Operacija B: Analiza tveganja in zmanjševanje škode (operacije 5, tveganje 1)

V socialnem delu gre za spremembe. Ali gre za dejavno spreminjanje, da bi si izboljšali življenje ali pa za prizadevanje, da bi obvladali spremembe, ki nam grozijo – npr. ohranjanje virov, sredstev in prednosti v  prihajajočih prekucijah (npr. pri starosti, bolezni). Spremembe prinašajo tveganja, ta pa s seboj svoje koristi in nevarnosti.

Živimo v spreminjajoči se družbi, družbi tveganj (Beck 2001) in s tem moramo živeti. Nadalje, makro-družbena tveganja - onesnaževanje okolja, naravne katastrofe, podnebne spremembe, politični in vojaški spopadi, ekonomske krize in druga tveganja najbolj prizadenejo revne, obrobne in nemočne dele družbe. Socialno delo je stroka, ki ji je poslanstvo delati z »ranljivimi skupinami«, torej z ljudmi, ki so izpostavljeni družbenim pritiskom v večji meri, in ki se, zaradi svoje življenjske situacije, znajdejo pred intenzivnimi izzivi, ki lahko povzročijo velikanske stiske.

Ob izpostavljenosti družbenim tveganje, ki jih povzroča »družba«, obstajajo še številni drugi primeri, ko se nam življenje spreminja in ko je treba prevzeti tveganje. Dogajajo se nam raznoliki življenjski dogodki, prehodi, krize identitete ali celo povsem banalna, nepričakovana in nepreskušena dogajanja – ne glede na to ali gre za nesreče ali ne – in nam spremenijo potek življenja ali življenjskih rutin.

Življenjski dogodki

Življenjski dogodki so visoko stresni dogodki, ki nam temeljito spremenijo življenjski svet. Taki dogodki nam zvišajo energijsko raven delovanja, hkrati pa nam obrnejo razumevanje vsakdanjega sveta na glavo, spremenijo pomene, vloge in zavezništva. To se ne zgodi zgolj ob neželenih, škodljivih dogodkih, kot so izguba ljubljene osebe, službe, stanovanja, bolezen, ampak tudi ob dogodkih, ki jih doživljamo pozitivno – kot na primer – poroka, rojstvo, nova zaposlitev, nov dom itn. Raziskave so pokazale, da če se nam pripeti več tovrstnih dogodkov v nekem časovnem obdobju, nastopijo posledice duševnega ali telesnega blagostanja (Holmes & Rahe 1967, Nastran Ule 1993, Gallagher 1995: 329–333, Lamovec 1998: 215–220).

Socialno delo po izročilu pogosto zavzema uradno mesto skrbnika, čigar naloga je obvladovati ogroženost ljudi in zagotoviti najboljše možne izide. Je naslov, na katerega se ljudje obrnejo, ko vidijo, da so njihove lastne socialne, osebne in finančne zmožnosti nezadostne, da bi se spopadli s svojo situacijo. Naloga socialnega dela je oceniti stopnjo tveganja in zagotoviti odgovor, dajatev, ki bo zmanjšala tveganje do sprejemljive mere. Tveganje je torej pogosto mera upravičenosti do socialne ali kakšne druge dajatve. Ocena pa je lahko zelo preprosta, kot pri preverjanju materialne ogroženosti s količino dohodkov in premoženja pri denarnih pomočeh ali pa precej zapletena, kot na primer v primeru družinskega nasilja ali česa podobnega.

Hkrati pa v sodobni, kapitalistični (pa tudi verjetno v post-kapitalistični) družbi prevzemanje tveganja oblikuje človekovo identiteto in njega samega. Ljudem je treba omogočiti prevzemanje tveganja (ne zgolj se mu izogibati). Namen in končni cilj analize tveganja je zmanjševanje škode – ali bolje varnost podjetnosti – biti zmožen delati stvari, ne da bi se pri tem izpostavljali prevelikemu, nepotrebnemu ali neželenemu tveganju.

Zato je treba tveganje analizirati, ne le oceniti. Glavno analitično orodje pri tem je v tvegani situaciji razlikovati med grožnjami ter nevarnostmi oz. koristmi (ali celo dobički), hkrati pa že ugotavljati, kakšni ukrepi bi zmanjšali škodo.

