module-9-safety-planning

Report
Integrated
Safety-Organized Practice
Module Nine:
Safety Planning
Children’s Research Center
A nonprofit social research organization and division of the
National Council on Crime and Delinquency
www.nccdglobal.org
www.nccd-crc.org
1
Our Thinking Draws From
the Legacy of Others
Insoo Kim Berg
Steve de Shazer
Rob
Sawyer
Andrew Turnell
Sue
Lohrbach
Susie
Essex
Steve Edwards
Nicki
Weld
Sonja Parker
Carver
County
CRC Staff
John Vogel
Sophia Chin
Heather Meitner
…and we hope YOU will continue to build
on these ideas and approaches.
2
Definition
Safety is:
Actions of protection
taken by the caregiver
that mitigate the danger
demonstrated over time.
Adapted from Boffa, J., and Podesta, H. (2004) Partnership and risk assessment in child protection practice, Protecting Children,
19(2): 36–48. Turnell, Andrew & Susie Essex Working with Denied Child Abuse, Open University Press, 2006.
3
Agreements
• “Try on.”
• Everyone always has the right to pass.
• Know that silence is a contribution.
• We agree to share airtime and stick to time limits.
• We agree to speak personally, for ourselves as individuals.
• We agree to disagree and avoid making assumptions or generalities.
• We agree to allow others to finish speaking before we speak and
avoid interrupting and side conversations.
• We will all work together to hold to these agreements and authorize
the trainer to hold us to them.
4
Module
Subject
1
Interviewing for Safety and Danger
2
Three Questions to Organize Your Practice
3
Small Voices, Big Impact: Keeping Children at the Center of the Work
4
Solution-Focused Inquiry
5
Introduction to Mapping
6
Harm Statements, Danger Statements, and Safety Goals
7
Mapping With Families
8
Safety Networks
9
Safety Planning
10
Landing the General Authority Practice Model in Everyday Work
11
Organizational Environments: Reflection, Appreciation, and Ongoing
Learning
12
Summary and Looking to the Future
5
Let’s Review and Reflect!
What have you tried from the
module last month?
What worked well?
What were your challenges?
How did you handle those
challenges?
6
What are we going to
cover today?
• Safety as more than a list of
services
• Sample safety plans
• Building safety plans
» Collaborative
» Rigorous
» Action-Driven
• Practice!
7
What are we going to
cover today?
SFQs
+
+
Who is worried
About what potential
caregiver
actions/inaction
Possible impact on the
child
+
+
Who is a part of
the network/plan
What will caregiver
DO differently
For how long?
+
Rigorous
Collaborative
= Action-Based
SAFETY
PLANS
8
Safety Plans as More
Than a List of Services
9
Checking in: What’s the difference
between these two plans?
Plan #1:
•Cheryl needs to go to the therapist weekly to work on depression,
the causes, and the impact it has on her life.
•Cheryl needs to go to the psychiatrist at least monthly to make sure
that she is taking her medication and that it is working properly.
•Cheryl needs to attend a therapeutic group for “women facing
depression” weekly so she can hear how other women have responded
to this.
•Cheryl needs to go to job retraining course.
•Cheryl needs to go to parenting class.
10
Plan #2:
Cheryl agrees to present the following to her children and to her safety network:
•Neighbor Paul, sister Sarah, foster mother Trina, and outreach worker Betsy all agree to be a part
of Cheryl’s safety network.
•Cheryl will ask for help with the children if she is feeling more than a seven on a 10-point scale
for depression.
•Cheryl will not be alone if she is thinking about hurting herself again and will ask for help from
someone in the network if this happens.
•Cheryl agrees to keep a logbook of her work in resisting the worse parts of the depression. She
will scale the impact of the depression every day in the book and write details of everything that is
helping her reduce that impact.
•Paul, Sarah, and Trina all agree to call or visit once daily (once in the morning, once in the
afternoon, and once in the evening). They will talk to Cheryl, ask how she is doing, and also scale
the impact of depression on her. They will also talk to the kids and ask them how they are doing.
