1. Safety Planning in the Signs of Safety Framework Sophia Chin and Philip Decter Massachusetts Action Learning Group Family-Centered Services Project

2. Particularly want to thank… Andrew Turnell Sonja ParkerSusie EssexNicki Weld

3. Short Exercise Think about a time in your work when you or someone you supervised made a safety plan you felt really proud about – (perhaps it was one that was good enough for a child to remain in the community when they might have otherwise needed to be placed).  What was it about that plan that made it so successful?  What were the most important elements of that plan?  How did you know it was working?  How were you (or your supervisee) able to create it?

4. Safety Planning in High Risk Cases, Fabricated or Induced Illness, Susie Essex and Margaret Hiles. August 2008 This light globe seems faulty

5. Safety Planning in High Risk Cases, Susie Essex This light globe still seems faulty… …but now we’ve Installed a whole new lighting system!

6. Safety Plans are… DETAILED plans made in response to SPECIFICALLY identified dangers (behavioral and action driven) A process, not an event Family, network and child-friendly A method for keeping children safe and a change strategy An aspiration, not a guarantee The focus should be on creating guidelines that make contact between the children and the potential danger transparently safe at all times

7. Insight and Safety Are Not The Same Thing Turnell: “Complete or substantial agreement on the maltreatment and it’s causes may not be possible but this does not mean families and parents will not work toward improving the safety of their children.” “Acknowledgement of responsibility, while preferred, is neither a sufficient or necessary condition of safety.”

8. A paradigm shift? INSIGHTACTION

9. A paradigm shift? INSIGHTACTION

10. A paradigm shift? INSIGHTACTION The best predictor of future maltreatment…past maltreatment. The best predictor of future acts of protection…past actions of protection. The sooner caregivers start demonstrating new protective actions that respond to the danger/worry…the better!

11. Guided by the critical question: If there is a danger, what is family and network willing & able to do about it?

12. A new way to think about safety planning?

13. Safety Planning Process

14. Safety Mapping Harm/Danger Statements These are the dangers that the safety plan needs to address. “CFY are worried that Grandpa will touch Katie and Toni’s private parts and ask them to touch his private parts.”

15. Safety Planning Process Safety Mapping Harm/Danger Statements Goals are the WHAT of future safety. WHAT the family will be doing differently to address the dangers “Mom and Dad will work with CPS and a safety network (of family, friends and professionals) to develop a safety plan that will show everyone that Katie and Toni will never be alone with grandpa and that there will aways be a safe adult present Safety Goals

16. Safety Mapping Harm/Danger StatementsSafety Goals Safety Planning Process The safety plan is the HOW of the future safety. HOW the family will achieve the safety goals. “Mom and Dad will work with CPS and a safety network (of family, friends and professionals) to develop a safety plan that will show everyone that Katie and Toni will never be alone with grandpa and that there will aways be a safe adult present Safety Plan

17. Key Principles of Safety Planning It takes a village to raise a child. Relationships, relationships, relationships! Safety Planning is a journey not a product. The journey needs direction! SAFETY = specific behaviors that directly address the dangers. A list of services that parents will attend is not a safety plan! Involve the children. The bottom line is agreement about what future safety is.

18. Safety Mapping Harm/Danger StatementsSafety Goals Enhancing Safety Networks Safety Planning Process Family and community members form an expanded safety network to help the family move closer to a bottom line of enhanced safety for children.

19. Developing The Plan: Helping the family/network think their way to actions Create a clear set of guidelines that all agree with by… Orienting the family/network Coming Prepared Elicit the Family’s Vision Asking good questions Including monitoring and feedback loops Presenting it to the children

20. Safety Planning Process Safety Mapping Harm/Danger Statements Safety Goals Safety Plans Enhancing Safety Networks Safety Guidelines

21. Guidelines in your Safety Plans Detailed actions of both the caregiver and the network that ensure the danger statement and safety goal are being addressed; The “how” of future safety; Created with the family/network (although can be drafted by CPS); and Used as a way to have everyone ‘think through’ all the ways protection needs to be demonstrated over time.

22. 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

23. What are we worried about? 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.

24. What are we worried about? Kim: "I'm doing what I need to do and don't know why my son has not been able to come back yet!" Kim: "I'm worried about my son growing up without his mom and want him back.” Kim she appreciates her sisters help but that Donna can be "a know it all" and that it's hard to work with her sometimes on Paul's care

25. What’s going well? Kim reports she has been clean and sober for 4 years before this incident - a report supported by her sister Donna - during which time Paul has come to school clean, on time and with his work done In her past work with the department, Kim worked with her worker, a home-based outreach team, went into drug treatment, and ensured that Paul came to school and was appropriately clothed and bathed Paul was able to go into a kinship foster placement with his Aunt Donna and her wife Ann. He was able to stay in the same school system and it is reported by Aunt and school guidance counselor that he continues to "thrive" despite these changes. Kimberly had made a plan with Donna in the past that if anything were to happen to her Paul should go to stay with her.

