2010 Conference on Differential Response in Child Welfare

Safety and Risk Management – Three Key Case Decisions Barry SalovitzSenior Director, Strategic ConsultingCasey Family Programs

Workshop Objectives1. Expand collective knowledge and understanding

of safety and risk concepts and practices

2. Explore application of the concepts and practices to 3 case decisions using case vignettes to simulate decision making

3. Identify and examine the nature of common risk and safety fidelity errors

3 Case Decisions

1. Child Safety2. Case Opening – Services Provision

3. Reunification

Decision #1

1. No Safety Plan

2. In Home Safety Plan

3. Out of Home Safety Plan

Decision #2

1. Services Not Needed

2. Services Needed – Offered

3. Services Needed – Court Ordered

Decision #3

1. Reunification Recommended

2. Reunification Not Recommended

What is a “Framework”?

• Basic conceptual structure

• Ties together sets of mutually congruent & supportive beliefs, values, principles & strategies

• Addresses a common purpose

Flying Without a Framework

1. Idiosyncratic beliefs, practice, decision-making2. Conscious and unconscious bias3. Errors in decision-making4. Inconsistencies5. Haphazard documentation6. Consultation & supervision suffers7. Lack of standards for QA/QI

The Framework Test• What decisions need to be

made?

• The causes or factors are associated w/ area of interest/concern

• What information needs to be assessed?

• How should this information be interpreted?

• What practice model is best suited?

• What interventions are appropriate?

• What constitutes progress and lack of progress?

• How much progress is expected before recommending a child return home, or case closure, or other permanency option?

• Practice model that unites everything in a way that can be applied in the field

Sample Framework Concepts• All safety threats involve risk; not all risks involve safety

threats • Protective capacities are strengths; not all strengths

function as protective capacities• Safety plans and service plans – complementary, but

different functions• CA/N cases are open for active safety threats; risk

cases are sometimes open; child well-being cases alone are often not open

• CA/N cases are closed when safety threats have been resolved or protective capacities are sufficient to protect; high risk has been reduced

Why Differentiate Safety and Risk?

What About Well-Being?

What About Permanency?

“The sacred requirement…

…to assess a child’s safety in the home & respond appropriately; should not be simply a required agency event, or only a form completion compliance task. You must make it a way of thinking”.

Safety Decision

Safety Threats

Protective Capacities

Child Vulnerability

A Framework for Safety Decision-Making

Source: Morton, T. & Salovitz, B. (2006) “Evolving a Theoretical Model of Child Safety in Maltreating Families” Child Abuse & Neglect, Vol. 30, Issue 12, December 2006, pp. 1317-1327. 

Safe

• caregiver provides protective capacities sufficient to protect his/her child from serious harm

Unsafe

• caregiver does not provide protective capacities sufficient to protect his/her child from immediate or imminent serious harm

Safety Questions

1. safety threats present (serious harm)?

2. adult protective capacities and child vulnerability mitigate or aggravate?

3. child requires immediate protection?

Serious Harm vs. Safety Threats

• Cause or Association?

• Consequence or Manifestation?

Serious Harm

• Actual or threatened consequence of an active safety threat– Is life-threatening or risk thereof;– Substantively retards the child’s mental or

physical health or development or risk thereof;– Produces substantial physical or mental

suffering, physical disfigurement or disability, whether permanent or temporary, or risk thereof; or

– Involves sexual victimization.

Safety Threats

• Underlying conditions and contributing factors

• Behaviors, motives, perceptions, beliefs, conditions

• May exist within a caregiver, the family as a whole and/or the family’s ecology

Safety Threats Involve:Underlying Conditionsneeds of family members, perceptions, beliefs, values, feelings, cultural practices and/or previous life experiences that influence the maltreatment dynamic within a family system and can increase the likelihood of child maltreatment or its severity

AND Contributing Factors

social problems or conditions (family or community), that can increase the likelihood of child maltreatment or its severity

A Safety Threat May Be a…..

