Safety and Risk Assessment #

e
december
2009
series number:
006
breakthrough series collaborative
Safety and Risk Assessments

A project between Casey Family Programs and the American Humane Association
who we are
About Casey Family Programs
Casey Family Programs is the nations largest operating foundation focused entirely on foster care and improving the child welfare system. Founded in 1966, we work to provide and improve and ultimately prevent the need for foster care in the United States. As champions for change, we are committed to our 2020 Strategy for Americas Children, a goal to safely reduce the number of children in foster care and improve the lives of those who remain in care. We have decades of front-line experience in foster care and are committed to helping states, counties and tribes implement effective child welfare practices. We provide nonpartisan research and technical expertise to child welfare system leaders, members of Congress and state legislators so they may craft laws and policies to better the lives of children in foster care, children at risk of entering the system and their families. The foundation, established by United Parcel Service founder Jim Casey, is based in Seattle. For more information about this report, contact Casey Family Programs at info@casey.org or visit our website at www.casey.org.
december 2009
series number: 006
breakthrough series collaborative
Safety and Risk Assessments
TABLE OF
CONTENTS
Overview.................................................................................................................................. 6 Introduction....................................................................................................................... 6 BSC Project Background.................................................................................................. 7 Methodology Concept and Structure................................................................................ 7 Methodology Components................................................................................................ 8 Core Issues Impacting This BSC.................................................................................... 10 Report Information Sources............................................................................................ 11 Practices and Strategies..................................................................................................... 15 Introduction..................................................................................................................... 15 Safety and Risk Decisions and Tools.............................................................................. 16 Race, Ethnicity, and Culture............................................................................................ 23 Family and Youth Engagement........................................................................................ 28 Community Partners....................................................................................................... 33 Applying the Methodology................................................................................................... 38 Successful Application of the Methodology................................................................... 38 Challenges in Applying the Methodology........................................................................ 44 Success and Challenges in the Tribal Context................................................................ 49 Using the Methodology beyond This BSC...................................................................... 52 Conclusion...................................................................................................................... 54 Organizational Culture Change........................................................................................... 55 Introduction..................................................................................................................... 55 The Culture of Child Welfare Organizations.................................................................... 55 Supporting Organizational Culture Change through the BSC......................................... 56 Conclusion...................................................................................................................... 62 Appendices........................................................................................................................... 64 Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I BSC Model for Improvement................................................................. 64 Change Package.................................................................................... 66 Glossary................................................................................................. 75 Key Areas for Practice Improvement..................................................... 77 Themes for Spreading and Sustaining Practice Improvements............. 78 Team Impact Statements....................................................................... 79 Faculty and Staff.................................................................................... 87 BSC on Safety and Risk Assessments Teams....................................... 89 Change Package Measures................................................................... 91
casey family programs | breakthrough series collaborative | Safety and Risk Assessments
TABLE OF
CONTENTS
Appendix J Appendix K Appendix L Appendix M
BSC on Safety and Risk Assessments: PDSA Planning Form.............. 95 Sample Team Progress Report.............................................................. 96 BSC on Safety and Risk Assessments: Spread Readiness and Activities......................................................... 106 Key Areas of Practice........................................................................... 108 Community Partners.................................................................. 109 Family and Youth Engagement................................................... 120 Race, Ethnicity, and Culture....................................................... 131 Safety and Risk Decisions and Tools......................................... 136
SECTION ONE:
OVERVIEW
Introduction
Early in 2008, 21 public and tribal child welfare agencies from across the nation came together in a Breakthrough Series Collaborative on Safety and Risk Assessments to help each other improve the way that they assess and make decisions related to the safety and risks of children who come to the attention of the child welfare agency. Over the next 18 months, the participants tested small changes, shared what they learned, began to spread improvements throughout their agencies, increasingly engaged the families and communities they served, and strategized to sustain their gains. Some agencies made adjustments to established practices; others focused on building a common understanding of the basics of safety and risk assessments for everyone involved in a childs life. Some found ways to pilot newly mandated changes that had yet to be field-tested; others sought to integrate existing initiatives or establish new programs. The Collaborative saw both individual and collective practice outcomes. Ten of the 21 teams reported an average decrease of 41% in their total number of re-referrals1 and collectively re-referrals dropped by 35% across the entire Collaborative. What makes this effort remarkable is not just the outcome, but the process of the work. A key component of any BSC is the collaborative nature of the project; participating public child welfare agencies had unique opportunities to share practices and ideas and learn from each other in a variety of ways. Small rural tribal jurisdictions mingled with enormous urban public ones. Agencies undergoing reorganizations learned from agencies well into successful reform efforts. A cross-section of staff and constituents from senior administrators to front-line workers, youth, and parents met by phone, online, and in person, sometimes in small groups of 3 or 4, sometimes in workshops of 20, sometimes as the full Collaborative of nearly 200 participants. Together they focused on the actual front-line casework, on improving what happens when individual workers engage with individual families. And they focused on the structure of sustainability, the pathways of lasting change. While the outcomes of the project are measured at its formal conclusion, the specific improvements made over the last year and a half tell only part of the story. The full measure of the effort lies also in the seeds of improvement that will likely continue to grow, from attitude shifts experienced by participants to validation of new directions for whole agencies, from efficiencies in specific procedures to the engagement of families, youth, and community partners. This report tells the beginning of the story: what the BSC on Safety and Risk Assessments sought to accomplish, who participated, what they did and how they did it, what we know about their results, and how the project helped prepare them for sustained change. This document is intended to provide public, tribal, and private agency staff with ideas for practice improvements and the context in which they were developed; to provide agency leaders with insights into organizational culture change and continuous improvement; to add to the store of knowledge in the child welfare BSC community and to describe the evolution of the model that took place in this BSC; and to provide the funding and executing organizations with an account of significant aspects of the project. Many of the lessons learned apply to all child welfare BSCs; this report leaves generalizations to the reader.
Re-referral is defined as a child who is referred to the abuse/neglect hotline twice within a 6-month period.
The report is organized in four sections: Overview: Provides background on the project and an overview of the methodology used. Strategies and Practices: Describes practices and strategies employed by participants to improve safety and risk assessments in child welfare and related decision making in key areas, and provides quantitative and qualitative indicators of improvement. Applying the Methodology: Describes factors contributing to BSC success, the challenges encountered, and examples of sustained and expanding activity by participating jurisdictions. Organizational Culture Change: Discusses the methodology and the experience of participants in the context of organizational culture change.
BSC Project Background

BSC methodology was developed by the Institute for Healthcare Improvement,2 a group in Massachusetts known for its success in addressing intractable issues in healthcare. In 2001, the national foster care foundation, Casey Family Programs (Casey), introduced the methodology to child welfare, conducting numerous BSCs on topics such as Recruitment and Retention of Resource Families, Kinship Care, Differential Response, Disproportionality, and Education. Casey expanded its efforts in 2007, funding several BSCs planned and executed by other organizations, the first of which was the BSC on Safety and Risk Assessments, led by the American Humane Association. Caseys top priority was to help jurisdictions safely reduce the number of children and youth in foster care; therefore, a focus on safety and risk assessments was a logical choice for its next BSC. American Humane had never conducted a BSC before, but it has a long history of providing technical assistance to public child welfare agencies. By 2007, it had begun to expand its child protection efforts, hiring a new director of child protection reform with considerable expertise in safety and risk assessment. American Humane was a natural fit for Caseys new partnership model of BSCs. Besides the partner structure, the BSC on Safety and Risk Assessments involved several facets new to the BSC. Most notably, it had an extended timeframe, with an additional learning session and action period allowing teams to address the spread3 and sustainability of newly improved practices. The project also produced innovative concepts and tools to support the work of participating teams.
