When clients and practitioners have differing views of risk: Benchmarks for improving assessment and practice

Abstract

The assessment of risk is a top priority within routine counselling and psychotherapy services. However, staff often receive little training in this area. Research suggests that differences between practitioner-rated and client self-report assessments are to be expected and has indicated that the rates of difference can be relatively high (i.e., >50%). However, no national benchmarks have yet been presented which allow both practitioners and services to assess their degree of difference between client- and therapist-ratings of risk. This study uses data drawn from the CORE National Research Database and the risk domain of the CORE-OM (n=25338) to address this issue. Percentage of difference in assessment rates are presented to enable services to compare their rates of difference with those obtained in other services. The CORE-OM risk domain identified 44% of clients as ‘at risk’ while the practitioner assessment identified 10% of clients as being ‘at risk’. For the overall sample, 18% of clients were classified by the practitioner as presenting no risk when the CORE-OM risk domain identified them at risk. There were large variations between services. The practical use and implications of the results presented are discussed by managers of NHS primary care counselling services.

Keywords:

• CORE-OM
• primary care
• assessment
• counselling
• risk
• suicidality

This work was supported by funding from the Artemis Trust and also from the Research and Development Priorities & Needs Levy via Leeds Mental Health Teaching NHS Trust. We would like to thank Tracy Mullin of PTRC and Richard Evans of the CORE System Trust for their constructive input, along with members of Psychological Therapies Research Network North (PsyReNN) for their helpful comments on the benchmarks. We also thank Alex Curtis-Jenkins at COREIMS for his technical input into the data collection process.

Notes

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