489 Mt. Auburn Street Watertown, MA Phone (617) Facilitated Safety Organized Practice Integrating Practice and Decision Support Tools: Signs of Safety and Structured Decision-Making Facilitated by: Phil Decter & John Vogel

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, Working with ‘Denied’ Child Abuse by Andrew Turnell and Susie Essex, Open University Press, 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: ENGAGEMENT: Solution Focused Interviewing Solution Focused Interviewing Strategies for Interviewing Children Strategies for Interviewing Children CRITICAL THINKING: CRITICAL THINKING: Safety Mapping Safety Mapping ENHANCING SAFETY: ENHANCING SAFETY: Harm + Danger Statements Harm + Danger Statements Well-Formed Goals Well-Formed Goals Building Safety Networks Building Safety Networks Safety Planning 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, judgment- loaded 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)? Best Available Research Practitioner Judgment and Expertise Client characteristics, values and preferences BEST OUTCOMES Environment and organizational context Adapted from Institute of Medicine, 2001

Integrated practice SoS Strength based, solution focused SDM Research Consistency Focus SoS Inquiry Engaging SDM Research- supported decision guidance

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 SDM and SoS make it easier…

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? Overall SDM and SoS Linkages

What can this look like?

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? SafetyThreats 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? Both SDM and SoS start with inquiry:

Complicating Factors: Safety:Harm and Danger: Strengths The next step: Linking the kinds of questions we ask

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 Why a map and an Assessment?

OPEN : Brainstorming to gather a broad, wide-open set of responses-Seek multiple perspectives NARROW : Focused inquiry to provide clarity and details: Seek understanding and agreement CLOSE: Resulting understanding and agreement for plan of action. Stages of a Dialog Integrating the map and the Assessment

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 are the worries?

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 is working well?

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?) What needs to happen next?

OPEN Facilitative Behaviors to gather information Check for understandingCheck for understanding NARROW Strategic and Critical Thinking to organize information Check for agreementCheck for agreement CLOSE Collaborative Attitude to select the best approach and reach agreement What are the worries?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  Develop shared agreement about the nature and severity of the problem  Agreement about an agency Danger Statement  Understanding of the Safety Level What works well?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  Develop Safety Goals  Specify Acts of Protection  Describe Supporting Strengths  Protective Capacities What needs to happen?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?  Understanding of RISK LEVEL  Clear expectations of the actions that network members will take.  Safety Plan/Service Plan  Reunification Plan, Implementation Plan Facilitative Framework for Integrating SofS & SDM

How do you do this?

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 Facilitative Practice

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 Purpose Context Group Agreements Network/Stakeholders Desired Outcome Content Next Steps +/∆ Why? What? How?

Stage of the meetingKey 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? A structure for facilitated dialog

Stage of the meetingKey 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? Mapping “with” SDM

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 Integration Involves:

Clinical Vignette Kim 32 ? 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. 10 Donna 39 Ann 40 Paul

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

Signs of Safety Solution Focused Interviewing Solution Focused Interviewing Strategies for Working with Children Strategies for Working with Children Safety Mapping Safety Mapping Danger Statements Danger Statements Safety Goals Safety Goals Building Safety Networks Building Safety Networks Safety Planning Safety Planning Structured Decision-Making Safety Assessment Safety Assessment Risk Assessment Risk Assessment Family Strengths and needs assessment Family Strengths and needs assessment Risk Reassessment Risk Reassessment The combined elements

Current PracticeIntegrated 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 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 Before and after: What does practice look like?

The tools available The way the process is organized High emphasis on child, family & community participation in all aspects of the work So what changes?

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 Summary