Methodology Concept and Structure

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Institute for Healthcare Improvement. (2003). The breakthrough series: IHIs collaborative model for achieving breakthrough improvement. Cambridge, MA: Author. BSC methodology uses the term spread to define the process for expanding successful practice changes from the initial target site throughout the larger agency.
Guided by a small planning team, the BSC brought together 21 teams of public and tribal child welfare agency staff, constituents, and community partners, each dedicated to developing and executing small tests of practice change in eight key areas of safety and risk assessments. A group of experts known as faculty advised teams on topics ranging from constituent involvement to assessment tools. Teams communicated their results to one another at four two-day meetings called Learning Sessions, they participated in monthly conference calls, and they shared improvement efforts, measures, results, and resources on an ongoing secure website. Tested practices were refined through a basic quality improvement cycle, eventually spreading beyond
the participating teams to extended teams, additional work units, other offices, and other participating agencies. The core of the methodology was the two-part Model for Improvement, consisting of (1) three basic questions that guided the work conducted by participants, and (2) the central activity of change testing, the well-known Plan-Do-Study-Act cycle (PDSA). The three questions were: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? These questions informed what changes were tested, how they were evaluated, and what iterative adaptations were made to develop them into larger practice improvements. These iterative adaptations were made using PDSA cycles, which allow for extremely rapid testing and results on a small scale, gradually getting larger as learnings are applied and successes are realized. Ultimately, these resulting improvements were spread beyond the initial test sites in response to the models first question. The BSC methodology situates the Model for Improvement in an environment designed to circumvent established barriers to improvement such as bureaucratic inertia, top-down reform, overly complex pathways to change, and organizational dysfunction. It does so by establishing small cross-hierarchical teams with diverse perspectives and teaching them to work below the threshold of organizational resistance in testing small practice improvements that are then spread from the bottom up once they have been validated. While the project depends on high-level authorization and support, many of the components that support team experimentation exist outside everyday agency structures and paradigms.
Methodology Components
PLANNING TEAM The BSC was led by an American Humane planning team consisting of a director, who guided the overall effort; a project manager, responsible primarily for support to participating teams; and a project associate, in charge of data and measurement. In addition, two Model for Improvement advisors with BSC experience were contracted to provide guidance and support in ensuring model fidelity. All planning team roles overlapped significantly. The planning team was responsible for developing all materials, guiding and planning all Collaborative meetings and calls, teaching the methodology, supporting the work of the teams, reporting on progress, managing co-chairs and faculty, consulting on data collection and analysis, and managing the projects web data collection tool. Staff also debriefed with teams in crisis, held them accountable for outcomes, and responded to highly varied cultural demands. The significance of relationship development in an expansive project that operates on an intimate level cannot be overstated. THE CHANGE PACKAGE AND KEY AREAS FOR PRACTICE IMPROVEMENT Every BSC begins with a detailed framework for change that describes an ideal system, carefully defines the scope of the BSC, and provides the general themes that teams must address to improve their systems. This Change Package is essentially the BSC policy guide, providing rationale and explanation for every aspect of the changes to be tested by teams.
Over the course of five months, staff, advisors, and co-chairs drafted a change package to be vetted by a national panel of experts consisting of parents, young adults formerly in foster care, practitioners at all levels from front-line through high-level administration, researchers, and policymakers. The document included a detailed listing of 10 component areas of an effective and integrated system of safety and risk assessments and decision making that support the permanency and well-being of children. In this BSC, staff also developed a set of Key Areas for Practice Improvement to help teams prioritize and focus their testing. FACULTY A group of faculty was recruited from the expert panel that reviewed the change package. Faculty acted as content experts, advising the participating teams on specific topic areas and facilitating their collaborative efforts at meetings and on calls. The make-up of faculty loosely mirrored the team composition, including youth and parent representatives. Two high-profile co-chairs lent their expertise and visibility to the project. APPLICATIONS AND TEAM COMPOSITION Applications for participation in a BSC require extensive information from jurisdictions on past improvement efforts, current structure and demographics at the target site, and a list of proposed team members. The methodology is generally not suited to first-time improvement efforts; participants and jurisdictions alike should have the ability to innovate. In this BSC, teams largely self-selected based on the topic of focus and on their capacity to make a commitment both to the full duration of the project and the methodology. Teams were led by a senior leader, an individual with enough authority to address organizational barriers faced by teams making innovative changes. A day-to-day manager coordinated the work of the team; a supervisor and worker represented practice-level agency staff; and a birth parent, a youth who had been (or was) in care, and a community partner represented key constituents. Teams also selected one additional team member who represented an important perspective in their respective jurisdictions. The core team was supported by an extended team that helped identify and test improvements and spread those improvements that yielded promising results. LEARNING SESSIONS During the Collaborative, teams met in person at four two-day learning sessions (LS), meetings designed to introduce teams to key BSC concepts, support cross-jurisdictional and crosshierarchical learning, and help them develop action plans. At Learning Session 1, teams learned about the Model for Improvement and the Plan-Do-Study-Act cycle (PDSA). Learning Session 1 emphasized that in a BSC, anyone on the team can have and test ideas, all voices should be heard equally, measurement can support improvement, and constituent engagement and cultural responsiveness are key to improving child welfare practices related to safety and risk. Participants were introduced to one another and began to experience learning in an environment of parity. Subsequent LSs introduced concepts on spreading and sustaining improvement, and they deepened relationships, collaboration, and conversations around key topics in safety and risk assessment, family engagement, and the disproportionality of children of color in the system. Prior to each LS, teams completed pre-work assignments, including completing selfassessments based on the Key Areas for Practice Improvement and setting priorities for the upcoming Action Periods.
ACTION PERIODS The first LS was followed by an action period during which teams began to apply the new concepts, conducted initial PDSAs according to their priorities, and gathered initial data. They entered results, tools, and materials on the projects secure website (the extranet) and participated in monthly all-Collaborative calls that continued sharing between teams and addressed a variety of safety and risk assessment topics. Subsequent action periods between LSs saw further development of promising practice improvements, alignment with jurisdictional initiatives, and initial efforts to spread improvements. Over time, facilitation of the Collaborative was increasingly handed over to teams, who participated in LS agenda planning and led the allCollaborative calls. MEASUREMENT To a great extent, the BSC depends on clinical wisdom and counter-bureaucratic structure to achieve its ends. Quantitative monthly measurement plays a significant role in helping to identify practices that are candidates for further development, but it is not designed to provide hard evidence of practice efficacy. While teams were required to collect data related to the components of the change package, many jurisdictions had idiosyncratic methods of data gathering, target sites too small to demonstrate systemic impact, and incomplete data sets. Although individual teams were able to use their data to guide their progress, the variations in data collection and definitions limited the ability to demonstrate overall Collaborative outcomes.