26. What’s going well? Kim has attended drug treatment in the past including detox (more than five times) and inpatient substance abuse treatment (2x before this incident ). She completed an inpatient stay after this incident and reports now that will again begin to regularly attend NA meetings. Donna and Ann have been helping Kim financially and report they are willing and able to continue to do so. Kim is in individual treatment and has been regularly attending. She reports that she takes her Ritalin and Celexa regularly. Kimberly: "I want Paul back and will do whatever it takes to make that happen.” Paul: "I love my mom and want to be back with her.” Donna and Ann: “Kim is a great mom. She had been doing really well and we think she can be clear and sober again.” School: “We hadn’t seen any problems since Paul has been at this school.”

28. Kim and Paul: Danger Statements Who is worried Potential caregiver actions Potential future impact on child

29. Kim and Paul: Danger Statements DCF, Donna, Ann and the treatment team at the hospital are worried Kim might use heroin again while she is caring for Paul, might not be able to care for him and that he could get serious hurt or injured as a result. DCF, Donna, Ann and Kim are worried that Kim may continue to struggle to find a job, that she may get depressed as a result, start using drugs again and that Paul could get hurt. Kim, Donna, Ann and Paul are worried that DCF won’t see all the good things Kim is going and won’t be willing to have Paul come home again.

30. Kim and Paul: Safety Goal (aka Case Plan Outcome Statement) Caregiver Who else is a part of the plan What action has to be taken to address the danger?

31. Kim and Paul: Safety Goal (aka Case Plan Outcome Statement) Kim will work with DCF, Donna and Ann to develop a plan that will show everyone that she will always be drug-free when she is caring for Paul, and that if she does think she will relapse that she will ask for help from Donna and Ann to ensure Paul stays safe.

32. Safety Guidelines (for visitation)

33. Donna, Ann, landlady Trina and therapist Sam all agree to be a part of the Kim and Paul’s safety network Kim agrees to stay drug free whenever she is caring for Paul. Kim will begin supervised visits with Paul at Donna’s home with either Donna or Ann there at all times. Donna and Ann agree to cancel the visit and call DCF if they are worried Kim is using drugs again. Reasons for canceling the visits include if Kim has slurred speech or if she is just acting “stupid”. If Kim feels like she is going to use, she agrees to call Donna, Ann or Trina. Donna, Ann and Trina all agree to call DCF in these cases.

34. Safety Guidelines (for visitation) Kim will continue to see Sam for individual treatment. Kim has given Sam permission to call DCF if he is worried she is using drugs again or if she does not come in for an appointment. Kim agrees to work with Sam on a ‘words and pictures’ to help Paul better understand what is happening. DCF will refer Kim to a job placement program Kim agrees to give NA at least one more try DCF, Kim and the Safety Network agree to review this plan again in 4 weeks.

35. Developing Child-Participatory Ongoing Safety Plans

36. Importance of including children Engaging with children in the work helps makes children’s voices and perspective a meaningful part of the process Understand that children are likely witnesses to all that goes on in a house and therefore…  Children’s perspectives are vital to gathering information about what is happening…therefore children need to be our partners in assessment  Children can be, and often need to be, partners in their own safety planning

37. Case Example from Sonja Parker in Perth, Australia 1 year ago Mom Dad Amelia 8 Alexandra 6 Rebecca DCP substantiated sexual abuse of Amelia by Dad 1 year ago, which involved Dad touching Amelia’s vagina and putting his fingers inside her vagina. Dad has participated in multiple treatments and providers are saying OK to move ahead with supervised visits. Dad wants to visit with his children and both girls want to have contact with their dad.

38. by Sonja Parker aspirationsconsultancy.com

39. Safety Plan from Carver County, MN

40. Some Final Thoughts

41. All safety plans should consider the following:

42. Details to Consider in Creating Your Plans Neglect: Detailed exploration of the “neglect” and how it shows itself (remember: Impact on the child!) Careful considerations of the previous times, events and triggers that have led up to that neglect Specific routines that need to be in place that will allow everyone in the network to consider the child safe

43. Details to Consider in Creating Your Plans Physical abuse: Agreed upon methods for disciplining children especially in challenging situations or in the kind of situations that have led to abuse in the past Plans for caring for the children during stressful times (morning, bedtime, getting out the door, etc.) “Rough-house” play between parent and between different children Guidelines for what parents/caregivers can do when they begin to notice themselves “loosing it”

44. Details to Consider in Creating Your Plans Sexual abuse: Creating a plan that ensures the alleged perpetrator will never be alone with the child Plans that address the child’s privacy:  Dressing and undressing  bathroom + bathing time  Guidelines that directly physical contact (who, what, where, when)

45. Monitoring the Plan: Tools of the trade

46. Some Cautions Safety Plans are only words on paper Real work comes in creating, implementing, monitoring and adjusting them as time goes on Important to expect them to develop and change over time “Care and Courage.”