Transcript SD Module 6 - Bay Area Academy

Integrated
Safety-Organized Practice
Module Six:
Harm Statements,
Danger Statements,
and Safety Goals
Children’s Research Center
A nonprofit social research organization and division of the
National Council on Crime and Delinquency
www.nccdglobal.org
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www.nccd-crc.org
Our Thinking Draws From
the Legacy of Others
Insoo Kim Berg
Steve de Shazer
Rob
Sawyer
Andrew Turnell
Sue
Lohrbach
Susie
Essex
Steve Edwards
Nicki
Weld
Sonja Parker
Carver
County
CRC Staff
John Vogel
Sophia Chin
Heather Meitner
…and we hope YOU will continue to build
on these ideas and approaches.
2
Safety-Organized Practice
Safety is:
Actions of protection
taken by the caregiver
that mitigate the danger
demonstrated over time.
Adapted from Boffa, J., and Podesta, H. (2004) Partnership and risk assessment in child protection practice,
Protecting Children, 19(2): 36–48. Turnell, Andrew & Susie Essex Working with Denied Child Abuse, Open University Press, 2006.
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Agreements
•
•
•
•
•
“Try on.”
•
We agree to disagree and avoid making assumptions
or generalities.
•
We agree to allow others to finish speaking before we
speak and avoid interrupting and side conversations.
•
We will work together to hold to these agreements
and authorize the trainer to hold us to them.
Everyone always has the right to pass.
Silence is a contribution.
We agree to share airtime and stick to time limits.
We agree to speak personally, for ourselves as
individuals.
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Module
Subject
1
Interviewing for Safety and Danger
2
Three Questions to Organize Your Practice
3
Small Voices, Big Impact: Keeping Children at the Center of the Work
4
Solution-focused Inquiry
5
Introduction to Mapping
6
Harm Statements, Danger Statements, and Safety Goals
7
Mapping With Families
8
Safety Networks
9
Safety Planning
10
Landing Safety-Organized Practice in Everyday Work
11
Organizational Environments: Reflection, Appreciation, and Ongoing
Learning
12
Summary and Looking to the Future
5
Agenda
• Harm Statements
• Danger Statements
• Safety Goals
• Use with Families
• Linking SDM and Danger Statements and Safety
Goals
• Let’s Practice!
6
The Safety-Organized Practice
Process
Mapping/SDM Assessments
Harm and Danger Statements
Safety Goals
Enhancing Safety Network
Safety Plan Guidelines
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Essential Question
Are the children safe?
What Are
the Worries?
SFQ’s
Impact
Detail
Position
Sort
SDM
What’s
Working
Well?
What
Happens
Next?
SFQ’s
Impact
Detail
Position
Sort
SDM
SFQ’s
Impact
Detail
Position
Sort
SDM
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Checking In
•
What have you tried from the
module last month?
•
What worked well?
•
What were your challenges?
•
How did you handle those
challenges?
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Let’s Get Started!
• Think of a family you or someone you know is
working with now or in the recent past who has
been involved with CWS between six months and
ten years.
• How confident are you that you can state exactly
why the family is involved with CWS?
• How confident are you that the FAMILY
understands and can state exactly why the family
is involved with CWS?
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Let’s Get Started #2!
• How confident are you that you can state
EXACTLY what the family needs to do
differently so you will know the children are
safe?
• How confident are you that the FAMILY
understands and can state what needs to
happen so that everyone knows their children
are safe?
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Definitions
•
Harm Statements: Clear and specific statements
about the harm or maltreatment that has happened
to the child.
•
Danger Statements: Simple behavioral
statements of the specific worry we have about this
child now and into the future.
•
Safety Goals: Clear, simple statements about what
(not how) the caregiver will DO that will convince
everyone the child is safe now and into the future.
These are little gems of clarity.
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What’s It All About?
DANGER STATEMENT:
What we worry will happen next
HARM STATEMENT:
What already happened
GOAL STATEMENT:
What we hope happens instead
NOW
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What’s It All About?
DANGER STATEMENT:
Why we need to STAY involved
HARM STATEMENT:
Why we GOT involved
GOAL STATEMENT:
What will tell us we can STOP
NOW
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Value of Harm, Danger,
and Goal Statements
*Turnell, A. and Edwards S. (1999). Signs of Safety. New York: Norton
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Moving to Best Practice
While creating harm
statements, danger
statements, and safety goals in
the office is a great place to
start, EXTRA VALUE comes
when we can co-create these
with families!