Core Issues Impacting This BSC

CONSTITUENT ENGAGEMENT Engaging families, youth, and communities is understood to be essential to all child welfare efforts, from prevention to reunification to independent living to systems reform. For the BSC methodology in child welfare, constituent engagement has long been of central importance, and the planners of this BSC required each team to include a community partner, a youth representative, and a parent representative. The guiding values articulated in the change package declared that active engagement of birth parents, children, youth, and their kin with child welfare agencies, tribal agencies, and community service providers is fundamental to all safety- and risk-related activities. The first practice component based on those values stated that clinical decisions should be child-focused, strength-based, family-centered, and communityconnected. One of the Key Areas for Practice Improvement, Family and Youth Engagement, quickly emerged as a dominant focus of the work of the teams. CULTURAL RESPONSIVENESS Constituent engagement cannot succeed without cultural responsiveness any more than a person and community can be understoodby self or othersoutside of their cultural context. The BSC planners made this connection explicit in the change package, declaring that agencies must understand and respect the varying beliefs, values, and family practices of different cultural, racial, religious, and ethnic groups. Culturally responsive services and supports are child-focused, family-centered, community-connected, and strengths-based. They also made central the theme of disproportionality and the inextricably related issues of institutional racism and personal bias. They introduced these concepts early and supported a gradually expanding discourse among themselves, faculty, and the full Collaborative, encouraging all participants to examine organizational and personal aspects that contribute to culturally responsive decision making.
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DEFINITIONS OF SAFETY VERSUS RISK Central to safety and risk assessments is an ongoing debate about what constitutes safety and what constitutes risk, and how best to predict the likelihood of maltreatment. Planners of this BSC anticipated that differences between actuarial and consensus-based tools and decisions would create significant debate among participating teams. Instead, they found that many participants were eager to discuss fundamental definitions of safety and risk, and to help their jurisdictions become more consistent in their use of the terms. In the context of family engagement, defining these central terms goes far beyond semantics, beyond even addressing worker confusion about the distinct meanings and the ability to identify what is a safety issue and what constitutes risk. For many teams, it became a foundational element of the dialogue with families and community members, helping eliminate such longstanding issues as the ever-rising standard that families sometimes face once they are in the system: if all involved in a case agree on what constitutes an immediate safety threat and what a future risk, and how they are determined, then it becomes easier to create and understand distinct plans to address each, and it becomes easier to evaluate progress relative to the initial concerns. Similarly, establishing clarity about these concepts creates a foundation for work with diverse families, a reference point against which workers can check their biases, and a standard against which an agencys actions can be measured.
Report Information Sources

The BSC methodology began as a way to improve the application of existing treatments in healthcare.4 But it did not develop new treatmentsa person with a head injury, for example, received the same diagnosis and treatment in the emergency room whether or not the hospital participated in a BSC. But if it did, the person might have been treated faster, by different processes or professionals, and more consistently. Thus, the practice (diagnosis and treatment) was improved by changes in process (speed, responding professional, protocol). In child welfare, clinical practices and work processes are largely inseparable. Most of the tests of change performed by participating teams include small changes in practice as well as process. For example, the team from Florida Circuit 5 tested the use of a fact sheet to explain to families the assessment process, the roles of family members and agency staff, and decision making. The team reasoned that greater clarity on the part of the family would lead to better outcomes by eliminating the confusion that some families report as a barrier to progress. In accord with the healthcare model, this PDSA tested a more efficient process, with additional agency efforts on the front end (factsheet development, explanation to families) producing faster and better results (less confusion about process, more activity toward case goals). The Florida Circuit 5 team reported they felt like there was better engagement of family and understanding of process. As expected, the family gained clarity about the assessment, but just as importantly, they reported a positive feeling about the interaction. The benefit of an improved relationship between the agency and the family cannot be underestimated: People who understand a process may be able to execute it better, but a family who also trusts a worker enough to communicate openly with him or her can provide more and better information to help the worker establish a more useful plan, assess risks more accurately, and provide better supports. Over time, practices like this that increase transparency and engagement with families
Institute for Healthcare Improvement. (2003). The breakthrough series: IHIs collaborative model for achieving breakthrough improvement. Cambridge, MA: Author.
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may contribute to reductions in out-of-home placements, repeat referrals to the abuse hotline, and shorter timelines to permanency. Measuring such impacts quantitatively takes longer than the 18 months of a BSC, and other long-term outcomes impacting system change may also only emerge several years after the conclusion of the project (factors in system change are outlined below). The quantitative data collected monthly in the BSC provided teams and observers with one of several ways of looking at their results, information to be used in conjunction with clinical judgment, periodic selfassessments conducted by teams, practice outcomes reported by participants and their clients, the learning that emerges through collaborative dialogue, evaluations and surveys completed by participants, and personal reports from participants gathered by staff. This report draws conclusions from the following information sources: Monthly measures Self-assessments Study phase of the PDSA cycle Other qualitative information sources
MONTHLY MEASURES Each team in the BSC collected data on 10 monthly measures to help them track improvements. The measures were a companion to the change package and key areas for practice improvement, but their purpose was not to evaluate a teams progress in each individual changepackage component or key area. Instead, the measures formed an overall body, which, viewed as a whole, provided teams with ongoing information about their system and their improved capacity to conduct assessments and make decisions related to safety and risk. The measures did not require complex data collection or analyses; instead, they were designed to be relatively simple (such as the percentage of families attending meetings). Process measures sometimes required some new data gathering, while outcomes measures (such as re-referral rates) were designed to be easily derived from data already collected for mandated federal reporting. Measures included a mix of process and outcomes, and they were broken into five broad categories, each with two to four measures. The two process categories were Family Engagement and Participation, and Family Satisfaction; the three outcomes categories were Child Safety and Risk of Future Harm, Permanency, and Well-Being. Teams were required to collect data for all measures in the first three categories, but they could select a measure or create their own for the Permanency and Well-Being categories. Each team customized the measures and collected data for a target site only, such as the supervisory unit or zip code where the team tested and spread their initial practice changes. During the initial pre-work period, teams were presented with the list of measurement categories as well as some general guidance about how the data might be captured in their jurisdiction. Teams were then encouraged to have one-on-one conversations with the BSC project staff to best determine what these data would look like in their individual jurisdiction. Most teams had difficulty collecting and using quantitative data. Data definitions, collection, reporting capacity, and quality varied dramatically from agency to agency. Differences in definitions, target site sizes, and data collection abilities meant the Collaboratives monthly measures could not be aggregated to produce overall outcomes for the entire Collaborative.
(Data-related team challenges are outlined on next page.)
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SELF-ASSESSMENTS In addition to collecting monthly data, teams also measured their progress through a selfassessment conducted four times throughout the project. Using a scale from 0 to 12, the selfassessment instrument asked each team to rate their agency on its performance in the eight key areas for practice improvement and on the three requisites for spreading and sustaining practice improvements. Self-assessment results indicated those areas most in need of improvement and helped teams prioritize their work during each action period between learning sessions. Teams were encouraged to complete the self-assessments as a team so that all perspectives were included. In fact, many teams found that the feedback provided by the youth, birth parent, and community partner on the team helped ground the assessment process in the reality of practice as it actually existed rather than what policy stated it should be. The self-assessment results demonstrated the power of the BSC to move systems across the Collaborative as a whole. Throughout the life of the project, all teams saw improvements in their self-assessment scores in the eight key areas and three requisites. As depicted in the graph, the average scores for each key area and requisite improved across the entire Collaborative as teams tested and spread successful PDSAs over the course of the project.
Note: The points around the web represent the key areas and requisites, and each ring represents a self-assessment score value (as labeled). The graph indicates that scores are improving as they move towards higher scores on the outer rings.
The improvement in self-assessment scores over time demonstrates that teams perceived positive changes in their jurisdictions as a result of their participation in the BSC. Completing a self-assessment at the end of the project not only helped teams see how far they had come, but it also helped them plan for the work that needed to continue after the BSC concluded. STUDY PHASE OF THE PDSA CYCLE The BSC methodology features small tests of change and encourages teams to think small. Thinking small can be very challengingsometimes it is easier for agencies to spend time planning new initiatives than to test out small improvements in how they work with families. To encourage participants to scale down their plans, staff asked participants to ask themselves, What is a small change we can try with one family that may help keep the child safe in his or her home?
