Georgia’s Safety Response System Presenter: Lisa Lariscy GA DHS/DFCS Project Director, Safety Response System and Differential Response Presentation to: G-2 Date: April 03, 2014 Georgia Department of Human Services

Vision, Mission and Core Values Stronger Families for a Stronger Georgia. Mission Strengthen Georgia by providing Individuals and Families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults. Core Values Provide access to resources that offer support and empower Georgians and their families. Deliver services professionally and treat all clients with dignity and respect. Manage business operations effectively and efficiently by aligning resources across the agency. Promote accountability, transparency and quality in all services we deliver and programs we administer. Develop our employees at all levels of the agency.

SRS Presentation Objectives Georgia’s Safety Response System Origin of SRS Defining SRS Implementation Process for SRS Status of Statewide SRS with a View of Phase One: Intake Going Forward with SRS

Technical Assistance ACCWIC NRCCPS GEORGIA Develop and implement our child welfare practice and to facilitate organizational change GEORGIA ACCWIC NRCCPS Build Georgia’s capacity to implement and engage resources to support a significant child welfare practice change to ensure fidelity and sustainability to that practice change - Atlantic Coast Child Welfare Implementation Center (ACCWIC) As you are aware, GA brought in two entities to work with us several years ago… Provide child welfare subject matter expertise to strategically support Georgia in utilizing the latest state of the art child welfare practice framework focused on safety of children – National Resource Center for Child Protective Services (NRCCPS) Adopted from Action 4 Child Protection 4

Two Evidence-based Models National Safety Model Policy consultation, Live Learning Sessions, Intensive Training Academy Open-source website to support continued learning Evidence based safety intervention model Implementation Phases & Drivers Framework Also used by the CB and its T/TA Network Regional teams trained, Pilot Counties immersed Open-source website to support continued learning As a result of working with these two entities, we adopted two evidence based models… http://nirn.fpg.unc.edu http://action4cp.org Adopted from Action 4 Child Protection

Georgia Safety Response System* Allows for and guides strategic decision making for the safety of children. Intake Assessment /CPS Reports - A comprehensive Information gathering and analysis process used to determine the most appropriate agency response to an accepted CPS report. Through initial and ongoing contacts with the family, a comprehensive safety assessment is conducted. At any time a safety concern is identified, it is addressed through the most appropriate safety management practice (in home/out of home). Safety Plans are created to control the threat of danger to the child. A formal caregiver assessment is conducted to identify what must change with the caregiver(s). Services will be provided that focus on enhancing the caregiver’s diminished protective capacities. *Adopted by Action 4 Child Protection Adopted from Action 4 Child Protection

Implementation Science* DRAFT 4/21/2017 Allows for, and helps make informed strategic decisions for: Training, Supervision, Coaching Internal and External Collaboration/Coordination Feedback from practitioners and stakeholders Perspectives from all levels of the organization are heard Managers use data to guide implementation and align resources to support needed improvements Ensures fidelity and sustainability to the child welfare practice change Implementation Science focuses on People and Processes… County directors establishing regular communication with MR Reporters. MR Reporter providing feedback about the information they are providing and DFCS educating them re: the information we need. In working with our two pilot counties we have weekly calls and conduct live learning sessions with them in regards to the model. One of our pilot counties who doesn’t have resources, we are working to build more resources. They will have services as of April 1, that can be used in family support and investigations. We have conducted fidelity reviews in the pilot and will have another in May. We want to be able to sustain this practice over time regardless of the environmental changes. Funding, leadership changes. *Adopted from the National Implementation Research Network Adopted from Action 4 Child Protection 7

Implementation Drivers Performance Assessment Systems Intervention Coaching Competency Drivers Organization Drivers Facilitative Administration Training Selection Integrated & Compensatory Refer to Handout; Highlight those that we have “met” or have ‘in place”.. Discuss those that are needed. Data Driven Decisions Leadership Adaptive Technical Graphics by Steve Goodman,2009 (Fixsen & Blase, 2008) Leadership Academy for Middle Managers • www.ncwwi.org A Service of the Children’s Bureau, a Member of the T/TA Network 8

Stages of Implementation Sustainability Innovation Full Operation Initial Implementation Installation Exploration The Pilot Work in one stage might overlap with another, activities should build on each other, and it is ok to revisit activities that were thought to be finished or make other adjustments. We are in initial implementation with SRS Intake; installation stage with our other programs in the pilot counties… Ongoing learning, a long-term perspective, and commitment to the long haul are needed. Overall, however, the stages and the work carried out within them (if they are specific and purposeful as NIRN teaches) are intended to get us “from here to there.” Adopted from Action 4 Child Protection