When the network visits they will also write in the logbook and ensure the children have their
phone numbers as well.
•Betsy will perform two to three visits a week to the home and either she or her team will be
available 24 hours a day if Cheryl want to call. During her visits she will also scale the impact of
depression with Cheryl and write in the logbook. Betsy will work with Cheryl to make sure she get
to the MD.
•Cheryl, the safety network, and CPS will meet to review this plan again in three weeks.
11
Effective Safety Plans Are…
…detailed plans of ACTION made in
response to SPECIFICALLY
identified dangers
(behavioral and action driven)
Ensure no future trauma for the children
12
Effective Safety Plans
Create clear and observable guidelines about:
• Contact between the children
• The potential danger
• How they are to be protected from the danger
Ensure no future trauma for the children
13
What Does the
SDM® P&P Manual Say?
A SAFETY PLAN IS REQUIRED WHEN SAFETY DECISION IS #2 “Safe
with a plan.”
The following must be included in any safety plan:
1.Each safety threat identified in Section 1A.
2.Information written in a family-friendly manner.
3.Detailed information for each planned safety intervention.
4.Information that describes how the safety plan will be monitored
(e.g., who is responsible for each intervention action).
5.Signatures lines for family members, the worker, and his/her
supervisor.
Note: The safety plan should be documented in in CWS/CMS, MUST be
completed with the family, and a copy should be left with the family.
14
Safety Plans Are…
• Collaboratively made with the family, child, and
network;
• A process, not an event;
• A roadmap to achieve our hopes, not a
guarantee;
• A method for keeping children safe; AND
• A intervention and change strategy.
15
A Shift in How We
Think About Change?
INSIGHT
ACTION
“Fake it ‘til you make it!”
16
Don’t Forget:
Safety and
services are not
the same thing!
This must be reflected in the kinds of plans we create!
17
Sample Safety Plans
18
Terminology
CURRENT
PROPOSED
Safety Plan
Immediate Safety Plan
Case Plan
Ongoing Safety Plan
?
After-Care Safety Plan
19
Another way to think about this:
What we
used to call
“the safety
plan”
What we
used to call
“the case
plan”
The
Ongoing
Safety Plan
We are aiming for “sustainable safety”
20
Safety Planning
Safety plans develop sustainable safety in order to:
Immediate
safety plan
Keep the child home
Ongoing safety plan
Return a child home or move to
enough safety to close the case
After-care
safety plan
Keep the child
safe in the future
CWS INVOLVEMENT
21
An Immediate
Safety Plan
An Ongoing
Safety Plan
SDM Safety Threat Items
SDM Safety Threat Items
and/or High or Very High Risk
Level
Danger statement
Danger statement
(Safety goal)
Safety goal
Acts of protection
Acts of protection
Demonstrated NOW
Demonstrated over time
IMMEDIATE SAFETY
SUSTAINABLE SAFETY
Risk reassessment
Reunification assessment
22
Good safety plans =
trauma-informed practice?
We want to intervene at just the right level to
keep the child safe when we make immediate
safety plans.
23
Immediate Safety Plans
What actions of protection need to be taken
immediately that directly mitigate the
danger, in order for the child to remain
safely in the home?
24
Sample Immediate Safety Plan
Bill
Matt
Note: Safety
Plan Worksheet
is a training
example only.
it’s not a
countyapproved form.
Tonya
Adam
Age 8
(Tonya’s
brother)
Let’s take a look at a
sample immediate
safety plan for Adam.
See handout!
25
When do you need an
ongoing safety plan?
and/or
Unresolved Safety
Threats and Ongoing
Danger
SDM Risk Is High or
Very High
Any Open Case Needs an
Ongoing Safety Plan
Return the Child
Home
Close the Case
26
Sample Ongoing Safety Plan
Return Home
Visits are a critical place to see if early
signs of “acts of protections” are being
demonstrated!!!