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The answers to that question formed the starting point for a Plan-Do-Study-Act test cycle in which the study phase presented a key point of reflection. PDSA cycles are posted on the secure extranet website. Not a rigorous or scientific evaluation, the study instead consisted most often of asking those who were most impacted by the practice (usually families, youth, and/or front-line staff) about their experiences. The learning from this feedback was documented on the extranet, and it formed the starting point for the next iteration of the test. By repeating the test in multiple cycles with incremental changes, participants could gradually expand it from a single localized adjustment in a procedure, approach, or tool and move it toward true practice improvement. In each cycle, the study provided a point of reflection and assessment that informed the next adjustment. OTHER QUALITATIVE INFORMATION SOURCES This report also presents information gathered through group calls and activities, self-reporting, interviews, and other project-related correspondence, including: All-Collaborative calls Each month, the entire Collaborative participated in a conference call. Early calls focused on the methodology; as the project progressed, call content was increasingly shaped by teams, who frequently presented on specific practices and learning. Monthly reports Each month, staff prepared a report for each team. Reports were based on monthly measures, PDSA documentation, and discussion and correspondence with teams; and they summarized noteworthy efforts, challenges, and key questions for teams. Periodic calls with affinity groups Calls with affinity groups (e.g., parent leaders, workers, senior leaders, etc.) provided additional insight into the work of the teams from diverse perspectives. Team meetings at learning sessions A core component of each learning session were team meetings, two to three sessions during which teams addressed specific challenges, incorporated new learning, and made plans for the next action period. Breakout and speed sharing sessions Team participation in learning sessions increased steadily throughout the BSC. Teams frequently presented their practice improvements and related learning. Tri-team calls with faculty During the second half of the BSC, each team was paired with two others, periodically meeting by phone with staff and faculty to deepen the collaboration across jurisdictions. Support Staff had frequent phone and email contact with many participants to provide support around implementing the methodology, especially the PDSA concept, data collection and use, and spreading improved practices. Interviews As teams moved to spread their improvements beyond the test sites, staff interviewed each team to help identify priorities and strategies for the new phase of work. The BSC process: Learning session evaluations and team engagement surveys Throughout the BSC, the planning team gathered input from participants and, based on their feedback, adjusted agendas, activities, priorities, and even key structures (e.g., the tri-team connections mentioned above). Participants also completed a formal evaluation at the end of each learning session. Surveys were conducted with participants three times during the project to gauge individual engagement with team process.
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SECTION TWO:
Practices AND Strategies
Introduction
The Collaborative change package describes the overall mission of the BSC as helping: jurisdictions increase the capacity of their public or tribal child welfare agency, of their community, and of the families they serve to conduct assessments and make related decisions that keep children safe from imminent danger and protect them from future maltreatment. Concretely, this can be attained by: Defining and creating a common language and understanding of child safety and risk of future maltreatment within the context of child welfare Identifying roles and responsibilities for the public child welfare agency and the community, in order to effectively assess both safety and risk of maltreatment for the families who come to the agencys attention Implementing strategies, policies, protocols, and practices that respect and actively engage families and communities, while providing workers with support for ongoing learning and practice improvement through data and case analysis, training, supervision, resources, and supports necessary to complete thorough, accurate, child-focused safety and risk assessments to support an informed process of clinical decision making Integrating safety assessments and risk assessments in an ongoing and continuous way throughout the life of the case Participating teams followed the BSC methodology to pursue this mission. They tested small changes of practice in small target sites, refined them over the course of the collaborative, and finally began to spread the ones that were most successful to other parts of their jurisdictions. They found simple improvements that would work in day-to-day practice, improvements that would enhance the interactions between agencies and families and help those families keep their children safe. In addition to testing new ideas, teams sought not to reinvent the wheel, adopting adjustments from other teams, previous BSCs, existing practice models, and other sources. The bulk of the work of the teams took place in five of the seven key areas for practice improvement: Making sound decisions on safety and risk Using safety and risk assessment tools Respecting and responding to race, ethnicity, and culture Engaging the child/youth and family Collaborating with cross-system and community partners
This section describes practice improvements in each of these five key areas. The first two are combined for clarity, and practices are grouped by the sub-areas identified in the Key Areas for Practice Improvement. For each sub-area, a narrative description of improvements precedes a table of selected relevant practices and the team(s) that conducted them. Also included at the end of this report are individual Practice Cards with more information for agency staff who would like to try these practice ideas in their own jurisdiction; asterisks next to the practice description in the tables below indicate that a practice card is available. Teams sought to understand whether their tests were heading in the right direction through
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structured study of the tests and a combination of simple measures, self-assessments, and collective reflection. Each section concludes with a summary of the results identified through these sources. Many teams also reported changes in agency culture as well as practice improvements; these outcomes are detailed below in the Organizational Culture Change section.
Safety and Risk Decisions and Tools

INTRODUCTION The mission of this project was to help participating jurisdictions improve their safety and risk assessments of children who came to the attention of the child welfare agency and improve related decision making by using the BSC methodology outlined above. While planners emphasized key components of an effective system, they did not advocate for a specific practice model or safety and risk assessment tool. Instead, teams incrementally changed practices in ways that made the most sense for their agencies. Some teams, such as Carver County, MN and Oklahoma, were already implementing new practice models, and they used the BSC to develop and tune the concrete practices these models entailed, and to spread the consistent use of new practices and tools. Previous child welfare BSCs have focused on aspects of substitute care, permanency, and well-being rather than child protection. This BSCs focus created some concern that using a trial-and-error approach in child protection and safety practices could increase the potential risks to children. These concerns were mitigated by the guidance and support of senior leaders. The BSC methodology discourages the need for team consensus and encourages all members to try their own PDSAs, but because of the focus on safety and risk, front-line investigation workers needed to know they had the support of their supervisors and managers to try new ideas. The methodology provided numerous safeguards against significant error (such as the emphasis on small tests of change), while providing an environment that permitted the freedom to think innovatively. (For more on managing risk and the methodologys interaction with organizational culture, see Organizational Culture Change below.) As one participant said, The project allowed us to change and enhance our tools without approval from policy creators in the state office. Eventually, much of the work of the teams focused on one of the key practice areas, Safety and Risk Decisions and Tools (after Family and Youth Engagement, most PDSAs were conducted in these areas). Teams addressed a spectrum of issues ranging from defining key terms to better use of assessment tools to improved safety planning to enhanced involvement of children and families. By the end of the BSC, one faculty member noted that shared [safety and risk] decision making is a great thing that has happened for many teams. The secret to decision making is not getting the right tool, but having a good foundation for decision making and having good open-minded thinking about which criteria to include: less reliance on tools and more reliance on thoughtful decision making.