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Harm Statements
Who says (or it
was reported)
What caregiver
actions/inaction
It’s essential to get agreement from the person before
using his/her name in a harm statement.
Impact on the
child
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The Question That the Harm
Statement Answers
“What exactly has been reported that the
caregivers did to hurt the children physically,
developmentally, or emotionally?”
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Harm Statements
Clear and specific statements about the harm or
maltreatment that has happened to the child.
It was reported
Caregiver
actions/inactions
Impact on the
child
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Harm Statement Example
Doctor Bones reported that Adam’s dad, Matt, hit
Adam several times with an open hand and a
closed fist last Sunday, causing several bruises on
Adam’s head and back.
It was reported
Caregiver
actions/inactions
Impact on the
child
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Harm Statement Tips
•
•
•
The harm statement needs to include
specific details: who has reported the
concern (when it is possible to share
this), what exactly happened, and the
impact on the child.
They should be written in honest,
detailed, non-judgmental “just the
facts” language.
Screener narratives could include a
provisional harm statement based on
the facts marked on the SDM
screening tool.
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Harm Statement Practice
Wendy, age 4, runs around her apartment complex during
the day while her mother, Beth, sleeps. The apartment
manager recently found her playing with glass from a
broken window. Wendy’s right hand was cut from the glass,
requiring stitches.
It was reported
Caregiver
actions/inactions
Impact on the
child
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Danger Statements
Who is worried
About what
potential caregiver
actions/inaction
Possible impact on
the child
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The Question That the Danger
Statement Answers
“What is CWS most worried will happen to the
children if they are in the care of their parents
and nothing else happens to mitigate the
danger?”
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Danger Statements
Simple behavioral statements of the specific worry
we have about this child now and into the future.
Who is worried
Potential
caregiver
actions/inactions
Potential future
impact on child
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Danger Statement Example
CWS, Doctor Bones, the police, and Adam’s mom,
Tonya, are worried that Adams’ dad, Matt, may hit
Adam again, leaving him with bruises and even
more serious injuries.
Who is worried
Potential
caregiver
actions/inactions
Potential future
impact on child
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Danger Statement Uses
•
•
Danger statements clearly identify what the professionals are worried
may happen if there are not enhanced actions of protection by the
family and network.
Sharing danger statements with the family (and within the agency!)
helps create a sharpened focus on the key issues that need to be
addressed so the family can make changes and demonstrate actions of
protection. This can also prevent “case drift.”
Who is worried
About what
potential caregiver
actions/inaction
Possible impact on
the child
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Danger Statement Tips
•
•
•
•
Be real. If you raise the stakes, don’t
get carried away.
They should be written in honest,
detailed, non-judgmental “just the
facts” language.
If no harm already happened, the
danger is about what ALMOST
happened, or is LIKELY to happen,
based on caregiver actions.
SDM safety assessment items that were
marked could be resources for ideas on
what we are worried about.
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The Value of
Danger Statements
Internally:
• Enhanced clarity in our own thinking as we start
to think about our cases.
• Greater clarity as cases get moved from one unit
to another.
• Helps facilitate discussions between supervisor
and worker, manager and supervisor, perhaps
even legal and clinical!
• A process, not an event, and can be refined over
time.
Danger Statements &
Genograms are like
vital signs at shift
change in the hospital.
“what stands out to me about these harm and danger statements are no beating around the bush,
and everything is out on the table.”
- New worker just practicing H+D statements
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Crafting the Statements
•
•
•
•
•
Use the formula (But
don’t get stuck in it!)
Behavioral detail
Family language
Impact on child
Make sure all
concerns are listed
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Danger Statement Practice
Wendy, age 4, runs around her apartment complex during
the day while her mother, Beth, sleeps. The apartment
manager recently found her playing with glass from a
broken window. Wendy’s right hand was cut from the glass,
requiring stitches.
Who is worried
Potential
caregiver
actions/inactions
Potential future
impact on child
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Safety Goals
Who is a part
of the
network/plan
What will
caregiver DO
differently
For how long?
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The Question That the
Safety Goal Answers
“What does CWS need to see the
parents doing differently with their
children so everyone will know the
children are safe?” (not services)
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Danger
Statement
Safety
Goal
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“What is CWS most worried
will happen to the children if
they are in the care of their
parents and nothing else
happens to mitigate the
danger?”