Let’s take a look at a sample ongoing safety
plan for Cheryl and her daughters – written
both in a safety plan format and in a case plan
format.
See handout! In pairs, pick the safety item that you think
has the best chance for sustainable safety.
27
Sample Ongoing Safety Plan
Case Closure
Here we are looking for sustainable safety…
demonstrated over time!
Let’s take a look at a sample ongoing safety plan
for Cheryl and her daughters.
See handout! In pairs, pick the safety item that you think
has the best chance for sustainable safety.
28
After Care Safety Plan
How will we know safety will be sustained
over time? What will people do to keep the
children safe once we leave?
Let’s take a look at a
sample After Care Safety
Plan for Cheryl and her
daughters.
See handout!
29
Let’s Chat
Get into pairs and discuss this question:
How is this different from or similar to what you
are doing now?
30
Building Collaborative,
Rigorous, Action-Driven
Safety Plans
31
Steps in Building Safety Plans
① Building relationships, assessing danger and safety
② Get clear on the danger statements and safety goals
③ Orient the family and the children to the task
④ Identify and involve the network
⑤ Address the critical concerns
⑥ Reach agreement on the plan
⑦ Bring it back to the children
⑧ Monitor, build on it, and continue to assess
32
Safety Planning Is a Process,
Not an Event
① Building relationships, assessing danger
and safety
② Get clear on the danger statements and
safety goals
③ Orient the family and the children
④ Identify and involve the network
⑤ Address the critical concerns
⑥ Reach agreement on the plan
⑦ Bring it back to the children
⑧ Monitor, build on it, and continue to
assess
33
1. Building relationships,
assessing danger and safety
USE YOUR SFQs!
34
2. Get clear on the
danger statements and safety goals
Who is worried
About what
potential caregiver
actions/inaction
Possible impact on
the child
Who is a part
of the
network/plan
What will
caregiver DO
differently
For how long?
35
Danger Statements
Simple behavioral statements of the specific worry
we have about this child now and into the future.
Who is worried
Potential
caregiver
actions/inaction
Potential future
impact on child
36
The Question That the Danger
Statement Answers
What is CWS most worried will happen to the
children if they are in the care of their parents and
nothing else happens to mitigate the danger?
37
Goal Statements
Clear, simple statements about what the caregiver will DO
that will convince everyone the child is safe now and into
the future.
Who is a part
of the
network/plan
What will
caregiver DO
differently
Actions of
protection taken
by caregiver
that mitigate
the danger
For how
long?
Demonstrated
over time
38
The Question That the
Safety Goal Answers
What does CWS need to see the parents
and their network doing differently with
their children so everyone will know the
children are safe? (not services)
39
The safety plan gets us from the
danger statement to the safety goal!
Danger Statements
(What we are worried could
happen without intervention)
Acts of Protection
(Taken by the caregiver that
mitigate the danger,
demonstrated over time)
Safety Goal
(What we need to
see to know we can
close the case – not
services)
40
3. Orienting the family
Why?
What?
How?
• My job is to make sure children are safe,
and I am worried because…
• You and the people around the child are
going to need to do some new things.
• We will include other people in the plan.
• This will not be easy! We are all going to
ask hard questions to make sure the plan
will work.
• We are going to keep refining this.
• Everyone involved, especially you and
CWS, will need to approve.
41
Orienting the Family
Here’s an idea!
Step 1:
•Take your provisional danger
statements and the safety goal to
the family and the network.
•What acts of protection could they
come up with to move their family
toward the safety goal?
•Don’t forget agency bottom lines.
42
Orienting the Family
Step 2: Share the Safety
Definition with the family
Safety is:
Actions of protection
taken by the caregiver
that mitigate the danger
demonstrated over time.
Adapted from Boffa, J., and Podesta, H. (2004). Partnership and risk assessment in child protection practice, Protecting Children,
19(2): 36–48. Turnell, Andrew & Susie Essex. (2006). Working With Denied Child Abuse, Open University Press.
