Safety and Risk Framework: Concepts and Applications

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• Safety and Risk Framework Concepts and
  Applications
•  

Barry Salovitz Senior Director Casey Family
Programs
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The sacred requirement

• to assess a childs safety in the home and
  respond appropriately, should not be simply a
  required agency event, or only a form completion
  compliance task. You must make it more a way of
  thinking.

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What is a Framework?

• A basic conceptual structure that ties together a
  set of mutually congruent and supportive beliefs,
  values, principles and strategies seeking to
  address a common purpose.

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Flying Without a Safety and Risk Framework -
Dangers

• Idiosyncratic beliefs, practice, decision-making
• Conscious and unconscious bias
• Errors in decision-making
• Inconsistencies
• Documentation is haphazard
• Consultation and supervision suffers
• Lack of standards for quality assurance and
  quality improvement

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The Framework Test

• 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

• What decisions need to be made?
• The causes or factors associated with the area of
  interest/concern
• What information needs to be assessed?
• How should this information be interpreted?
• What practice model is best suited?

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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

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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.  
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Safe

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

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Unsafe

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

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Serious Harm

• actual or threatened consequence of an active
  safety threat or missing or insufficient
  protective capacities that is significantly
  affected by a childs degree of vulnerability
  and 
• is life-threatening or risk thereof
• substantively retards the childs mental health
  or development or risk thereof
• produces substantial physical suffering,
  disfigurement or disability, whether permanent or
  temporary, or risk thereof involves sexual
  victimization.

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Safety Factors

• set of specific signs of present danger
• combine with a child's vulnerability
• may directly impact a child's safety status
• unless offset or mitigated by sufficient
  protective capacities
• (Handout)

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What primary strengths do you look for

• in a caregiver for your child, niece, nephew,
  grandchild, or godchild?

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Protective Capacities

• behavioral, cognitive, and emotional
  characteristics of a parent/caregiver
• specifically and directly can be associated with
  reducing, controlling and/or preventing serious
  harm to a child
• (Handout)

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Vulnerability

• degree to which a child can avoid, negate or
  modify the impact of safety threats
• missing or insufficient protective capacities
•  
• (Handout)

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Safety Threat

• family situation, behavior, emotion, motive,
  perception, or capacity that is out of control,
  immediate or imminent, and is likely to have
  serious effects on a vulnerable child

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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)
• (Handout)
• (Example)

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Safety Threats Involve

• Underlying Conditions
• needs 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
• (Examples)

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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.  
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Risk

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

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Risk Factors

• highlight the family system
• may include demographics, needs, strengths,
  safety threats, functioning levels
• associated with understanding the nature of the
  familys involvement with the CW system
  (maltreatment, underlying conditions
  contributing factors)
• likelihood of future A/N

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Differentiating Safety Risk

• SAFETY
• is dichotomous (safe/unsafe)
• identifies serious harm occurring immediately, or
  when conditions are present where the serious
  harm can occur at any time
• must be assessed quickly

• RISK
• is a continuum
• identifies the likelihood of any degree of harm
  that may occur at some point in the future
• is assessed over time
• (Guided imagery)

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Differentiating Safety Risk Assessments

• Risk Assessment
• estimates the likelihood of future abuse/neglect
• helps to identify the nature of the safety threat
  and/or the underlying conditions contributing
  factors that are sustaining both safety threats
  and/or future risk
• helps identify how to intervene support
  positive change

• Safety Assessment
• assesses present danger
• identifies what needs to be controlled
• helps identify how to control immediate safety
  threats

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A Framework for Risk Decision-Making
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Emerging Danger

• likelihood of serious harm that is not immediate
• threats are starting to surface or escalating in
  intensity, pervasiveness, duration and/or
  frequency
• protective capacities are weakening

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Emerging Danger Examples

• alcohol use increasing
• stress over difficult child behavior elevating
• childs grandmother told mother that she can no
  longer dump the child on her when the mother
  goes out drinking
• perception of the child increasingly negative
• caregiver reports having to spank the child more
  often
• frustrations with the demands of the child
  increasing
• caregiver not home at the time of last two
  scheduled caseworker visits
• missed last two appointments w/ drug and alcohol
  counselor
• inconsistent responses to accidental injuries
  to child
• childs willingness to talk with you has
  significantly changed
• (case example)

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Safety Decision Examples

• Safe
• In-Home Safety Plan
• C. Out-of-Home Safety Plan
• D. Legally Authorized Out-of-Home Safety Plan

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Safety Plan

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

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Supplementation of Protective Capacities

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

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Safety Planning Guidelines

• specific and concrete control strategy
• must be implemented immediately
• whenever possible, parent should have a prominent
  role in its development and implementation
• should employ least restrictive strategies
  possible while assuring the childs safety

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Safety Planning Guidelines (cont)

• can often 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

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Safety Plan Guidelines (cont)

• 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

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Guidelines for Discontinuing a Safety Plan

• When a threat of serious harm no longer exists
• or
• control of the threat within the family is
  probable can be maintained without safety
  focused intervention or active safety plan
  monitoring

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Service Plan

• Intervention strategy designed to
• resolve safety threats
• reduce risk
• promote child well-being and
• attain permanency

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Critical Issues for Reunification/Case Closure

• The safety re-assessment must focus on the extent
  to which
• 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
• (Case)
• (Handout)

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The Key Question
Not whether the threats will ever appear again,
but Whether they can be controlled with the
child in the family