Razlikovanje med temi prvinami tveganja je nujno, saj v vsakdanjem življenju okoliščine, ki naredijo neko situacijo tvegano oz. ogrožajočo, združimo z dejanskimi dogodki, ki so nevarni oz. škodljivi. Če je nekdo »psihotičen«, ni nujno, da je nevaren. Statistično nič bolj kot katerikoli drug človek brez take nalepke, a psihotično vedenje uvede določeno nepredvidljivost dejanj. Torej moramo opraviti oceno intenzivnosti (resnosti grožnje) in tega, kakšna je psihotična situacija, ločeno od verjetnosti nevarnega dogodka (in ju šele potem združiti v enačbo tveganja).

Še več, moramo pogledati tudi koristne plati dogodkov in jih pretehtati zoper nevarnosti v situaciji. Korist je namen tveganega vedenja. Nenazadnje pa bi bilo neetično (pa tudi neumno) ocenjevati le tveganje, ne da bi pri tem bili že usmerjeni v zmanjševanje morebitne škode. Pri tem pa ne gre le za iskanje najmanj škodljivega načina, kako priti do koristi, temveč tudi za to, da uporabimo najmanj restriktivne ukrepe, da se izognemo škodi.

Tovrstne ukrepe moramo predvidevati na več točkah ukrepanja: kot način preprečevanja tveganja (ne vozim, ko sem pil), kot način ublažitve nevarnih dogodkov (nositi čelado) in način popravljanja škode (zavarovanje, opravičevanje). Uporabimo lahko več različnih sredstev in načinov zmanjševanja škode: tehnične (javljalci dima, čelade, elektronske naprave), izobraževalne (informiranje, ozaveščanje, učenje spretnosti ipd.), socialne (spremstvo, vsebovanje, mediacija …), pravne (zapisani dogovori, vnaprejšnja navodila, sodne prepovedi …).

Pri analizi tveganja torej: analiziramo situacijo, ugotovimo intenzivnost tveganja, njegovo sprejemljivost in načrtujemo ukrepe zmanjševanja tveganja. Gre za zavarovanje življenjske situaciji in za podporo pri prevzemanju tveganj.

Socialno delo je za spremembe

Socialnega dela ne potrebujemo tam, kjer je treba vzdrževati obstoječe. Kjer obstaja rutina, kjer je treba le izpolnjevati obrazce in jim slepo slediti, kot pravi Bill Jordan (1987), ni potrebe po socialnem delu. Socialno delo potrebujemo tam, kjer je potrebna sprememba, kjer je stiska tako velika, da je ljudje več ne obvladajo, kjer se dogajajo spremembe in jih morajo ljudje bolje preživeti, kjer so se spremembe zgodile in se ljudje morajo naučiti z njimi živeti, ali ko obstaja precejšnja možnost, da bo prišlo do sprememb in se je nanje treba pripraviti, ali pa jih preprečiti.

Reference:

Beck U. (2001) Družba tveganja na poti v neko drugo moderno. Ljubljana: Open Society Institute.

Gallagher, B., J. (1995) The Sociology of Mental Illness. Englewood Cliffs: Prentice Hall.

Holmes, T. H., and Rahe, R. H. "The Social Readjustment Rating Scale." Journal of Psychosomatic Research 11 (1967): 315–328.

Jordan, B. (1987), Counselling, Advocacy and Negotiation. British Journal of Social Work Vol. 17, N. 2 (April 1987): 135-146.

Lamovec T. (1998), Psihosocialna pomoč v duševni stiski, Ljubljana: Visoka šola za socialno delo.

Nastran-Ule, M. (1993), Psihologija vsakdanjega življenja. Ljubljana: Znanstveno in publicistično središče.

Operation B: Risk analysis and harm reduction (operations 5, risk 1)

Social work is about change. It is either actively inducing change to improve one’s life or striving to contain the imminent change, i.e. conserving the person’s assets and benefits in coming perturbations (e.g. old age, illness). The change brings risks – with its benefits and dangers.

We live in a changing and risk society (Beck 1992) and we have to deal with it. Furthermore, macro-social risks, like pollution, natural catastrophes, climate change, political and military conflicts, economic crises and others strike the most the poorer, marginal and powerless segments of the society. Social work is the profession, which deals with “vulnerable groups”, i.e. the people who are exposed to societal stress to a greater degree or who, on the account of their life-situation, find themselves facing intense challenges that can result in massive distress.

Notwithstanding exposure to societal risk, ones produced by the “society”, there is a number of other instances where our life changes and presents risks to be taken. Various life events, passages, identity crises or even quite banal unexpected and unprecedented happening, no matter whether they are mishaps or just ‘haps’, occur in the life-course, affect daily routines.