43
Orienting the Family
Step 3a: Map for Past and Current ACTS OF PROTECTION
What is working well?
What are the worries?
What should happen?
Look for potential acts of Look for things that could
protection that have been get in the way of safety,
working already.
that the parents,
children, and safety
network can be on alert
for – that they can plan
around.
Look for the parents,’
children’s, and network’s
ideas about what could
be done to increase
safety.
44
Orienting the Family
Step 3b: Capture the conversation on the safety plan
worksheet
Safety Plan Worksheet
Danger Statement(s):
Safety Goal(s):
Who
What action will be taken How will we know it
worked?
Who
What action will be taken How will we know it
worked?
45
4. Identify and Involve the Network
“It takes a
village to raise a
child.”
Keeping a child in close contact with
safe, familiar people is an example
of a Trauma-Informed Practice!
46
Eliciting local cultural wisdom
• You can’t engage the village if
you don’t understand the
village.
• Our safety plans have to fit
the culture of the family we
are working with.
• The best plan won’t work if
the plan does not fit with the
culture.
47
A Bottom Line
You can’t make safety only with
the people you are worried about.
48
5. Address the critical concerns:
Asking hard questions
What would
Adam say if he
was here?
How willing and
able are you to
do this?
What will we do
if the network
member doesn’t
come through?
What if his father
won’t stay away?
On a scale from 0–10 where
10 is safe and 0 is danger,
where do you think things
are right now?
What would be have to
happen to increase the
number by 1? What will get
us to the 10?
A
rigorous
plan!
How are we going
to know any of this
is really working???
49
Keep the plan focused on
ACTS of protection
Who?
Will do what?
How will we know
it is working?
A list of services is not a safety plan!
50
What is the role of services?
•
Services are to support caregivers to take steps
toward safety.
•
People do need help.
•
When you want families to start attending services,
be clear to yourself and the family: What actions
within the family are you hoping will change as a
result of this service?
Remember, services are a means to an end. That end is
sustainable safety for the children!
51
6. Reach agreement on
at least a provisional plan
“People support what they have a hand in creating.”
- Margaret Wheatley
52
Reach Agreement on at Least a Provisional Plan:
GRADIENTS OF AGREEMENT (Kaner, 2011)
VETO
NEUTRAL
I won’t do
that plan.
I don’t have
strong feelings
either way.
1
2
RELUCTANT
BUT WILLING
I don’t like
it, but I am
willing to
try it.
3
FULL ENDORSEMENT
I love this
plan!
4
5
SUPPORTIVE
I really like
this plan.
53
7. Bring it back to the children
Empowering children and giving them a voice is an example of a
Trauma-Informed Practice!
54
Present the safety plan
to the children and let them draw!
Let’s review an
example!
55
8. Monitor and Refine
Network: Who,
what, when,
how?
“Dry Runs”
Journals, log
books
Safety objects
Supervision
Check the SDM
Reassessments
56
Networks
• Remember Module 8.
• How is the network going to help monitor the plan?
• What will they do if things don’t go well? What are our
agreements on this?
• Scale your ongoing relationship with the network and
your ability to accurately monitor their ability to keep the
child safe.
• Troubleshoot as needed.
57
Journals, Log Books
• Who will journal the progress?
» The parent?
» The caregiver?
» The child?
» Other members of the safety network?
• What is the plan to ensure that progress on the
safety plan guidelines are being documented?
• How will the journals or log books be shared
with the network and with you?
58
Safety Objects
If the child to sends a signal to her network that
she feels unsafe, such as turning a light on at
night, or bringing a safety object toy to school, or
sending a text message, how will you know about
it?
59
Dry Runs
• Try a dress rehearsal.
• Stage a false safety threat and see how the
network responds.
• Debrief how it went:
» What worked?
» What were the challenges?
» How can the safety plan be
adapted?
60
Things to Focus on in Supervision
•
•
•
•
•
•
Genogram
SDM safety assessment
Danger statement
Safety goal
Who is in the network?
