Facilitated Safety Organized
Practice
Integrating Practice and Decision Support Tools:
Signs of Safety and
Structured Decision-Making
489 Mt. Auburn
Street
Facilitated
by:
Watertown, MA 02472
Phone Vogel
(617) 923-1770
Phil Decter &www.family-centeredservices.org
John
Why are we spending time on this
Webinar? (Purpose)
To engage you in an ongoing dialog about
ways that Signs of Safety and Structured
Decision Making can be used together to
make it easier to understand Danger,
Risk and Safety with families and to
partner with those families to enhance
safety for their children.
What do we hope you walk away
with? (Desired Outcomes)
 An increased understanding of how the elements of
Signs of Safety and Structured Decision Making can
work together to enhance child welfare practice.
 An appreciation of how the process of Facilitation
assists in this and makes it easier to build
understanding and agreement among all stakeholders
about the level of safety, risk, and what needs to
happen to enhance safety for children.
 An interest in continuing this conversation!
Brief Summary of the Signs of Safety
Signs of Safety comes from our understanding of
the ideas in:
Signs of Safety, By Andrew Turnell and Steven Edwards,
W.W. Norton and Company, 1999.
Working with ‘Denied’ Child Abuse by Andrew Turnell and
Susie Essex, Open University Press, 2006.
 And from trainings and conversations with Andrew
Turnell, Steve Edwards, Sonja Parker and countless other
children, families and workers around the world!
Signs of Safety: Objectives and Components
• ENGAGEMENT:
• Solution Focused Interviewing
• Strategies for Interviewing Children
• CRITICAL THINKING:
• Safety Mapping
• ENHANCING SAFETY:
• Harm + Danger Statements
• Well-Formed Goals
• Building Safety Networks
• Safety Planning
Signs of Safety: Principles
•Respect service recipients as people worth doing
business with
•Cooperate with the person, not the abuse
•Recognize that cooperation is possible, even where
coercion is required
•Recognize that all families have signs of safety
•Maintain focus on safety
•Learn what the service recipient wants
Signs of Safety: Principles
•Always search for detail
•Focus on creating small change
•Don’t confuse case details with judgments
•Offer choices
•Treat the interview as a forum for change
•Treat the practice principles as aspirations, not
assumptions
Signs of Safety: Worker Disciplines
• A clear and rigorous distinction between harm,
danger and complicating factors; and between safety
and strengths
• Rendering all statements in straight-forward rather
than professionalized language that can be clearly
understood by all involved.
• As much as possible all statements focus on specific,
observable behaviors (e.g. ‘Mary is not taking
prescribed medication or attending appointments with
the psychiatrist’) and not meaning laden, judgmentloaded terms (e.g., ‘she is controlling’, ‘he is in
denial’, ‘she’s an alcoholic’).
• Skillful use of authority.
A Reminder: SDM® System
•
Developed by Children’s Research
Center (CRC) in mid-1980’s
•
Now used in more than 25 states in the
US and also in Canada, Australia,
Bermuda
•
Refers to a suite of assessments and
related case management decision
guidance
Purpose of the SDM tools
• Identify crucial decision points in child welfare
casework
• Increase consistency in the decision making
• Increase accuracy of the decision making
• Target resources to families most at need
(through differential responses to the different
scored levels of risk)
Individual SDM Tools
•Hotline
•Safety
•Risk
•FSNA
•Risk Re-Assessment
•Reunification Assessment
Why
SDM and SofS?
Why integrate Signs of Safety (SofS) and
the Structured Decision Making® System (SDM)?
