Safeguarding in research – expect the unexpected
Emma Brooks, Chloe Chessell, Emily Davey, Emily Day, Hannah Marcham, Zoe Ryan and Chloe Williams are researchers at the University of Oxford and Oxford Health NHS Foundation Trust in The Oxford Psychological Interventions for Children and adolescents (TOPIC) Research Group. Here, they share experiences working on a National Institute for Health Research (NIHR) funded study called identifying Child Anxiety Through Schools (iCATS).
12 July 2021
Sometimes in research, we encounter situations which are unexpected and where risk is uncovered. The British Psychological Society (BPS) guidance on safeguarding children and young people (2018) and BPS Code of Human Research Ethics (2nd edition, 2014) are extremely thorough, practical and provide many recommendations for psychologists at all levels of seniority. The guidance includes an awareness of risk factors and how psychologists can assess and manage risk within their work.
In this article we discuss our reflections of assessing and managing risk within the context of a research study and also share some tips, which we hope will be useful for other early career researchers.
Our research involved conducting hundreds of questionnaires and semi-structured diagnostic interviews using the Anxiety Disorders Interview Schedule for Children (ADIS) with primary school aged children and their parents/carers, asking questions about fears, worries and low mood. We recruited families with children who were experiencing anxiety symptoms, as well as those who were not. During this study we encountered many occasions in which safeguarding concerns arose or risk information was shared with us.
Encountering risk in research
Some children have experienced trauma, domestic violence, neglect, or bereavement in their lives; and some have thoughts of harming themselves or others. Whilst we did not explicitly ask questions related to these experiences when administering questionnaires or conducting diagnostic assessments, conversations of this nature could arise in unexpected situations. We had to be sharp in our probing and decision-making skills, to establish how to assess risk appropriately and act quickly.
Managing risk appropriately is a big responsibility; we worry about the families and if something were to happen, it could leave us feeling at fault. As our project was research-focused rather than clinical, we did not provide long-term care. This could feel difficult when stepping away from families, particularly if they could benefit from mental health or other support. All of this sometimes left us feeling emotionally fatigued and troubled. There were times when it was difficult to know where the boundaries were, between collecting enough information to ensure the individual is safe and going beyond what is appropriate in a research context. It was critical to have clear protocols for managing risk and a supportive team to discuss concerns.
Scenario 1: Whilst helping a young child complete a questionnaire, the researcher noticed the child had written that they are often left at home alone with their younger sibling.
In this scenario, we need to follow protocols for good risk management to ensure the potential risk was documented and communicated with appropriate individuals.
Protocols of good risk management
All researchers should expect some level of risk and be prepared to manage this. A detailed risk protocol can greatly increase researcher confidence when risk arises. A protocol for managing risk needs to contain project-specific guidance, and staff need to be trained in this protocol before any research takes place. The protocol should reiterate the need to discuss the limits of confidentiality with the individual before any conversations where risk/safeguarding issues might come up. It should also outline what information needs to be gathered, including examples of follow-up questions to ensure that there is enough clarity about the risk.
Examples of what a risk protocol might include:
- Explain the limits of confidentiality and the potential need to share information with other professionals (i.e. parent, teacher, GP)
- Record a description of risk
- Explore triggers (i.e. what makes it happen?)
- Ascertain timing and frequency (When did it first happen? How often? How long does it happen for?)
- Identify whether there is existing involvement of a professional. If so, who/when/what action was taken? (i.e. Teacher, GP, Social Worker)
- Who to contact in the event of risk disclosure and who makes decisions on next steps (i.e. the Research Assistant completes a risk form for the supervisor, who decides if/how this risk needs to be disclosed to anyone outside of the project)
Scenario 2: The researcher is interviewing children in school, and a child has shared with them that being in school makes them think about ways to harm themselves. The researcher now has to return them to class.
It is important to have guidance within the protocol for when a child discloses serious risk and it feels inappropriate for them to return to class straight away. For such situations, having a small activity (e.g. a game or colouring, depending on their age) available can help to ease the transition back to their school day or to keep the child occupied until a member of school staff becomes available.
Scenario 3: Whilst taking part in research at school, a child discloses to the researcher that they are worried about their school friend who said that they want to run away from home because their sibling hurts them. Their friend is not taking part in this project.
There are advantages to being in a school setting when a child discloses risk information, as we are able to quickly pass on relevant information to a school safeguarding lead (or other staff member), regardless of whether or not the child is taking part in the research project. As mentioned in the BPS Safeguarding Children and Young People (2018) guidance, psychologists and researchers should be aware of the robust safeguarding policies schools have in place to ensure the wellbeing of their pupils.
However, there are some potential difficulties when sharing risk with schools as each school can manage risk differently, particularly with their safeguarding and risk logging procedures. When we communicated risk with some schools, it sometimes involved simply passing on information via a conversation with a staff member, whilst other schools required safeguarding documents to be written and signed. We felt reassured that information was being taken seriously when asked to log and sign safeguarding forms, and when schools asked follow-up questions to ensure they had not missed any information.
Going forwards, we recommend a formal risk procedure to schools as a matter of course. If schools have an alternative procedure, we are happy to follow it as long as we are comfortable that the risk is being documented appropriately.