What does CWS need to see
the parents doing differently
with their children so
everyone will know the
children are safe? (not
services)
35
Or think of them like book ends
Danger Statement
Safety Goal
36
Goal Statements
Clear, simple statements about what the caregiver will DO
that will convince everyone the child is safe now and into
the future.
Who is a part
of the
network/plan
What will
caregiver DO
differently
Actions of
protection taken
by caregiver
that mitigate
the danger
For how
long?
Demonstrated
over time
37
38
Example of a Safety Goal
Matt will work with CWS and his safety network (family, friends, and
professionals) to show everyone he will always discipline Adam in ways
that do not injure him (such as using time-outs, taking away Adam’s
Gameboy, and giving incentives like earning a toy). CWS will need to
see this safety plan in place and working continuously for a period of
six months so that everyone is confident that the safety plan will keep
working once CWS withdraws.
Who is a part
of the
network/plan
What will
caregiver DO
differently
For how long
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How Long?
How
long
Low or moderate risk
Strong safety network
Long history of past protection
History of past successful change
efforts
Less vulnerable child
High or very high risk
Less safety network
Less history of protection in past
More evidence of prior change efforts
that did not last
More vulnerable child
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How Long?
How
long
Low or moderate risk
Strong safety network
Long history of past protection
History of past successful change
efforts
Less vulnerable child
High or very high risk
Less safety network
Less history of protection in past
More evidence of prior change efforts
that did not last
More vulnerable child
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Two Kinds of Safety Goals
X will make a
plan to show
everyone that Y
child will be safe
by doing … CWS
will need to see
this plan working
continuously for
nine months …
So that we can begin to
make plans for this child to
go home
So that we can close
this case
42
• Mistake services for
What happens
without a wellformed safety goal?
safety
• Intervention drift
• Lack motivation to make
hard changes
• Hard to measure
progress
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Safety Goal Tips
Directly relate to the danger
statements
Be specific and describe
what we are expecting the
parents to do differently,
rather than what we are
expecting to see stop
Craft them collaboratively
whenever possible
Write them in
straightforward, measurable
language
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Safety Goal Tip:
Avoid “Dead Man’s” Goals
Dead Man’s
Goals
Well-Formed
Goals
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Safety Goal Tip:
Avoid “Dead Man’s” Goals
Dead Man’s Goals
• Mr. Smith will
not leave Billy
alone again.
• Mr. Smith will
not hit Billy
again.
Well-Formed Goals
• Mr. Smith will always
make sure there is a
supportive and safe
adult who can look
after Billy.
• Mr. Smith will always
discipline Billy in ways
that won’t hurt him.
46
Safety Goal Practice
Wendy, age 4, runs around her apartment complex during
the day while her mother, Beth, sleeps. The apartment
manager recently found her playing with glass from a
broken window. Wendy’s right hand was cut from the glass,
requiring stitches.
Who is a part
of the
network/plan
What will
caregiver DO
differently
For how long
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Example Safety Goals
Ongoing Safety Goal for Return Home:
Beth agrees to work with her neighbor and her best friend
Joy to show everyone that she can stay awake during the
day and childproof her home to make it safe for Wendy
when she returns home.
Ongoing Safety Goal for Case Closure:
Beth agrees to work with her neighbor, her landlord and her
best friend Joy to show everyone that she can supervise
Wendy whenever she is outside playing. This plan will be in
place for at least 3 months.
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Use With Families
49
The Value of Family-Generated
Danger Statements and Safety Goals
With families:
• Increase family clarity and understanding about
agency fears and goals
• Greater sense of family ownership and more buyin and commitment to change
• Important even in this attempt to engage the
family not to give up agency “bottom lines”
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Tips for Family Work
• Explain what danger
statements and safety goals
are and why they are
important.
• What’s your stake in the
ground, or your bottom line
for safety?
• Be open to negotiating the
wording—this is their family
and these statements are
designed to galvanize them to
create more safety—but stick
to your bottom lines.
51
Best Practices in Creating Danger
Statements and Safety Goals
1. Make sure the danger statement and
safety goals have the agency’s bottom
lines.
2. Try sharing them and refining them
with the family (while still holding the
bottom line!).
3. Best practice is using your SFQs to
develop statements that have both
agency bottom lines AND family buy-in.
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After You Have Started,
SCALE IT With the Family!
On a scale from 0–10, where 10 = “this really
matters” or “I really agree (with the danger or
goal),” and 0 = ‘You are completely off base or
wrong’, where would you say this is?
0
5
10
53
Venues for Crafting or Sharing
• At a parent’s house or in the
office
• In a TDM
• In an internal case review
meeting
• Or on a case plan!