Environment
and
organizational
context
Best Available
Research
BEST OUTCOMES
Client
characteristics,
values and
preferences
Practitioner
Judgment and
Expertise
Adapted from Institute of Medicine, 2001
SoS
Strength based,
solution
focused
SDM
Researchsupported
decision
guidance
Integrated
practice
SoS
Inquiry
Engaging
SDM
Research
Consistency
Focus
SDM and SoS make it easier…
• To engage with children and families using clear, straight forward
•
•
•
•
•
•
practices that focus your work on what matters most – safety
To make sense of what we see: by using common definitions of the key
words in child welfare practice - Safety, Danger, and Risk
To bring the best of research and large data sets to our work of
identifying the patterns of abuse or neglect children are facing
To describe in behavioral, non-judgmental terms the impact of caregiver
actions on children
To work toward a goal of using the same lenses and thresholds in making
decisions about children and their families
To share decision making and responsibility by promoting networks to
support children and families
To partner with those networks and the families to create meaningful and
achievable plans for change
Overall SDM and SoS Linkages
Assessment of
safety
Risk
Assessment
FSNA
Risk
Reassessment
Practice principles
Solution focused interviewing, Safety mapping, three houses, words and pictures, danger
statements, goal statements, expanding networks, safety planning
Can child stay?
Ongoing
case?
Focus of
ongoing
safety plan?
Ongoing
case?
What can
this look like?
Both SDM and SoS start with inquiry:
What are we
worried about?
What is
working well?
What needs to
happen next?
Both SDM and SoS start with inquiry:
SoS Questions 
SDM tools 
What are the
worries?
What is working
well?
What needs to
happen next?
Safety
Threats
Protective
capacities
Safety plan
Risk
Risk factors present
Risk factors not
present (in MA,
testing protective
capacities)
Provide ongoing
services OR close
Strengths and
needs
Priority needs
Strengths
Case plan
Reunification
assessment
Lack of progress on
case plan
Visitation issues
Safety threats
Progress
Quality visitation
Safety threats
resolved and/or
protective
capacities
Reunify OR
continue service OR
change plan goal
Both SDM and SoS start with inquiry:
What is the impact of
the caregivers actions
on the child?
What information do I
need to get the most
out of the SDM
assessments?
The next step: Linking the kinds of questions we ask
Harm and Danger:
Safety:
Complicating
Factors:
Strengths
Why a map and an Assessment?
MAP
• Use in the field/office
• Family-centered
• Format for helping professionals
organize their thinking and
judgment
• Shared language for
professionals, family members,
anyone involved with the family
ASSESSMENT
• Typically documented in
office
• Research-based
• Consistency
• Reliability (definitions)
• Equity
• Aggregate data
Integrating the map and the Assessment
OPEN: Brainstorming to gather a broad, wide-open set
of responses-Seek multiple perspectives
Stages of a
Dialog
NARROW: Focused inquiry to provide clarity
and details: Seek understanding and agreement
CLOSE:
Resulting
understanding and agreement
for plan of action.
What are the worries?
 Open Stage: Gathering up the relevant information,
observations, perceptions and intuitions about the
worries—within the context of Child Welfare and
boundaries outlined by SDM Definitions
 Narrow Stage: Focusing on Details, Definitions and
behavioral Descriptions (Safety Threats)
 Close Stage: Collaborative decisions about the worries
which rise to level of Harm, Danger or Complicating
Factors
Generate a Clear Purpose for CPS Intervention: Harm and
Danger Statements
What is working well?
 Open Stage: Gathering up the relevant information,
observations, perceptions and intuitions about the things
that are working well in the context of Child Welfare and
boundaries outlined by SDM
 Narrow Stage: Focusing on Details, Definitions and
behavioral Descriptions (Protective Capacities)
 Close Stage: Collaborative decisions about what works
well which rises to level of Safety or Supporting
Strengths
Generate Clear Desired Outcomes for CPS Intervention:
Safety Statement
What needs to happen next?
 Open Stage: What are the resources, skills and attributes
identified as Supporting Strengths which may be helpful in
addressing the worries? (What are the Danger Indicators and Risk
Factors, and Protective Capacities identified from the SDM Tools?)