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STRATEGIES AND PRACTICE IMPROVEMENTS DISTINGUISHING BETWEEN SAFETY AND RISK Beginning with their applications, some teams identified a need to define key terms and use them consistently. San Francisco, for example, included the following goal for their participation in the BSC: to define and create a common language and understanding of child safety and risk of future maltreatment within the context of child welfare. Catawba County, NC, stated, We want to develop a common language among staff and the community to better articulate the level of risk. Other teams were surprised to learn during the course of the BSC that agency staff were not using consistent definitions of safety and risk and could not explain the differences between these two terms. It became clear that if staff could not articulate safety and risk, it would be difficult for families to understand and address related concerns. Many teams tested practices designed to reduce this confusion, creating a shared understanding of safety and risk and promoting more transparency and consistency in the application of agency standards. Teams including Carver County, MN; Buncombe County, NC; Olmsted County, MN; Pasadena, CA; Pomona, CA; and Utah implemented strategies around consistently defining safety and risk for all agency staff, families, and community partners. The jurisdictions used a variety of methods, including supervisor trainings, worker think tanks, safety and risk discussions during supervision and agency meetings, and laminated cards with definitions and standard safety questions for workers to ask families and use in meetings. Consistently focusing on standard definitions and questions that continually brought the focus back to safety concerns allowed stakeholders and families to make more informed safety and case-planning decisions. One of the most active teams in this area was the Pasadena office of Los Angeles County. The team succeeded in implementing and spreading practice shifts that helped develop clear definitions of key terms, ensure consistent application of safety and risk standards, and elevate the importance of these standards in reducing out-of-home placements. Pasadena called this the 3-4-2 Strategy: 3 overall agency goals (increased safety, reduced out-of-home placement, and reduced timelines to permanency), 4 practice elements (safety, risk, protective capacities, and purposeful visitation), and 2 standard questions around which all casework practice is now built (What was the original reason the child came to the attention of the agency? and Is everything in the case plan addressing this reason?). The practice shift helped all levels of the agency and community partners use the same standard language when talking about safety and risk. It also emphasized full disclosure of the safety and risk concerns, making the safety planning process more transparent. Families were thus more aware of the agencys concerns, and case-planning discussions were linked back to those concerns. Pasadena is currently working to spread this strategy and the associated language to its partners in the judicial system. In the teams own words, they now have clear definitions and guidelines for staff and the community that bring about uniformity and consistency in how families are assessed for abuse and neglect, [and] families have an understanding of what is necessary to demonstrate their ability to provide a safe environment for their children. The team from the Pomona office of Los Angeles County focused on defining safety and risk for families in their Team Decision Making (TDM) meetings. Too often, they discovered, families were unable to engage because the jargon-filled language often used by the agency excluded families from joining the conversation. Safety and risk definitions were displayed in English and Spanish, and the TDM facilitator explained and clarified how safety and risk were assessed for families. The
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definitions were refined as the team gathered more feedback from families, and caseworkers now talk with families about safety and risk in follow-up home visits. This simple act allowed agency workers to realize how much they use child welfare jargon without clearly defining these words for families. When parents understand how the agency is defining and assessing safety and risk, they are more engaged in decision making for their children. Pomona now distributes laminated cards with safety and risk definitions at all TDMs. Some specific practice improvements in this area included:
Tested Practice Improvement Jurisdiction
Defining Safety and Risk Supervisor Safety and Risk Training
Pasadena, CA Pomona, CA Stanislaus County, CA Buncombe County, NC
Communicating Safety vs. Risk
FOLLOWING PROTOCOLS Most, but not all, teams entered into the BSC with an existing set of tools and practices used to assess safety and/or risk of harm to children. While some were satisfied that the tools being used were adequate and appropriate to their needs, others wished to acquire or develop new tools, or revise existing tools to meet particular needs. For example, Fresno County, CA, intended to integrate their existing emergency response structured decision-making tools into their ongoing and family reunification work, as well as into the team decision-making process. Buncombe County stated that while the current safety/risk assessment tools we use do assist our ongoing assessment on some level, we are not convinced these tools have sound validity. The risk reassessments for In Home and Foster Care are not at all meaningful.We intend to be a part of the solution to ensure that safety/risk assessments promote positive outcomes for families and children. Texas had a risk assessment tool that used the concept of guided risk assessment, but the team realized that it was inadequate to deal with issues arising from the high concentration of military families served in the test site. During the course of the Collaborative, several teams experimented with their own tools or those borrowed from other jurisdictions. Some specific practice improvements in this area included:
Enhanced Risk Assessment Tool Hard Copy of Assessment Tool
Texas Wyoming Larimer County, CO Indiana Utah
Family Strengths Questions at Point of Referral Adapting the Safety Assessment to Apply to Foster Homes
Interviewing Collateral Contacts
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CONTRIBUTING TO AND DOCUMENTING DECISION MAKING An essential part of the child protective services process is the development of a safety plan that ensures that children are safe in their homes during the completion of the initial investigation process. Teams in the BSC tested a variety of practices that sought to make their safety planning process more responsive to families needs while also meeting the requirements of the agency. For some jurisdictions, this meant the creation of a safety planning form. While Carver County, MN had a history of creating safety plans with families, there had never been an expectation that these plans would be documented. One worker tested whether completing written safety plans at the beginning of an assessment with families would improve the safety planning process; she found that this practice helped ensure that both the worker and the parents understood the safety concerns of the agency as well as the details of the plan. Safety plans were written on carbon copy paper; families received a copy immediately after it was completed. Case transitions between assessment and ongoing workers were clearer because the written plan was available. The BSC team spread this practice throughout the agency by including safety planning in supervision meetings and encouraging workers to share exemplary safety plans with each other. Some specific practice improvements in this area included:
Immediate and Written Safety Plan Danger Statements in Safety Planning
Carver County, MN Wyoming Carver County, MN
SOLICITING INPUT FROM FAMILIES/YOUTH A common strategy employed by many teams was the simple but powerful act of engaging families, youth, and even young children in providing input on safety and risk issues. In some jurisdictions, it was common practice for agency staff to use their professional expertise to assess safety and risk and create safety plans without direct input from families. This BSC allowed workers to augment their expertise by more directly involving families in the decisions that impact them. Several teams spread the practice of using safety assessment and planning tools with families early on in the case. Rather than bringing a staff-completed safety assessment to a Child and Family Team Meeting, Indiana completed it with families in an effort to be more transparent and earn family buy-in. Wyoming brought paper copies of their safety assessment and planning tools to initial investigation home visits and completed them with families. Both teams found that completing tools with families made the safety and risk issues more transparent and concrete and allowed child welfare staff and families to better work together to create safe environments for children.
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Signs of Safety is an evolving strengthsbased, solution-focused, safety-organized approach to child protection practice first created in Australia by Andrew Turnell and Steve Edwards during the 1990s. It has gained popularity in the United States in the last decade and was in use by several teams participating in this BSC.
Carver County, MN, used specific tools from the Signs of Safety model5 to engage children in safety assessment and planning. These tools allowed children to talk about the situation in their home in a safe way, and workers felt better able to develop safety plans that responded to the childs needs. Workers also reported they felt they were doing real social work because they were able to successfully engage children around safety without re-traumatizing them.