• Situation (e.g. unsafe home, criminal activity)

• Behavior (e.g. impulsive actions, assaults)

• Emotion (e.g. immobilizing depression)

• Motive (e.g. intention to hurt the child)

• Perception (e.g. viewing child as a devil)

• Capacity (e.g. physical disability)

Protective Capacities

• Capabilities, motives, perceptions, beliefs or emotions that can avert the impact of threats of serious harm

• May exist within a caregiver, the family system & its ecology

• May have racial, ethnic, religious or cultural influences

Vulnerability• degree to which a child can avoid, negate or

modify the impact of safety threats

• missing or insufficient protective capacities

 

Safety Decision Examples

A. Safe B. In-Home Safety Plan C. Out-of-Home Safety PlanD. Legally Authorized Out-of-Home Safety

Plan

Safety Plan

intervention strategy to control a safety threat or supplement insufficient protective capacities to protect a child from serious harm

Safety Planning Guidelines

• specific and concrete control strategy• must be implemented promptly• whenever possible, parent should have a role

in its development and implementation• should employ least restrictive strategies

possible while assuring the child’s safety

Safety Planning Guidelines • Can be developed and implemented by

incorporating identified protective capacities• must assess the caregivers willingness and

capability to agree and abide by the terms of the safety plan

• active participants must be capable of monitoring/enforcing its terms

Safety Plan Guidelines

• must be continuously re-evaluated and modified, whenever necessary

• cases should not be terminated, outside a court order, when an agency managed safety plan is active

Supplementation of Protective Capacities

The addition of additional protective capacities to the family system without removal of the child

Guidelines for Discontinuing a Safety PlanWhen a threat of serious harm no longer exists orcontrol of the threat within the family is

probable; can be maintained without safety focused intervention or active safety plan monitoring

Risk

• likelihood of any harm to a child in the future due to abuse or neglect

Risk Factors

• highlight the family system • may include demographics, needs, strengths,

safety threats, functioning levels• associated with understanding the nature of the

family’s involvement with the CW system (maltreatment, A/N history, underlying conditions & contributing factors)

• likelihood of future A/N

RISK is concerned with... SAFETY is concerned with...Assessing the likelihood of future harm; identifying the nature of the risk/safety issues

Assessing present danger

Decision making based on a time continuum

Decision making based on the present to the immediate near future

Harm on a severity continuum from mild to serious

Serious harm

Safety threat resolution; risk reduction through improved family system functioning; well being

Immediate protection; protective capacities supplementation

Safety and Risk FundamentalsSafety is a subset of risk. All safety concerns are risk

issues. Not all risk concerns are safety issues.

Service Plan

Intervention strategy designed to:resolve safety threatsreduce riskpromote child well-beingattain permanency

Treatment completion or attendance as a change proxy

Positive changes in parental behavior and attitudes might occur absent completion of treatment programs.

Critical Issues for Reunification/Case Closure

• Underlying conditions or contributing factors related to safety threats have been resolved/diminished

• Protective capacities have increased • Child vulnerabilities have been reduced• Feasible plan for reunification support exists

Predictors of Reunification

• Visitation record• Completion of substance abuse treatment

programs• Parent’s income; higher income leads to quicker

reunification• Stable housing• Age of child; babies reunify at lower rates• Behavior problems of child; behaviorally-

troubled children reunify at half the rate of children with few behavioral problems

“Children should be returned home when they are considered to be safe for the foreseeable future, not simply for the next 24-48 hours.”

A present danger orientation is not sufficient to answer the question.

ANY QUESTIONS?

Case #1: Cannon Family

1. Is the child safe from immediate and serious harm?

2. Is a safety plan needed?3. If yes, what plan is most appropriate?4. What else, if anything, would you want

to know to inform your decision?

Case #2: Adams Family

1. Should this case be opened for services and why?

2. Voluntary or Court Ordered?3. What else, if anything, would you want

to know to inform your decision?

Sample Family Case

1. Is this family ready for reunification and why?

2. If yes, what reunification support plan would you recommend, if any?

3. If no, what additional progress needs to occur?

4. What else, if anything, would you want to know to inform your decision?