54
Ideas for Using
Danger Statements and Safety Goals
• Write them on the
first page of the
case plan.
• Write them in court
reports as an
opening statement.
55
Questions for Families That Help Form
Danger Statements
• What do you think I’m
worried about?
• What do you think your
child is worried about?
• What do you think my
supervisor (or the judge) is
worried about?
56
Questions for Families That
Help Form Safety Goals
•
It’s a year from now, and the
danger in your family is no
longer there. How would you
describe your family? What
would you be DOING
differently?
•
In your children’s wildest
dreams—where your family is
thriving and happy—how
would they describe your
family? What would you all
be doing differently?
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Eliciting the Child’s Voice for
Danger Statements and Safety Goals
• Three Houses
• What happened?
• Safety House
• What was the
impact?
• What needs to
happen for the
child to feel safe?
• In the child’s
own words!
58
Interim Goals/Baby Steps
On a scale from 0–10, with 0 being the danger statement
occurring and 10 being the safety goal occurring, where
are you? What actions would the parents/network need to take
for this to move up one? What might we be able to do then?
0
Parent and network actions of protection?
Danger
Statement
10
Safety
Goal
Supervised
visits?
Unsupervised
visits?
Overnight
visits?
59
Linking the SDM® System With
Danger Statements and Safety
Goals
60
What is the core issue?
• The SDM system can help you to very quickly
identify the core safety threat, or danger, to the
child.
• Finding the core means sorting through the
complicating factors to get to the most critical
safety threats facing the child.
• Once this is done, identifying the danger
statement and safety goal is much easier.
61
The SDM® System Can Be a Shortcut to
Constructing a Danger Statement
Facts
Definition
• What facts are present that led you to consider
marking an item on the SDM safety assessment?
• Check the definition – does it meet the criteria?
• Use the facts that led you to the item and its definition
as a starting point for constructing your danger
DS+ SG
statement and safety goal.
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The SDM® System Can Help
Construct the Danger Statement
Facts
• Father, Jim, gets drunk to the
point of passing out three
nights in a row when he is
the sole caregiver of 4-yearold Sam.
63
The SDM® System Can Help
Construct the Danger Statement
Facts
Definition
• Father, Jim, gets drunk to the point of passing out three nights in a
row when he is the sole caregiver of 4-year-old Sam.
• The caregiver has abused legal or illegal substances or alcoholic
beverages to the extent that control of his/her actions is
significantly impaired. As a result, the caregiver is unable, or will
likely be unable, to care for the child; has harmed the child; or is
likely to harm the child.
64
The SDM® System Can Help
Construct the Danger Statement
Facts
Definition
Danger
statement
• Father, Jim, gets drunk to the point of passing out three nights in a row
when he is the sole caregiver of 4-year-old Sam.
• The caregiver has abused legal or illegal substances or alcoholic
beverages to the extent that control of his/her actions is significantly
impaired. As a result, the caregiver is unable, or will likely be unable, to
care for the child; has harmed the child; or is likely to harm the child.
• CWS is worried that Jim might get drunk again when he is the only one
watching Sam, that Jim might black out; and that Sam could get scared
or seriously hurt.
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The SDM® System Can Help
Construct the Danger Statement
Facts
Definition
• Father, Jim, gets drunk to the point of passing out three nights in a row when
he is the sole caregiver of 4-year-old Sam.
• The caregiver has abused legal or illegal substances or alcoholic beverages to the
extent that control of his/her actions is significantly impaired. As a result, the
caregiver is unable, or will likely be unable, to care for the child; has harmed the
child; or is likely to harm the child.
• CWS is worried that Jim might get drunk again when he is the only one
watching Sam, that Jim “might black out,” and that Sam could get scared or
Danger
seriously hurt.
statement
Safety
Goal
• Jim will work with a network of family, friends, and professionals to make a
plan that will show everyone there will always be a sober adult watching
Sam. CWS will need to see this plan in place and working continuously for
six months to know the plan will continue once CWS withdraws.
66
Linking Danger and Risk
• What exactly are
we worried
about? (The
danger
statement)
Risk
• How worried
should we be?
(Risk level)
Danger
67
Let’s Practice!
68
Kim and Paul Genogram
Ann
40
Donna
Kim
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.
69
What Are We Worried About?
•
Kim overdosed on heroin and became unconscious while cooking dinner.
Paul, age 10, was home at the time and was scared when he couldn’t wake
his mom. Her landlady heard the fire alarm and had to call the police and
open the door.