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Some specific practice improvements in this area included:

Completing Assessment Tools with the Family Engage Children in Safety Planning
Catawba County, NC Wyoming Indiana Oklahoma Carver County, MN
USING SUPERVISION TO ACQUIRE GUIDANCE IN DECISION MAKING Several of the ideas described above relied on supervision as a resource for workers in making sound decisions. Supervisors helped define terms like safety and risk and helped ensure that workers were using them consistently, and they supported workers around changes in the use of tools, revised safety plans, and family engagement. Several teams worked toward creating new paradigms for safety and risk decision making that necessarily involved changes in supervision and staffing. Most notably, Larimer County, CO, embarked on an effort to move its practice in line with the Signs of Safety model. To accomplish this, the team visited the Olmsted County, MN, team during the first action period to observe and learn, engaged in a Signs of Safety book study, and sent a team of agency and community partners to a two-day seminar. Each step required significant input and support from supervisors, who learned about the new approach and helped workers implement it. Some specific practice improvements in this area included:
Communicating Safety vs. Risk Supervisor Safety and Risk Training
Buncombe County, NC Stanislaus County, CA
IDENTIFICATION OF RESULTS MONTHLY MEASURES To measure improvement in effective decision making on child safety, teams tracked re-referral data on a monthly basis. Re-referrals were defined as children reported to the hotline for abuse and neglect who had had a previous referral in the past six months. Teams reported this data for all children, white children, and a chosen child population of color to compare outcomes by race and/or ethnicity. Clearly, numerous practice changes may be related to changes in re-referrals, and these practice shifts differed by agency. Overall, however, this measure indicated that jurisdictions were making better safety decisions and plans with families. Individual Team Re-Referrals Of the 21 teams, 10 reported individual decreases in the number of re-referrals for the
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total child population in their jurisdiction, with an average decrease of 41 percent. Rereferrals for white children dropped 33 percent across these 10 teams, while re-referrals for children of color dropped 52 percent. Aggregate Collaborative Re-Referrals Over a 12-month period (August 2008-July 2009), when the majority of teams were posting quality data, the total number of re-referrals reported across the Collaborative dropped by 35 percent. Re-referrals for white children dropped by 40 percent and rereferrals for children of color decreased by 38 percent. SELF-ASSESSMENTS Two key practice sub-areas were directly related to safety and risk decision making: Making Sound Decisions and Using Safety and Risk Assessment Tools. Prior to each learning session, teams assessed themselves in each key area using a 12-point scale on which 0 was poor and 12 was excellent. In the area of Making Sound Decisions, teams assessed their work in five sub-areas: Gathering and considering key pieces of information proven to be relevant to sound decisions Using supervision to acquire guidance in decision making Achieving transparency and openness during key decision-making points over the life of the case Providing workers with adequate resources and supports for making sound decisions Considering the cultural implications of the decisions made In the area of Using Safety and Risk Assessment Tools, teams assessed their work in three sub-areas: Distinguishing between safety and risk Following protocols related to the use of safety and risk assessment tools Using tools to contribute to and document decision making The overall Collaborative average self-assessment score for Making Sound Decisions increased from 6.2 to 8.0, with eight teams reporting improvements of 3 points or more. The Collaborative reported similar results for Using Safety and Risk Assessment Tools. The overall average score increased from 5.8 to 8.2, and 10 teams reported improvements of 3 points or more. Among the teams reporting improved decision making around safety and risk, the Navajo Nation, Southwest Region, stood out with scores that averaged 2.6 at the beginning of the BSC and 9.6 at the conclusion.
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The Florida Circuit 18 team improved in the key sub-area of Using Safety and Risk Assessment Tools from an average of 1.7 to 10.0 over the course of the Collaborative, noting that workers are understanding better that risk is the underlying factor that exists in the home and that safety is where they are right now. Every time a home visit is completed, safety and risk [are] assessed. The home visit summary sheet documents decisions that are madethere is also a safety plan in the [computer system]. The following quotes from final self-assessments describe some of the system-wide improvements in the area of risk and safety decision making experienced by teams: More attention is given to CPS investigative summaries and case files to ensure that all safety and risk assessments have been completed and dated. Through case staffing and case consultation, staff are using traditional [Navajo] teachings with parents on the importance of safety and risk issues with their own children [and] so they become aware of their roles as parents and the importance of children coming first and foremost in all areas of family life. CPS and case managers bring the strengths of the family into focus for parents to review and build from. Parents plan how to develop safety for their own children...If traditional services are requested, [the] case manager will help with locating a traditional practitioner and encourage the family toward well-being and balance. Navajo Nation, Shiprock Staff have been able to more effectively present information to the juvenile court system showing efforts to prevent placement. Wyoming QUALITATIVE SOURCES Sound decision making in safety and risk assessments was the foundational issue for the BSC, and faculty and staff tried to be attentive to keeping the issue at the forefront throughout the Collaborative. Presentations, plenary as well as breakout sessions, were conducted at each learning session. At LS1 in fact, it became apparent that teams were eager for instruction in this area. Because the initial LS was focused to a large degree on presenting the Model for Improvement that the process teams would be using to test and study small practice changes, the core issue of safety and risk assessments was discussed only in the charge to the group and at a breakout session that was attended by only a portion of the participants. Evaluations from the LS made clear the desire for more intensive coverage of this issue. Have someone give a clear definition of what [are] safety and risk, and what is the difference More specific learning regarding doing risk assessments related to children in placement around visitation and return
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Responding to this need, LS2 included a plenary that focused on defining the differences between safety and risk and applying safety principles to case situations. It was clear that this was information teams wanted to hear and believed was useful to their work: The continued explanations of safety and risk assessments make it a part of the everyday life. Knowing the difference is key to the work. The BSC is getting that message, and continuing it will become easier. We are getting better on safety and risk as we are studying more. Very valuable discussion around differentiating between safety and risk. Appreciate the tools to help flush out immediate safety concerns vs. potential risk. As the teams conducted their work in this area (as described above), it became clear that they believed they were having a positive impact on the ability of staff and supervisors to make appropriate decisions on child safety and risk of harm, leading ultimately to better outcomes for children and families: We have seen a decrease in the number of children in care in the target site county. Intake workers are engaging families in home safety plans, when appropriate, in lieu of bringing children into the system. Children are being able to be sent home earlier with in-home safety plans as opposed to waiting until the completion of the familys treatment plan...The safety plans are staffed with line supervisors on every case and with ADAs when appropriate. This was a different approach in that historically in-home safety plans were reserved for only a few cases and were rarely used in cases involving the court system. We learned that less invasive involvement with families can work to ensure the safety of children in appropriate cases. We also learned that in-home safety plans are beneficial in getting children to reunification quicker. Oklahoma, STUDY phase of PDSA The third practice change (identified by Catawba County from involvement in the BSC) includes a change in philosophy. This philosophical shift is looking at risk factors, safety factors, and protective factors in every case. We have created new forms and new ideas around this innovative way of thinking. This change is still in process but we have seen some real benefits in how we look at cases and how decisions are made around families strengths and needs. Catawba County, NC, Team Impact Statement Staff are demonstrating that they are more prepared to share information gathered about safety and how it led to current decisions. Supervisors are using the Staffing Guide to help guide line staff about how to articulate this information, as well as to ascertain any gaps or missing details. Utah, Final Self-Assessment
Race, Ethnicity, and Culture

INTRODUCTION During development of the change package, BSC staff and faculty recognized that race, ethnicity, and culture and the disproportionate representation of children of color in the child welfare system are intertwined with the topic of safety and risk assessments. Jurisdictions interested in improving safety and risk for all children cannot ignore the unique cultural needs of their clients. Furthermore, cultural biases inherent in safety and risk assessment processes may be leading to disproportionate and disparate outcomes for children of color at every decision point, such as substantiation of abuse/neglect referrals, removals from the home, and reunifications.
