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Speaking of nomenclature…what about “protective factors”?

Posted Oct 23 2008 8:32am

Speaking of nomenclature, I’m increasingly growing mistrustful of the term “protective factors.”   It sounds very “evidence-based” to refer to “risk and protective factors” when discussing one’s approach to risk assessment.   However, I’ve noticed a subtle misunderstanding that has creeped in along with the popularity of these terms.  Often, it sounds like some clinicians are thinking of risk and protective factors are two sides of the same coin or–better put–two sides of the same scale and you arrive at a formulation of risk by weighing one against the other.   The potential mistake is to think that protective factors “cancel out” risk factors.

Although I have a section called “protective factors” in the map I use to teach about risk formulation and documentation, I am increasingly finding myself replacing these words in workshops with the awkward phrase, “Launching off point factors.”  What I mean to convey is that it is probably best to think of “protective factors” as factors that increase the likelihood of success for crisis and treatment planning, rather than factors that technically “protect” against risk previously identified.  A distraught, intoxicated individual with suicidal ideation and a gun can have all the protective factors in the world and that doesn’t change the risk one bit.   These factors may, however, present opportunities to engage in crisis planning, develop a therapeutic relationship, and engage a supportive system, all of which create conditions in which risk can be addressed, and which could ultimately influence decisions about the most appropriate level of care.

In our next revision of risk-related documentation, I’m considering recommending that we get rid of the term “protective factors” altogether because of the danger that it can be misleading.  I don’t have a great substitute, unfortunately.  Best I can come up with right now is “Opportunities for Crisis and Treatment Planning,” but I wonder if an ordinary person coming to a section so-labelled would know what it meant.  Needs more work.

      
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