 Narrow Stage: What are the alternatives for intervention
which may support the caregiver’s strengths? Which of these
are most feasible? (Is a Safety Plan Necessary?,What level of
Intervention is Necessary given the Overall Risk?)
 Close Stage: What specific actions are necessary by all of the
stakeholders to promote Acts of Protection related to the
Danger (How does this information get shared with the family and
stakeholders?)
Facilitative Framework for Integrating SofS & SDM
OPEN Facilitative Behaviors to
gather information
What are the worries?
C
h
e
c
k
f
o
r
What works well?
What needs to happen?
u
n
d
e
r
s
t
a
n
d
i
n
g
NARROW
Strategic and Critical Thinking to
organize information
Reveal Patterns of past worries, Search for
details, elicit multiple perspectives and
stories, Hear the voices of children,
Collaborate to describe CPS threshold, Rely
on Shared Definitions, Sort out understanding
of Harm and Complicating Factors, Utilize
SDM Tools, Describe behavior= IMPACT
Reveal Patterns of past success using
exception questions, Appreciative inquiry to
tell story when things worked well, Search for
details, Elicit multiple perspectives and
stories, Hear the voice of children, Use SDM
Tools to identify Protective Capacities,
Describe behaviors=IMPACT
Who can be part of the network? What might
network members do to support change?;
What resources are available to help promote
change?; Are changes needed in “what
people do” or “what they think” or both?
C CLOSE Collaborative Attitude to select the
h best approach and reach agreement
e
c Develop shared agreement about
k the nature and severity of the
problem
f Agreement about an agency
o
Danger Statement
r
Understanding of the Safety
a Level
g
r
e
e Develop Safety Goals
m Specify Acts of Protection
e Describe Supporting Strengths
n Protective Capacities
t
Understanding of RISK LEVEL
Clear expectations of the actions
that network members will take.
Safety Plan/Service Plan
Reunification Plan, Implementation
Plan
How do you do
this?
Facilitative Practice
• Is founded on collaboration and partnership
• Shares responsibility for decision making
• Builds agreement and understanding
• Strives for clear purpose and outcomes
• Uses appreciative inquiry
• Asks strategic questions
How does Facilitation in Safety/Risk Assessment
Make Practice Just a Bit Easier?—A Collaborative
Thinking Process
 Focuses efforts on a clear purpose of CPS
intervention
 Makes use of shared definitions of key words in
practice
 Generates shared responsibility for success among all
of the stakeholders—most importantly, the family
 Relies on collaborative decision making
 Identifies clear desired outcomes
SofS and SDM both strive for
COLLABORATION
Collaboration is: Participation which generates
understanding and agreement
Participation which strives for understanding leads to clarity,
connection and room for disagreement
Understanding which strives for agreement leads to shared
commitment
Shared commitments lead to ownership and shared responsibility
for action
How can we promote Collaboration?
Structure of a meeting
Why?
Purpose
Context
Group Agreements
What?
How?
Network/Stakeholders
Desired Outcome
Content
Next Steps
+/∆
A structure for facilitated dialog
Stage of the meeting
Key question to guide the meeting
Purpose
Why are we meeting today?
Context
Are there other things going on that make it harder
for us to pay attention to each other?
Group Agreements
How do we want to work with each other?
Network/Stakeholders
Is everyone that should be here actually here?
Desired Outcome
What do we want to walk away with from this
meeting?
Content
What do we want to talk about?
Next Steps
What steps do we need to take from here?
+/∆
How did we do? What should we do differently next
time?
Mapping “with” SDM
Stage of the meeting
Key question to guide the meeting
Purpose
We are meeting today to do some more learning about mapping + the
SDM tools and to practice our skills together
Context
We have a tough case with a baby with a teen mom who is depressed and
we all think we could benefit from thinking it through together
Group Agreements
All voices heard from/OK to make a mistake/one person talks at a
time/let the person facilitating work
Network/Stakeholders
Is everyone from our unit here? Would we like to invite an external coach
like Karen to this?