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The application to participate in the BSC required a commitment to addressing the issues of disproportionality and disparities in safety and risk assessments and decision making. At LS1, faculty and staff modeled open and frank conversations about race, ethnicity, and culture, and the ways they impact work with children, families, teams, and one another. Not surprisingly, it became clear that teamsand the individuals on themnot only had very different levels of experience but also held widely differing opinions on the topic. Staff worked to meet participants and teams where they were in their understanding of race, ethnicity, and culture. They also made Race, Ethnicity, and Culture the first key area for practice improvement, subdivided measures related to timeliness and decision making by race, required teams to identify jurisdictional issues of disproportionality in their applications, and featured sessions on the topic at every learning session. This exploration of race, ethnicity, and culture was a challenging journey for some teams and participants. At LS2, for example, the topic was catapulted to the forefront when a handout shared during a team presentation was perceived by some participants to be racially insensitive. The ensuing dialogue shed light on the racial biases and lenses that every person brought to the work. BSC staff used the opportunity to revamp the planned agenda and create time for a large, extended conversation about race in which all 170 participants were offered the opportunity to speak in a safe, respectful environment. While not all in the room thought that the time spent was worthwhile, more indicated that the topic warranted further exploration. As one participant commented, The follow-up discussion about ethnicity, race.was appropriate and we should have more discussion about it. I do not believe you can do this workwithout discussing this matter. In the second half of the collaborative, staff continued to underscore this issue when possible. Sessions at the final two learning sessions facilitated individual self-examination as well as highlighted work that child welfare systems must do to eliminate disparate outcomes. LS4 ended with a challenge for each person and each team to make personal and professional commitments to continue addressing race, ethnicity, and culture and working to eliminate racial disproportionality and disparities in their jurisdiction. While the overall journey of this BSC allowed participants to grapple with these challenging issues on a personal and professional level, the Model for Improvement provided the opportunity to try new concrete practice ideas to improve the way an agency responds to the racial and cultural needs of the families it serves. Teams approached the issue from such diverse angles as collecting data to identify disproportionate representation, encouraging dialogue on a topic rarely discussed at work, and restoring traditional cultural practices. STRATEGIES AND PRACTICE IMPROVEMENTS ACCURATE DATA Several teams realized that their data on race and ethnicity were incomplete or inaccurate, often because the information system allowed workers to sidestep the discomfort of inquiring about a familys racial, ethnic, and cultural background. Without accurate data, areas of challenge related to disproportionality and disparate outcomes could not be identified. Larimer County, CO, realized that many workers were filling out ethnicity data on their own (or leaving it unknown) rather than asking the family to self-identify race/ethnicity. During the BSC, workers made the switch to asking families directly. They found not only that they collected more accurate data but that the questions often created the opportunity to talk more freely about race,
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ethnicity, and culture and how it might impact the familys case. Collecting more accurate race and ethnicity data also allowed Larimer County to better assess the level of disproportionality of children of color in their jurisdiction. By adding specific questions to its intake protocol and tracking responses, Olmsted County, MN, identified a connection between referral sources and the race of children being referred for investigation (some schools were referring a higher percent of children of colors than others). This led to a wider discussion within the agency about disproportionality and disparity, and a plan to engage in more extensive data collection and analysis around the issue. CONVERSATIONS ABOUT RACE, ETHNICITY, AND CULTURE Other teams tested practices that centered on the idea that engaging in open and honest discussions of race, ethnicity, and culture could lead to better engagement and improved outcomes. Several teams supported workers in having open conversations with families about how race, ethnicity, and culture impact issues of safety and risk. Workers reported that through these conversations they learned much more about the families they were working with. Kay Kent, a worker from Buncombe County, NC, developed an open-ended script to help her begin these conversations, and she made the following observations: Doors opened that I could not have imagined. Families began sharing enriching, enlightening, and often humorous responses. I began asking families what they think I might need to know and understand about their background and their unique experiences in order to break down any barriers that might exist because of our differences. The script even asks families if they have any general questions about my race or cultural background. I have learned and continue to learn daily about the families with whom I work. I have expanded the script to acknowledge any differences such as religion, tradition, or heritage that had I not asked, I would have never known existed. I am seeing that even the families I work with who are the same race may have differences that affect their points of view. When I engage with families, I can feel barriers melting and doors for communication opening, and I observe that families are empowered by the fact that I care enough to ask and truly want to understand them better. Some specific practice improvements in this area included:
Discuss Race, Ethnicity, and Culture with Families
Buncombe County, NC Pomona, CA Carver County, MN Indiana Florida Circuit 5 Larmer County, CO Olmsted County, MN El Paso, TX Stanislaus County, CA
Ask Families How They Culturally Identify Discuss Culture and Values in Relation to Placement Options at TDMs
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RESTORING TRIBAL PRACTICES Two tribal teams worked to better integrate their traditional values into the safety and risk assessment process. The Chippewa Cree Tribe team refined the state safety-assessment tool by substituting more culturally responsive questions. This helped them better assess safety and risk within the context of their cultural beliefs and values. The Navajo Nation, Shiprock team focused their BSC work around implementing the Peacemaker program within their child welfare agency. Peacemaker is a program that uses traditional Navajo Fundamental Law to resolve conflicts rather than turning to the Western court system on the reservation. It has traditionally been used for other conflicts, and this was the first effort to implement it in child welfare as an alternative response to the typical Western child protection system in place on the reservation. The work is ongoing as they struggle with the challenges of restoring traditional practices that have been discouraged for so long by a child welfare system imposed by the dominant Western culture. USING CULTURAL GUIDES Several teams explored ways to use the expertise of people from different cultures to guide their interactions with children and families around racial, ethnic, and cultural issues. Prior to the BSC, Fresno County, CA, had implemented a cultural broker program in which community members from different racial and ethnic communities were trained in the child welfare process and served as advocates for families. The cultural broker supports the family and serves to bridge cultural gaps between families and the agency. During this BSC, Fresno County began using cultural brokers in new ways, such as accompanying investigative workers on initial visits to help engage families. Some specific practice improvements in this area included:
Incorporating Traditional Tribal Values Papoose Bag Education
Navajo Nation, Shiprock Chippewa Cree Tribe Fresno County, CA Pomona, CA Larimer County, CO
Cultural Brokers/Advocates Parent Mentors for Hispanic/Latino Families
IDENTIFICATION OF RESULTS MONTHLY MEASURES Teams attempted to track their level of culturally responsive practice through a family and youth survey. However, only one team (Pomona) was able to consistently collect a significant number of surveys each month. Pomonas measure of cultural responsiveness went from a low of 41 percent of families reporting culturally responsive treatment in November 2008 to a high of 97 percent in June 2009. They dropped down to 74 percent in August 2009, but the overall picture of their culturally responsive practice improved over the course of the BSC. Disproportionality and disparities were measured by breaking down re-referral and timeliness measures by race and/or ethnicity. Teams were asked to report numbers for their total child population, white children, and children of color. Teams chose one population (most often African
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American) to track for children of color; therefore, it was specific to the jurisdiction and did not include all populations. At the beginning of the project, 8 out of 13 teams6 reporting re-referral data7 by race had higher re-referral rates for children of color than for white children. For example, Buncombe County, NC, reported that 65 percent of minority referrals were re-referrals, compared to only 22 percent of white referrals. By the end of the BSC, 7 of these teams reported re-referral rates for children of color that were equal to or less than their white counterparts. Buncombe County reduced rereferral rates for both white and African American children to 18 percent. The majority of teams discovered that the timeliness measure8 was not very useful for them, because almost every jurisdiction already reported timely investigations or assessments for all children at the beginning of the project. However, two teams (Buncombe County and Olmsted County, MN) reported lower rates of timeliness for children of color at baseline, and by the projects end, both teams were reporting equal or better rates of timeliness for children of color. SELF-ASSESSMENTS On a 12-point scale, the collaborative average score for the key area of Race, Ethnicity, and Culture improved from 5.3 at LS1 to 7.6 at LS4. Within the key area, teams assessed their practice on three issues: use of culturally respectful and responsive practices and tools; ensuring that decisions are free of racial and ethnic bias; and developing, requesting, and providing services that are supportive of families cultural identification. Eight teams saw particular improvement in this key area, with their score growing by 3 points or more by the end of the project. For example, Larimer County, CO, improved its self-assessment score in this key area from 6.7 to 10.3, with the biggest improvement coming in their view of their use of culturally respectful and responsive practices and tools. In their final self-assessment, several teams reflected on the ways in which the BSCs focus on race, ethnicity, and culture had not only improved their ability to make sound decisions on safety and risk for all children within their jurisdictions, but the focus had also expanded their understanding of the impact of the connection between individual awareness and willingness to engage in courageous conversations to the work being done by the agency. Regionally our knowledge base has grown and [we] have found the tools that we are using are assisting our front-line staff in respecting and responding to race, ethnicity, and culture. Unfortunately, we cannot guarantee bias-free decisions but we are having honest open communication. We are also attempting to bring our community partners along in our work. Texas
Three tribal teams did not break down rereferral data by race, and three teams had not reported complete re-referral data at the time of report writing. Two teams chose a re-referral unit for their target site, so 100 percent of their referrals were also rereferrals; thus, the percentage of re-referrals was not relevant for these teams. Re-referrals are defined as having had a previous referral for abuse/neglect in the past six months. Definitions of timeliness varied across jurisdictions and state/county requirements. Measurements could include first contact after a report, timeliness of investigation, or timeliness of assessments.