SRS Statewide Roll Out Scenario Implementation Science Phase 2011 September 2013 December 2014 February 2015 2016 June 2017 Exploration and Program Design √ Project Installation (Includes committee variation to meet project phases) Initial Implementation (Staff are trained and begin practicing at the frontline ) Full Operation (Learning is integrated into practice policies and procedures) Innovation (Well informed changes can be made) Sustainability (Strategies to Support Leadership & Practitioner Changes) As you can see, Georgia DFCS will implement our Safety Response System in three phases. Phase One- Intake, Phase Two…… On the left side of this visual you will see the various stages of Implementation… Exploration – As you can see, in 2011 we were in the exploration stage of this project. We clearly had identified the need for intervention/change in early of 2011 and explored for several months which child welfare practice would give us the highest level of ensuring the safety of children. Additionally, we wanted to ensure that this child welfare practice change would be done correctly and would sustain over time with quality. Project Installation In 2011 we specified our goal—a safety intervention model, to be called Georgia’s Safety Response System, with a full differential response—having not only an investigative response to an accepted CPS report but also having a non-investigative response to accepted CPS reports. We aligned our organizational structure to support implementation of the Safety Response System in December 2011, naming a Project Director who remains as such and forming committees to support the SRS implementation. As shown in this visual of statewide roll out, we began initial implementation of intake in September of 2013, and will implement Family Support and Investigation in early 2015 ; and Family Preservation and Foster Care in late 2015. As each of these programs are initiated, assessing the agency climate to monitor our safety intervention practice transition and collecting and analyzing fidelity data will be crucial to maximize fidelity to the SRS. Full operation, for intake by late this year will consist of staff proficiency in the SRS model and the SRS practice being the standard. Additionally, managers and supervisors would be facilitating fidelity to the SRS with front line staff. During the Innovation Stage, careful consideration must be given to differentiate between planned changes to the SRS model/practice and staff drifting from the SRS practice. Purposeful changes to the model would only occur based on evaluation findings, established feedback loops, and new knowledge about the practice. Sustainability of the Safety Response System will require a sustainability plan to include continued monitoring of the safety intervention practice, supporting mid-management, ongoing connection with internal and external stakeholders and planning for environmental changes such as changes in Leadership and changes in funding streams. (i.e. Three Division Directors and two DHS Commissioners since we began our child welfare practice change.) Questions? SRS Phase 1 : Intake SRS Phase 2: Family Support & Investigation SRS Phase 3: Family Preservation & Foster Care Adopted from Action 4 Child Protection

Pilots’ Contribution to a Successful Implementation Avoid sink or swim scenario. Detect and trouble shoot the unexpected issues that could sink the change initiative. Practice turning “intention into action” on a smaller scale. Experiment with innovations without the pressure to predict every twist and turn in the change process. Increase awareness that change does not happen all at once. Instill confidence that the process of change can be managed responsibly. Feed lessons learned on what works/does not work back to implementation planners and decision-makers.

Georgia’s Safety Response System Status of SRS Pilot Status Statewide Status

SRS – Pilot and Statewide SRS Pilot Counties Selected: Richmond/Urban/NE and Sumter/Rural/SW SRS Counties Began Piloting the Model in Intake, Family Support and Investigations 09/2012 SRS Counties Began Piloting Family Preservation and Foster Care 10/2013 (ongoing with challenges) SRS Phase One: Intake – began initial implementation in 09/2013 Adopted from Action 4 Child Protection

Implementation Capacity 60 item survey sent to pilot county and regional staff, state implementation team, state quality assurance and training Reflects staff perception of implementation capacity N=67, 45% response rate

Implementation Capacity Performance Assessment (Fidelity) 3.20 Coaching 3.49 Systems Intervention 3.60 Live Learning 4.08 Facilitative Administration 3.45 COMPETENCY 3.98 ORGANIZATION 3.66 Training 4.52 Decision Support Data System 3.88 60 item survey sent to pilot county and regional staff, state implementation team, state quality assurance and training during Feb & March 2013 Reflects staff perception of implementation capacity N=67, 45% response rate Successes Strong sense of shared vision, mission and values Strong leadership at the state and field level is being demonstrated and acknowledged SRS training - still leaving room for improvement! SRS live learning Areas that Require Continued Focus Improving staff selection and coaching would improve competency scores Improving facilitative administration and external stakeholder relationships would improve organizational support goals Performance Assessment - Staff may benefit from more regular feedback regarding their strengths and the skills they need to develop to implement SRS with fidelity Selection 3.84 LEADERSHIP 4.40 Based on a Likert Scale of 1-7, N=64 Shared Vision, Values & Mission 5.15

