Improving professional decision-making in situations of risk and uncertainty: a pilot intervention

Dr Mary Baginsky

Mary Baginsky

Dr Mary Baginsky,Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, reflects on our seminar led, online, by Professor Cheryl Regehr on 28 September 2021. (763 words)

Professor Cheryl Regehr is Provost and Vice-President for the University of Toronto and former Dean of the Factor-Inwentash Faculty of Social Work. She is also a Visiting Professor at our Unit this term. We were delighted that she agreed to lead a seminar that focused on her recent work. In this she explained how the Social Sciences and Humanities Research Council (SSHRC) of Canada has supported a number of her recent research projects that have examined stress, trauma and decision-making in social work (see examples below). The aim is to develop a new model for improving decision-making in situations of high-risk to reach a better understanding of the factors that drive decision-making in these situations. Professor Regehr and her team piloted a new approach for improving professional decision-making. The researchers examined biological, emotional, cognitive and contextual influences and this involved measuring social workers’ heart rates and recording their reflections on the decisions they had taken at specific times. The participants were able to link their emotional responses to the points at which they had been under physical stress. By raising their awareness to the relationship between their physiological responses and their automatic responses to the decisions they made the intention was to help them move towards more deliberate decision-making.

The interaction between social workers and their environment has been the subject of numerous studies in this country and elsewhere. For example, Whittaker (2018) has written about how the anxiety surrounding decision-making in areas such as child protection and mental health may lead to over-defensive practice at individual and organisational levels. He draws attention to the ongoing tension between a rational view of decision making, where individuals make decisions logically and analytically rather than subjectively and intuitively. This is a debate that has gone on within social work for many years and is unlikely to go away in a hurry. It is important because while it is obvious that decisions that are made by social workers impact on people’s lives, we know that decisions are not consistent (Platt and Turney, 2014; Saltiel, 2015). This was very apparent in a recent study I conducted where I observed social workers’ interactions with families (Baginsky et al., 2020) which I shall explore in more detail in the future.

Cheryl Regehr

Prof Cheryl Regehr

For me the main take away message from Professor Regehr’s seminar was that the team was providing one way to minimise these variations. As Whittaker (2018) describes, there is a growing literature in social work linking psychological models to decision making. The work led by Professor Regehr widens this to an exploration of physical and biochemical functions on social work decision making. It will not be sufficient on its own but raising the awareness of social workers to the effect of their affective and physiological responses on their decisions and on their practice in general will, it is to be hoped, make a significant contribution.

Dr Mary Baginsky is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London.

This seminar was part of the Contemporary Issues and Debates in Social Work Education, Research and Practice series which brings academics and practitioners together to consider recent research and the implications for practice. Please contact Jess Harris ( if you would like your name to be added to the mailing list.

Useful references

Baginsky, M., Hickman, B., Harris, J., Manthorpe, J., Sanders, M., O’Higgins, A., Schoenwald, E. and Clayton, V. (2020). Evaluation of MTM’s Signs of Safety Pilots. Evaluation report and Evaluation report appendices. London: The Department for Education.

Platt D and Turney D. (2014) Making Threshold Decisions in Child Protection: A Conceptual Analysis. British Journal of Social Work, 44, 6, 1472-1490.

Regehr, C., LeBlanc, V. R., Bogo, M., Paterson, J., and Birze, A. (2015) Suicide risk assessments: Examining influences on clinicians’ professional judgment. American Journal of Orthopsychiatry, 85,4, 295-301

Regehr, C. (2018) Stress, Trauma and Decision-Making for Social Work.  New York: Columbia University Press

Regehr, C., Enosh, G., and Bosk, E. (2021) An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives. Int Journal of Environmental Research in Public Health. 18,14, 7671

Saltiel D. (2016) Observing Front Line Decision Making in Child Protection. British Journal of Social Work, 46, 7, 2104-2119.

Whittaker, A. (2011) Social defences and organisational culture in a local authority child protection setting: Challenges for the Munro Review? Journal of Social Work Practice25, 4, 481-495.

Whittaker, A. (2018) How do child protection practitioners make decisions in real life situations? Lessons from the psychology of decision making. British Journal of Social Work, 48, 7, 1967-1984.