Life events

Life events are highly stressful events that fundamentally change our Life-World. These events not only heighten the energy levels of functioning but also turn our notions of everyday life upside down, change the meanings, roles and alliances. This happens not only in adverse, undesired events like loss of a dear person, loss of employment, eviction, illness but also in the events that we deem positively, which we desire – like getting married, getting a child, a new job, new home etc. The research has shown that if few such events happen in a certain period (e.g. 6 months) some consequences to mental and physical well-being are very likely to happen (Holmes & Rahe 1967, Nastran Ule 1993, Gallagher 1995: 329–333, Lamovec 1998: 215–220).

Social work is very often (habitually) placed in a statutory position of a guardian whose role is to deal with hazards of people’s lives and to secure the best possible outcomes. It is an instance, to which people can turn to, when they see their own social, personal or financial capacities as insufficient to deal with the risk situation.  The task of social work is to assess the degree of risk and to provide response, provision that would diminish the risk to an acceptable measure. Risk is therefore often a measure of the entitlement to social or other provision. The assessment may be a rather simple one as in testing the means in the case of financial benefits or quite a complex one as in case of family violence and similar.

The risk taking is, however, constituent of person’s identity and self in the contemporary, capitalist society (and probably in post-capitalist too). People should be enabled to take risks (not just avoid them). The finality, the purpose of risk analysis is harm reduction, or better – the security of venture – being able to do things without exposing oneself to exaggerated, unnecessary or unwanted risks.

This is why the risk should be analysed and not just assessed. The main analytical tool is to distinguish in the risk situation the hazards, the dangers (harm) and the benefits (or even profits) of risk taking, and simultaneously consider the measures that would reduce the harm.

Distinguishing these elements of risk is necessary, since the circumstances that make a situation risky or hazardous, are in everyday life often confounded with the actual events that are dangerous. If one is psychotic, he or she is not necessarily dangerous. Statistically speaking on average not any more than any sane person, but psychotic behaviour introduces certain unpredictability of action. Hence, the assessment of the intensity (seriousness of the hazard) and the quality of psychotic situation must be done separately from assessment of the probability of a dangerous event (and combined into a risk formula only subsequently).

Moreover, the favourable events, the benefit of risk taking, and their probability must be taken into account, and be weighed against the odds of the situation. Benefits are the rationale of the risk taking behaviour. Finally, it would be unethical (and even stupid) to assess only the risks without considering the means of reducing the possible harm. It is not only the way of finding out the least harmful way of securing the benefits, but also about using the least constrictive measures to avoid harm.

These should be foreseen on various points of intervention: as means of preventing risk (not driving when drunk), as ways of accommodating the dangerous events (wearing a helmet) and modes of repairing the harm (insurance, making up). Various means of the harm reduction may be used: technical (smoke detectors, helmets, electronic devices), educational (informing, awareness raising, learning skills etc.), social (escorting, containing, mediating …), legal (written agreements, advance directives, court induced restrictions …).

In risk analysis we therefore: analyse the situation, pronounce the intensity of the risk, its acceptability and plan the risk reducing intervention. It is about securing the life situation and providing support in risk taking. 

Social work is producing change.

Social work is not needed to maintain what there is. Where routines are established, where forms have to be filled, where procedures are set and to be followed, Bill Jordan (1987) says, there is no need for social work. Social work is needed where change is necessary, where distress is so great that people cannot cope with it anymore, where change is happening and assistance is needed to fare better through the process, where a change has happened and we have to learn to live with it, or when there is a substantial possibility for a change to occur and we want to get ready for it; or prevent it. 

References:

Ulrich Beck (1992) Risk Society: Towards a New Modernity. New Delhi: Sage. (Translated from the German Risikogesellschaft) 1986.

Gallagher, B.,J. (1995) The Sociology of Mental Illness. Engelwood Cliffs: Prentice Hall.

Holmes, T. H., and Rahe, R. H. "The Social Readjustment Rating Scale." Journal of Psychosomatic Research 11 (1967): 315–328.

Jordan, B. (1987), Counselling, Advocacy and Negotiation. British Journal of Social Work Vol. 17, N. 2 (April 1987): 135-146.

Lamovec T. (1998), Psihosocialna pomoč v duševni stiski, Ljubljana: Visoka šola za socialno delo.

Nastran-Ule, M. (1993), Psihologija vsakdanjega življenja. Ljubljana: Znanstveno in publicistično središče.