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 81