Scenario 4: A parent discloses deeply traumatic historical risk to a researcher who is new to conducting diagnostic interviews. The researcher completes the risk form and continues with the interview. Once the interview finishes, the researcher speaks to their supervisor and realises that the particular circumstances mean that they need to call the parent back to advise them that we need to disclose this information. Although the parent had provided consent, they do not seem happy.
As researchers, we need to observe the boundaries of informed consent and ask ourselves ‘what have families consented to?’. It is important to balance acquiring sufficient risk information to protect individuals from harm, with ensuring this does not exceed the limits of informed consent. The boundaries of confidentiality and situations where risk information would need to be disclosed to other relevant individuals (e.g. school or GP) should be made clear to participants before taking part in the project.
Despite being informed and agreeing to research confidentiality, some families understandably felt uncomfortable or nervous that shared risk might be passed on to other relevant individuals (e.g. school staff, GP). This was a challenging conversation to have, and required sensitive handling. Supervisors are integral for helping researchers in these situations. We always aimed to approach families in a gentle, non-confrontational way, explaining that we were passing on relevant information to people who were in a position to support them in getting the help they needed.
When a child disclosed risk, we always aimed to keep parents/guardians closely informed, especially when we needed to share our reports with other relevant professionals (e.g. the GP or social worker). When we were unable to contact families immediately, we passed risk information on to a relevant member of school staff (e.g. safeguarding lead), as schools have a duty of care for their pupils and need to know if a child is at risk.
Teamwork, supervision and self-reflection
We were lucky enough to be in a superb project team, with a small army of assessors and an amazing supervisor. When risk occurred, we could always immediately contact our supervisor to discuss the case. She was kind, patient, thorough, asked sensible questions and was always clear about the next steps and plan of action. Throughout the project, clinical supervision gave the research team the opportunity to discuss risk and reflect on any learning points, in line with the BPS Safeguarding Children and Young People (2018) recommendations.
Peer-based support through colleagues was invaluable. If we dealt with a particularly tricky case, someone was always available for a chat. However, following lockdown and the nationwide closure of schools, both child and parent assessments were completed from home. Although we agreed there were some advantages to a telephone or video call assessment compared to face-to-face (e.g. it’s more time-efficient), many of us felt more distant from families and our supportive team. To overcome these difficulties, the team met frequently on Zoom and set-up remote peer-based risk discussion sessions to continue to learn from each other. We recognised that we needed to be kind to ourselves when taking on board other people’s struggles and that it was okay to feel bruised after what we had heard. We took the time to talk to colleagues about what we experienced and didn’t bottle it up, and recognised the importance of knowing when enough is enough and when to take a break.
Being aware and accepting of our own limitations was also critical in being able to effectively manage risk. Recognising when emotional fatigue had set in was key; knowing when it was time to come off a call or step away from an interview to regroup. This involved sensitively drawing a long interview to a close and rearranging for another day, or taking a break for half an hour to get a drink and take a breather. If the assessor is fatigued, they cannot give the child or parent the attention they deserve.
We appreciate how much we benefited from being in a large and supportive team, but what if you are a lone researcher (a PhD student or ECR) conducting a project in which you are dealing with risk? In addition to ensuring that you have appropriate supervision procedures in place to immediately discuss any risk concerns, we would suggest ensuring you have a support network in place. Someone you can talk to openly and feel able to share your experiences with (whilst preserving the anonymity of participants).
Supporting colleagues who manage risk and safeguarding concerns can also be challenging and emotionally demanding for supervisors. Having clear procedures, training and support in place for supervisors is equally critical. Our supervisor was lucky enough to have her own wonderful supervisor too. She could always contact her supervisor or another colleague for advice, or to chat through those trickier cases.
Top tips for managing risk in research contexts
- Organisation is key. Make sure you know ahead of time who you need to speak to if risk information arises (e.g. Who is the school safeguarding lead? Who in your team do you need to liaise with? Do you have a back-up person you can speak to?).
- Liaise with the school. Before starting to work with any families, liaise with the school about how the disclosure of risk information will work in practice (e.g. Is there a confidential space you can share information? How will schools log the information you disclose? Should children go straight back to class if they are distressed?)
- Your feelings are normal. It is natural to want to provide more support and guidance than is required of your role. Depending on the nature of the study it may be useful to have a set of resources that can be shared with families and schools, with good quality advice for dealing with particular difficulties and for signposting to further support. Reminding yourself of the boundaries of your role (and of what families have agreed to) can help minimise feelings of not doing enough to help families.
- Learn from others. Some of our team were surprised at how frequently disclosure of risk information occurs. Speaking with your peers can help to prepare you for the types of risk information which may arise.
- Ensure researchers are appropriately trained. Supervisors have a key responsibility to ensure that it is clear to researchers what their role is when managing risk. Researchers should be appropriately trained and feel confident to ask questions if risk information is raised and to respond appropriately.
- Ensure researchers are appropriately supported. It is important that junior researchers (e.g. PhD students and Research Assistants) are not solely responsible for making decisions following the disclosure of risk information, or providing mental health support to a participant. Appropriate procedures need to be in place, prior to commencing the research, to support researchers who encounter risk information (there should be a step-by-step procedure for researchers to follow, and appropriate support for researchers to reflect on the information they have heard).
Disclaimer: All scenarios outlined in this article are fictitious or anonymous, with details either fabricated or omitted.