SRS Capacity Built as of March 2014 Statewide policies are being informed by pilot and core group of SRS Specialists 73 SRS Specialists Safety Response System Academy training – Ongoing Implementation Science training established SRS Fidelity Review tools for Phases 1 and Phase 2 established These academies are intensive 8 day trainings, with follow up activities to support transfer of learning. Adopted from Action 4 Child Protection

SRS Statewide Implementation A View of SRS Phase One: Intake Adopted from Action 4 Child Protection

Intake Assessment This is the first assessment of safety in Georgia’s Safety Response System. The Intake Assessment is a comprehensive information gathering and analysis process used to determine the most appropriate agency response. Objectives Assist reporters to provide behaviorally specific, detailed information Identify present and impending danger, vulnerable children, and diminished caregiver protective capacities Determine the response time Provide resource information Adopted from Action 4 Child Protection

The SRS Intake Process Engagement with the Reporter Obtain as much information as possible Document Reporter's Specific Concerns . What is the reporter trying to get across concerning potential abuse and/or neglect of the child? Expand on vague allegations & ask probing questions Consider the six areas of Family Functioning & ask specific information of the reporter regarding the children and family Ensure that all basic information has been collected from the reporter. Review and Application of History ●Complete Screenings on known household members and/or caretakers ●Consider information obtained ●Does CPS history and this report indicate an escalation in types of maltreatment, frequency of allegations.... Does this report when combined with historical knowledge of the family rise to the level of maltreatment as defined by GA Code and DFCS Policy?

The SRS Intake Process Yes Child Safe – Family Support Assignment Five Day Response Child Unsafe – Investigation 0 to 24 Hours Response

The Intake Assessment Six Areas of Family Functioning 1. Extent of Maltreatment Captures the description, type and severity of maltreatment alleged Additionally captures the reporter’s knowledge of events (first-hand/eyewitness, 3rd party, etc) Identifies the alleged Maltreator For all intakes

The Intake Assessment 2. Circumstances Surrounding the Maltreatment What was happening when the maltreatment occurred? Does the caregiver have an explanation? Acknowledgement, what were their attitudes & intentions Captures history of past CPS involvement patterns of maltreatment Identifying any progressing patterns of severity Identifies any protective measures taken by the non-maltreating caregiver

The Intake Assessment 3. Child Functioning Captures day to day functioning of EACH child, whether identified as a “victim child” or “no role” What is each child like normally? Captures developmental concerns Effects of maltreatment (emotional, psychological, physiological) How is the child at the time of the report? Will the child’s situation change quickly (safe at school vs. unsafe when arriving home?) School? On grade level? Regular classes? Crucial in determining vulnerability of child

The Intake Assessment 4. Adult Functioning (in general) How does this Adult (maltreator and non-maltreator, if applicable) function as an adult? Captures mental and physical health (both current and past) Identifies substance use, employment, criminal behavior/history Indications of violence Significant stressors present in home How does this adult relate to his community? How does the adult cope, problem solve, communicate, etc?

The Intake Assessment Parenting (in General) Captures history of protective behavior (or non-protective behavior), along with parenting style (Not related to malt.) Identifies sensitivity to child’s needs and expectations for both the child and self Is the parent satisfied as a parent? Is the parent more concerned with self than with child? What knowledge does the parent possess of normal child development and behavior? How would you describe the parent/child relationship? What are expectations for the child? Do not gather for foster parents or house parents of CPA/CPI)

The Intake Assessment 6. Discipline (in general) Captures parent’s approach to discipline Identifies parent’s purpose and intention in discipline Identifies parent’s specific discipline methods Does the parent remain self-control when using discipline? Is discipline used to punish or to teach? Is the discipline age-appropriate? What boundaries/rules has the parent set? How does s/he discipline the child? When does child receive discipline? Do not gather for foster parents or house parents of CPA/CPI)

The Intake Assessment History History can often be the tipping point--the point at which we say yes, this is now an accepted report or moves us from a family support assignment to an investigation. A thorough review of history and application to the decision making is essential to determine appropriate disposition. The review of history and application of that history to the current report takes time. Give Examples of two cases… 1) where we accept based on history o and 2) we assign to investigation instead of family support. Adopted from Action 4 Child Protection

Status of SRS Phase One Intake All Intake Staff Trained as of 12/2013 SHINES Modifications Identified SRS Specialists Support Activities: Provided Live Learning Activities On-site Support for Intake Staff statewide Provided individual coaching with Supervisors and intake staff Reviewed approximately 7000 intake dispositions Detailed written feedback on dispositions overturned This includes CICC Daytime Afterhours and regional intake units Adopted from Action 4 Child Protection

