Shared risk-holding as a mechanism for prevention in complex systems: An evaluation of the Creative Solution Forum

Introduction. Holding risk and preventing harm for service users experiencing multiple disadvantages (e.g., addiction, homelessness) remains challenging. Individuals often encounter fragmented responses shaped by organisational thresholds, boundaries, and cultures. Evaluation findings are presented from the Creative Solutions Forum (CSF), a practice‑based learning forum in Plymouth supporting professionals working with high‑risk, complex cases. Background.
The CSF was created in 2016 following concerns about Avoidable Deaths (AD),
hard, and gaps in coordinated multidisciplinary responses. Rather than functioning as a formal decision‑making panel, it operates as a relational‑reflective space for practitioners to share responsibility. Its ethos emphasises curiosity, open discussion and the creation of learning loops, which support practitioners navigating risk, fear and uncertainty. Methodology.
A mixed‑methods approach was used. A random sample (n=100) of referrals was
analysed with cohort data to explore patterns of complexity and outcomes across systems, and semi‑structured interviews (n=11) examined practitioner experiences. Findings. Findings highlight distinctive features of the CSF. Practitioners described the forum as reducing isolation, strengthening decision‑making and enabling more proportionate responses to risk. Learning loops helped reframe cases and supported coordinated action across siloed structures. Shared risk‑holding emerged as a central mechanism, assisting practitioners to manage risk and the legacy of trauma. Despite the cohort’s high‑risk profile, AD was limited. While causation cannot be inferred, the pattern is notable given the complexity. Conclusion. The evaluation suggests that prevention in complex systems is not solely a matter of additional services, but of how professionals are supported to think, relate and act collectively through practice‑based learning forums that work across systems. Implications. Investment in relational, cross‑boundary learning forums such as the CSF may
strengthen shared risk‑holding, enhance practitioner and service‑user wellbeing, and enable more preventative, less defensive practice. Such approaches may help shift systems towards collaborative, complexity‑informed learning