Who is in the plan?
• What are they all doing to
keep the kids safe?
• How will we know it is
working?
• When is the date of next
review?
• SDM risk reassessments
61
Check the SDM® Reassessments
62
Summary –
Steps in building safety plans
① Building relationships, assessing danger and safety
② Get clear on the danger statements and safety goals
③ Orient the family and children to the task
④ Identify and involve the network
⑤ Address the critical concerns
⑥ Reach agreement on the plan
⑦ Bring it back to the children
⑧ Monitor, build on it, and continue to assess
63
Let’s Practice!
64
Activity Worksheets
Mapping for Acts of Protection
Well?
Worries?
Happen?
Safety Plan Worksheet
Danger Statement(s):
Safety Goal(s):
Who
What action How will we
will be
know it
taken
worked?
Who
What action How will we
will be
know it
taken
worked?
65
Let’s Practice!
(Safety Plan Worksheet)
In pairs: One of you think about a family who is on your caseload right
now who would benefit from the kinds of plans we have talked about
today. Ideally, think of a referral or case where you are feeling stuck or
unsure of what to do next. But don’t pick your most challenging family.
• What are the initial safety threats from the SDM safety assessment?
• What counts were filed on the petition?
Who is worried
About what
potential caregiver
actions/inaction
Possible impact on
the child
Who is a part of
the
network/plan?
What will
caregiver DO
differently?
For how long?
66
Mapping for Acts of Protection
Now have a three-questions conversation, with one of you
documenting answers to these questions on the Mapping
for Acts of Protection worksheet:
•
What is working well to move the family toward safety?
•
What are the biggest worries you have right now about
the children?
•
What is at least one thing you would like to see happen
that would make you feel that the child would be safer
and the family is moving toward the safety goal?
67
Search for Existing Acts of Protection
What are we worried
about?
What is working well?
Jenna and her 18 month-old son
Stephen live alone. Jenna has been
unemployed for the last 7 months
and as a result has relapsed into a
drinking problem she had
previously. She says that she now
drinks a box of wine to a 5th of
Vodka daily.
Jenna has had periods of sobriety in
the past including one last year that
lasted 7 months during which time
she completed first a detox and
then a dual diagnosis day program.
During this time she would regularly
leave Stephen with her parents
when she was drinking.
On March 22nd, a neighbor called
police because Jenna and her father
Mike were arguing about her
drinking. He had found Jenna
passed out on the couch and
Stephen was in nightshirt and dirty
diaper unsupervised. Jenna had
left out her Prozac and pills were in
reach of Stephen. The police were
called and Jenna agreed to a blood
test – blood alcohol level was found
to be at .27. Stephen was crying
when his grandfather found him.
Jenna took the blood alcohol test
willingly and says she is willing to
work with the agency. She is
admits to being an alcoholic.
CPS, Jenna & Mike are worried that
Jenna may get drunk again while
she is alone with Stephen, that
Stephen could get into her things,
could get sick or seriously hurt.
Jenna has been regularly bringing
Stephen to his MD and he is up-todate on all medical appointments.
Mike and and Jenna’s mom Sharon
are both very worried that Stephen
could have been very seriously hurt.
Jenna is very scared about what
happened and says she is also
worried Stephen that Stephen could
have been hurt.
What needs to
happen?
Jenna says she wants to be sober
and to be a good mom for Stephen.
Jenna agrees to make a plan with
Mike & Sharon to show that she will
always be sober when she is caring
for Stephen. Mike, Sharon and
Jenna’s best friend Monica will be the
first ones to notice this change. This
plan will need to be in place and
working continuously for 6 months
for CPS to withdraw.
Mike, Sharon and Jenna all agree
that Stephen should stay with them
for the next two weeks and agree
not not to leave Stephen alone with
Jenna again until everyone in the
network agrees that it will be safe.
Jenna will make sure all her
medication is locked up and that
Stephen can’t reach it. Jenna has
also agreed to restart her substance
abuse support program.