•
Kim has an extensive history of heroin use and reports she has been
struggling with addiction “for more than 15 years.” This led to one referral
four years ago when Paul came to school multiple times smelling of urine
and feces.
•
Kim attributes this incident to a growing depression after losing 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 stopped attending NA over two years ago (“They get kind of preachy,
and the meetings were not good times”).
•
Kim has been diagnosed with Borderline Personality Disorder and ADD.
70
What’s Going Well?
•
Kim reports that she was clean and sober for four years before this
incident—a report supported by her sister Donna—during which time
Paul went to school clean, on time, and with his work done.
•
In her past work with the department, Kim worked with her worker and
a home-based outreach team, went into drug treatment, and ensured
that Paul went 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 the aunt and school guidance counselor that he
continues to “thrive” despite these changes.
•
Kim made a plan with Donna in the past that if anything were to happen
to her, Paul should go to stay with Donna.
71
72
Practice!
Make a harm statement, danger statement, and
safety goal for Kim and Paul’s family
Don’t forget to capture trauma,
if present, and list it in the “impact”
73
portion of the statement.
Kim and Paul
Harm Statement Example
It was reported that Kim overdosed on heroin
and became unconscious while cooking dinner.
Paul, age 10, was home at the time and became
scared when he couldn’t wake his mom. A
landlady heard the fire alarm and had to call the
police and open the door.
Kim and Paul
Danger Statement Example
Professionally generated statement:
• CWS, Donna, Ann, and the treatment team at the hospital are
worried that Kim might use heroin again while she is caring for
Paul, that she might not be able to watch him or take care of
him, and that he could get seriously hurt without her
supervision.
Family- and network-generated statement:
• Kim, Donna, Ann, CWS and the people at the hospital are
worried Kim might ‘lose it,’ pick up heroin again and that Paul
might get seriously hurt or even lose his mom.
75
Eliciting the CHILD’s Voice:
Example
Paul is worried that mom might use drugs again
and will get sick and have to go to the hospital.
76
Kim and Paul
Safety Goal Example
Kim will work with CWS, Donna, Ann, and treatment providers to show
everyone that she will always be drug-free when caring for Paul, and
that if she is going to use, she will ask for help from her network to
ensure a safe and sober adult is watching Paul. CWS will need to see
this safety plan in place and working continuously for a period of six
months to begin making plans for Paul’s return home.
Who is a part
of the
network/plan
What will be
done differently
For how long
does the plan
need to be in
place
77
Practice
In groups of three:
• One person describes a family
he/she is currently working with,
knows a lot about, and has at
least one safety threat.
• Brief genogram, reported
information, which SDM safety
threats exist now, brief facts
behind those threats.
• Try writing a harm statement,
danger statement, and safety
goal.
HARM
Who says
Caregiver
actions/inactions
Impact on the
child
DANGER
Who is worried
Caregiver
actions/inactions
Impact on the
child
SAFETY GOAL
Who is a part of the
network/plan
What will be done
differently
For how long does
the plan need to be
in place
78
One Last Thing: Thinking Ahead
In pairs:
• What’s one thing you heard today that
you value or makes sense to you?
• What are you already doing to put that
into action in your work?
• What else would you like to do to “land
it” even more in your work between now
and next time?
Opportunities to Practice
References
Children’s Research Center. (2008). Structured Decision Making®: An Evidence-Based Approach to
Human Services. Retrieved from http://www.nccd-crc.org/crc/pdf/2008_sdm_book.pdf
Department of Child Protection. (2011). The Signs of Safety Child Protection Practice Framework.
Department of Child Protection, Perth. Retrieved from
http://www.signsofsafety.net/westernaustralia
Johnson, W. (2011). The validity and utility of the California Family Risk Assessment under practice
conditions in the field: A prospective study. Child abuse & neglect, 35, 1, 18–28.
Turnell, A. & Parker, S. (2009). Introduction to the Signs of Safety. DVD and workbook. Perth,
Resolutions Consultancy. Available at Signs of Safety.net
Lee, M. L., Sebold, J., & Uken, A. (2003). Solution-Focused Treatment of Domestic Violence
Offenders: Accountability for Change. NY: Oxford University Press.
Child Protection Messages from Research (1995). Studies in Child Protection HMSO: London.
http://www.nctsn.org/resources/topics/creating-trauma-informed-systems
Heath, Chip and Dan (2007). Made to Stick, Random House.