitioners tended to focus on particular aspects of behaviour, neglecting others, thereby reducing the overall accuracy of the assessment’.
Some individuals were assessed as at risk (i.e.vulnerable), rather than posing a risk (i.e.harmful).
Tunnel vision meant that a narrative would be constructed and practice would be shaped so as to fit this particular narrative
Focus group participants noted that assessments can be process driven, resulting in them being seen as a ‘tick- box’ exercise (arguably as a result of the impact of Key Performance Indicators). It was agreed that a holistic, ongoing assessment was needed and assessments should be ‘living’ documents. Assessments were considered to be more robust when they were routinely revisited or updated; involved input from and consideration of impacts on the family; and drew upon multi-agency perspectives.’

These issues detract from a person-centred approach. It is important therefore that practitioners are aware of ways in which information can become distorted.

Information being treated discretely.

The focus may be one adult and incident. Can you tell me what you know about the care for Ms Jones at the day centre? This can lead to very specific responses that marginalise other adults who may be at risk. A person giving information may also be selective as to what they share because they may, for example, fear the response of a service provider or over-identify with that provider.

Selective interpretation of information as relevant or irrelevant.

For example, ‘what do you know about Ms Jones? A generalised request for information may be made’. When this occurs, the practitioner providing information is left to decide what is relevant or not.

The rule of optimism.

For example, ‘I just thought I better check this out with you but I’m sure there is nothing to warrant looking at this further’. If the practitioner eliciting information believes that there is no real issue but are following the procedures, they may take a dismissive - nothing to worry - approach which elicits a similar optimistic response from the person supplying the information.

Fixed ideas or overriding beliefs about the situation.

For example, ‘Can you tell us about Ms Jones we know her of old and I’m not surprised we’ve had yet another report about physical abuse from her partner. The practitioner who has taken the report may already have formed an initial view about the concerns and perpetrator. Their tone of voice or the information requested may unintentionally elicit information from others that confirms their opinion.

When these subjective approaches come into play as noted by Robinson et al., (2018)

‘the range of options open to the individual would narrow rather than broaden. Cases could become ‘stuck’; tunnel vision reinforces a particular view of the person, which results in a particular set of options being tried. When these do not work it is rarely the case that practitioners’ step outside of the tunnel to re-evaluate their options.’

For further information see:

Robinson, A, Rees, A and Dehaghani R (2018) Findings from a thematic analysis into adult deaths in Wales: Domestic Homicide Reviews, Adult Practice Reviews and Mental Health Homicide Reviews Cardiff University (Accessed 21/ 7/ 2019)