The agency, Jenna, Mike and Sharon
agree to review this plan together
again in two weeks.
Take a moment and look at your map. Circle anything on this map that
could be an act of protection that would respond to the danger if it
was repeated or enhanced. This is your first step in making a plan!
Next, write those down on your Safety Plan handout.
68
Drop Those Actions on the Plan!
Safety Plan Worksheet
Danger Statement(s):
Safety Goal(s):
Who
What action will be taken How will we know it
worked?
Who
What action will be taken How will we know it
worked?
69
Identify Network Members
• This will require some
assumptions.
• Who do you know the
family already has contact
with?
• Who do you think the
family might be willing to
include?
• Who do you wish they
would include?
70
Wrapping it Up
1. Who will do this action of protection?
• The parent?
• The network member?
• The child? (in some cases)
2. What exactly will they do?
3. How will we know it worked?
Complete this on your Safety Planning Worksheet
71
Debrief
• What stood out?
• How could you include
the children?
• What was different or
the same from how
• What would it be like
you regularly do safety to take this back to the
plans?
parents?
72
Summary: Safety Planning as a
Model for Change and Growth
Goal: What
future safety
looks like.
Dorrinton & Saunders and Associates 2006
73
Safety Planning as a
Model for Change and Growth
Goal: What
future safety
looks like.
Dorrinton & Saunders and Associates 2006
74
Sometimes…
75
Safety Planning as a
Model for Change and Growth
I
B E
n
a x
t
r
e
r
n
a
l
r
i
t
e
r
n
e a
r l
s
Honor
Learn
Evaluate
Heal
Forgive
Gratitude
Strengths and
Opportunities
Dorrinton & Saunders and Associates 200676
Some Cautions
Safety plans are only
words on paper
Real work comes in
creating, implementing,
monitoring, and
adjusting safety plans
as time goes on
Expect safety plans to
develop and change
over time
77
Signs of Safety Practice Element #4
Focus on Goals
The f oundat ion of t he Signs of Saf et y approach is t he explicit and
caref ul f ocus given t o t he goals of bot h t he f amily and t he agency.
Areas to Explore:
★ How will the abuse stop?
★ What will happen instead?
★ How will the agency and family know?
&
a l s n s a re e
o
G t io
ur
t a ake s
c
e
Ex p l a r. M m i l y
i
a
s
s im t h e f s t a n d
r
e
und bot h
p. 67 - 74
*Turnell, A. and Edwards S. (1999). Signs of Safety. New York: Norton.
Clear goals allow the evaluation of
progress and help workers and family
agree on when the case should be closed.
While this is simple to say and compelling
to believe, we know from experience that
it is probably the most difficult aspect of
the signs of safety model to implement.
78
Opportunities for Practice
79
One last thing…thinking ahead
In pairs:
• What’s one thing you heard today that
you value or makes sense to you?
• What are you already doing to put that
into action in your work?
• What else would you like to do to “land
it” even more in your work between now
and next time?
80
References
Children’s Research Center. (2008). Structured Decision Making®: An evidence-based approach to
human services. Retrieved from http://www.nccd-crc.org/crc/pdf/2008_sdm_book.pdf
Department of Child Protection. (2011). The signs of safety child protection practice framework.
Department of Child Protection, Perth. Retrieved from
http://www.signsofsafety.net/westernaustralia
Essex, S., Gumbleton, J., & Luger, C. (1996). Resolutions: Working with families where responsibilities
for abuse is denied. Child Abuse Review, 5, 191–202.
Lee, M. L., Sebold, J., & Uken, A. (2003). Solution-focused treatment of domestic violence offenders:
Accountability for change. NY: Oxford University Press.
Turnell, A., & Essex, S. (2006). Working with ‘denied’ child abuse: The resolutions approach.
Buckingham: Open University Press.
Child Protection Messages from Research. (1995). Studies in child protection. HMSO: London.
http://www.nctsn.org/resources/topics/creating-trauma-informed-systems
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