Desired Outcome
We get better at these skills and maybe get some ideas
Content
1) What is the key questions we want to get out of this?
2) What is the SDM tool that might help?
3) What are we worried about? What would the parent say? What does the
SDM definition/thresholds have to say?
4) What’s working well? What would parent say? What does SDM say?
Next Steps
What do we need to do next?
+/∆
How was this conversation today? What did we do well?
What do we want to do different next time?
Integration Involves:
 Facilitating a PROCESS of Safety and
Risk Assessment
 Searching for the best question to ask,
rather than searching for the best
answer to give
 Using all the different tools in our
disposal help us in that quest
Clinical Vignette
Ann
Donna
Kim
40
39
32
?
10
Paul
Allegation of substance abuse – Kim passed out while shooting heroin and
cooking dinner. Paul was home. Paul goes to live with his aunt Donna and her
wife Ann.
What are we worried about? (Open)
 Kimberly overdosed on heroin and became unconscious while cooking dinner. 10yo
Paul was home at the time. Her landlady heard the fire alarm and had to call the police
and open the door
 Kim has an extensive history of heroin use in the past and reports that she has been
struggling with addiction "for more than 15 years". This led to one DCF referral 4 years
ago when Paul came to school multiple days smelling of urine and feces
 Kim attributes this incident to a growing depression after loosing her job as a
saleswoman at a department store. She has been looking for work for more than 14
weeks without finding anything. Both Donna and Ann confirm this.
 Kim had stopped attending NA 2+year ago ("they get kind of preachy, and the meetings
were not good times.").
 Kim has been diagnosed with Borderline Personality Disorder, and ADD.
Making sense of what we learn (narrow)
 Kimberly overdosed on heroin and became unconscious
while cooking dinner. 10yo Paul was home at the time. Her
landlady heard the fire alarm and had to call the police and
open the door.
 Harm or complicating factor? How do we know?
 What would SDM say? What questions would it help us ask?
Making sense of what we learn (narrow)
 Kimberly has been diagnosed with Borderline Personality
Disorder and Attention Deficit Disorder.
 Harm or complicating factor? How do we know?
 What would SDM say? What questions would it help us ask?
What do we need to next? (close)
 Danger Statement (What are we worried will happen
in the future)
 Risk Level (How worried should we be)
 Safety Plans/Case Plans
The combined elements
Signs of Safety
Structured Decision-Making
• Solution Focused
• Safety Assessment
Interviewing
• Strategies for Working • Risk Assessment
• Family Strengths and
with Children
needs assessment
• Safety Mapping
• Danger Statements
• Risk Reassessment
• Safety Goals
• Building Safety
Networks
• Safety Planning
Before and after: What does practice look like?
Current Practice
•
•
•
•
•
•
•
•
Interview children
Interview parents
Interview collaterals
Make decisions about whether a
child is safe in home
Build case plans
Monitor case plans
Make decisions about when to
return a child home
Make decisions about when to
close case
Integrated SDM and SOS
•
•
•
•
•
•
•
•
Interview children
Interview parents
Interview collaterals
Make decisions about whether a
child is safe in home
Build case plans
Monitor case plans
Make decisions about when to
return a child home
Make decisions about when to
close case
So what changes?
The tools available
The way the process is
organized
High emphasis on child,
family & community
participation in all
aspects of the work
Summary
 At the core of both SoS and SDM is a desire to use inquiry to deepen
child welfare practice.
 Each approach subscribes to a overlapping set of values and principles
in child welfare practice that includes a focus on the family as central
to creating safety and solutions to problems, striving to develop
rigor and depth in all phases of the work, and a commitment to
balance the use of clinical judgment and research in decision making.
 Each approach brings a set of tools and strategies that can be used
together in ways that make the whole greater than the sum of its
parts.
 Facilitation is a process that helps us make sense of the information
we get – we can all make more use of SDM and SoS when they are
part of a facilitated safety and risk assessment process – not a
product