Status of Intake Organizational Change CICC Management In Place as of 12/2013 Electronic Reporting for Mandated Reporters in place County/Region Phone Line Transition Process Established Regions 3,4,5,7,8, 9, 13,14 & 15 transitioned to CICC Integrated Voice Recorded Message Volunteers in Place to Support Staffing Need Formal performance expectations inclusive of Georgia’s Safety Response System concepts and practices developed and executed for intake staff. This slide shows the status of the organizational structure change as it relates to the intake program and staff. These issues are solely focused on the current intake structure transitioning to a centralized intake management structure. Major organization change IVR with expansion to come? This is done as intake workers transition from the county to the CICC and as new people are hired. Adopted from Action 4 Child Protection

SRS Specialists Reviews – 11/09/13 – 2/9/14 Adopted from Action 4 Child Protection

SRS Specialists Review Results 68% agreement with disposition with the Intake Fidelity Review in the pilots.. However this was not a fidelity review but stretching it one can make some comparisions.. 88% qnd 78% with PD/ID, respectively in the pilots.. Adopted from Action 4 Child Protection

Questions regarding SRS Intake? Analysis of Reviews 88% agreement rate for ~ 7000 cases. Activities under way to enhance understanding and practice of SRS intake concepts related to Present and Impending Danger Maltreatment types and codes being revised to better guide staff in identifying maltreatment and to allow for consistent practice SHINES History modifications being made to allow for more efficient screening of CPS history Questions regarding SRS Intake? Application of Maltreatment types is inconsistent across the state and that is being worked to be corrected. These finding really do mirror intake pilot feedback what we found with them when conducting a fidelity review overall they had a 72%. Composite information collection, screening and identification of safety Adopted from Action 4 Child Protection

Georgia’s Safety Response System Going Forward with SRS SRS Phase Two: Early 2015 SRS Phase Three: Fall 2015

Going Forward with SRS Phases Two & Three Lessons Learned from SRS Phase One: Intake Policies Finalized prior to Training and/or SHINES Design Sessions SHINES Modifications Made Prior to Roll Out of Future Phases Continual Review of IS Drivers’ Effectiveness & Identifying Gaps & Ways to Address (Surveys, Review Findings, Data..) Ensure Knowledge Capacity in Place Prior to Roll Out Plan of Initial & Ongoing SRS Specialists Support Prior to Roll Out Structured Collaboration with Regions through IS Region Plans

Going Forward with SRS Phases Two & Three Adequate Staffing in Place Prior to Roll Out Strategy to ensure SRS Specialists are Understanding and Applying the Model Effectively Advocate for and Obtain Funding for Fidelity Review Team Ensure Effective Staff Recruitment, Selection and Development

Preparation for Phase 2 & Phase 3 Implementation Science Training Regions to develop Implementation Plans Staff Acquisition and Training SRS Project Team to support the pilot work SRS Specialists will continue to meet monthly and enhance their capacity and cascade learning SRS Academies are currently planned on an consistent ongoing basis to build capacity and model expertise

SRS Concepts for Readiness Activities Family Functioning Assessment The six areas in the FFA What information is needed in each area? Maltreatment – new policy Caregiver Protective Capacities (three types) Analyzing the family’s functioning Present Danger Understanding what constitutes a PD Situation How to Assess for Present Danger Safety Criteria – observable, happening now & significant

SRS Concepts for Readiness Activities Present Danger Safety Plan Understanding the purpose of the PD Safety Plan How to Plan Appropriately for Controlling the Present Danger How To Use the PD Safety Plan appropriately Informal & Formal Safety Service Providers Judging Provider Suitability Conditions for Return to the Home of the Caregiver

SRS Concepts for Readiness Activities Impending Danger Safety Plan Understanding the purpose of the ID Safety Plan How to Plan Appropriately for Controlling ID Informal & Formal Safety Service Providers Judging Provider Suitability Conditions for Return Impending Danger Understanding Impending Danger Use and application of the safety threshold in assessing for ID

SRS Concepts for Readiness Activities Identification of appropriate collaterals Using collaterals to fill in family functioning gaps & to support/refute information Analysis & Understanding of the Family’s Functioning Determining service providers to strengthen families Stages of Change Assessing Change

Safety Response System Project Team Lisa C. Lariscy Project Director, Safety Response System and Differential Response lclariscy@dhr.state.ga.us (912) 222-5296 (BB) Kristan Small-Isom Safety Response System Coordinator Krsmall@dhr.state.ga.us (404)463-8575 (Desk) Ami Perryman Safety Response System Coordinator ajperryman@dhr.state.ga.us (706) 994-9104 (BB) Fill in your contact info/name ….