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We changed the [assessment] tool to be more culturally respectful and sensitive; the workers actually ask about their culture; we also are trying to match the culture with the worker if that option is available to us. Florida Circuit 18 Fresno continues to grow in working to eradicate racial disparities and disproportionality, [engaging] more in conversations about fairness and equity in the context of things like Team Decision Making meetings and Icebreakers and the Permanency Teaming Model. Fresno County, CA QUALITATIVE SOURCES Over the course of the BSC, staff observed growth in the degree to which individuals and teams were able to engage in open conversation about race, ethnicity, and culture as part of their personal and organizational journeys. It is the belief of faculty and staff, based on a review of team work and interactions on conference calls and learning sessions, that this growth has been mirrored in improved practice with families and children in their jurisdictions. This belief is echoed in the testimony of the teams themselves: We have clarified exactly what we mean by cultural sensitivity. We are now able to more accurately assess family culture and not confuse it with preconceived notions about racial or ethnic culture. This impact has been directly experienced in team meetings where safety, risk, and culture are discussed in the process of developing safety plans for families. Pomona, Team Impact Statement We now have another significant data collection point to determine the degree of disproportionality that exists within our system. Larimer County, CO, STUDY phase of PDSA Family and [the] social worker enjoyed having Spanish conversation. All family members from the 5-year-old to adults participated. Laughter and teaching by family to social worker...Currently the Spanish class has met weekly with 10 to 12 regular participants. Participants are nervous about actually using their new skills with families. Two social workers have been able to make appointments with families without interpreters. Social workers report a changed relationship with the Spanish-speaking families. More depth in the relationship. Olmsted County, MN, STUDY phase of PDSA involving Spanish lessons for workers
Family and Youth Engagement

INTRODUCTION Both the original change package and the later key areas for practice improvement emphasized family engagement as a paramount component in achieving good safety outcomes for children and youth. Parents and youth are the best experts on their own families, and engaging them in making important safety and risk decisions helps the agency gather more information and make better decisions, and families may be more invested in achieving case plan goals if they have a trusting relationship with their worker and are involved in creating case plans. As with responding to race, ethnicity, and culture, teams were in very different places around truly partnering with youth and families, both at the agency and case level. Some teams, especially those who had participated in past BSCs, had been actively engaging families in planning
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and decision making for many years; others were still engaged in child welfare practice that emphasized the expertise of the professional over that of families. The presence of a youth and birth parent on each team was a constant reminder and reinforcementand sometimes the impetus forcontinued focus on and prioritization of this key area. Family and Youth Engagement proved to be the most popular key area for teams, who tested 108 PDSA cycles, almost one-third of all those posted on the extranet. Teams were also asked to document spread and sustainability activities for at least one PDSA/practice shift on the extranet, and nearly one-half of these were directly related to Family and Youth Engagement. It should be noted that many PDSAs crossed key area boundaries, and tests identified as Family and Youth Engagement by teams also involved other key sub-areas, such as Using Safety and Risk Assessment Tools (by completing them in collaboration with the family) and Community Partners (by holding team decision-making meetings in local family resource centers). Some of the strategies successfully tested included engaging families earlier, preparing them better, and providing peer support to them. STRATEGIES AND PRACTICE IMPROVEMENTS SOLICITING INPUT FROM FAMILIES/YOUTH Early engagement. Many teams discovered the power of engaging families early in the process. A significant test of early engagement involved scheduling investigative visits instead of making them unannounced. Although by no means a new practice in the child welfare field, it was new for many jurisdictions that had adopted an incident-based investigative focus in the last two decades. Larimer County, CO, and Oklahoma, for example, tested a new PDSA on this practice and found that it was standard practice for other jurisdictions in the collaborative. Their experience and expertise assured Larimer County and Oklahoma that the improved engagement that resulted from calling before you knock outweighed concerns about parents cleaning up or making other changes that could affect the workers assessment of the childs current safety or risk of future harm. A number of teams started holding family team meetings early in the case, which allowed them to identify family strengths and supports, build stronger case plans with family input, and hopefully prevent removals from the home. Others were looking at ways to identify and engage fathers starting from the initial contact. Information sharing at early engagement has been enhanced by providing clear definitions of terms such as safety and risk and giving families a brochure that explains the agencys investigation process. Engagement throughout the life of the case. Effective family engagement starts with initial contact, but it must also continue throughout the duration of the agencys involvement with the family. Teams experimented with a number of practices that sought to bring meaningful engagement to the fore at different points in time during the familys involvement with the child welfare agency. Family team meetings were held to plan visits between parents and children, at case transfer from investigations/assessments to treatment, and before closure of a family services case plan. Teams tested the use of checklists as well as open-ended questions to engage families in planning and decision making, and found that both could be successful under the right circumstances.
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Some specific practice improvements in this area included:

Call Before You Knock
Oklahoma Larimer County, CO Wyoming Catawba County, NC Larimer County, CO Oklahoma Florida Circuit 5 Pasadena, CA Utah Florida Circuit 5 Florida Circuit 5 Olmsted County, MN Fresno County, CA
Early Family Meetings
Early Transparencies with Families
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Engaging Fathers Initiative Engage Families during Assessment and Case Planning
PREPARING CHILD/YOUTH AND FAMILY TO PARTICIPATE Merely inviting family members to a meeting is not enough to engage them in the assessment of safety and risk or the ongoing work of the case plan. It is essential to explain the purpose of the meeting, the processes that will be followed, and the expected outcomes. Teams did this by holding informational meetings with the family prior to the team meeting; providing a brochure explaining the process before the meeting; beginning the meeting with an explanation and definitions of relevant terms; and holding a short post-meeting to ensure that parents had a clear understanding of the decisions made. During the meeting itself, some teams shared the safety and risk assessment tools completed by the agency or completed the tools with families. Other teams invited parents or youth who had previously been through the process to participate in preparing the family or child. Teams also focused on preparing staff for the process of working with and preparing families. Larimer County, CO, provided in-service training to all intake workers and involved supervisors regarding how to present Family Safety and Resource Team Meetings to clients and to help workers overcome challenges in explaining the value and purpose of such meetings to families. Some specific practice improvements in this area included:
Family Meeting Preparation Defining Safety and Risk with Families Training on Presenting Family Safety and Resource Team Meetings to Families
Stanislaus County, CA Pomona, CA Larimer County, CO
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CREATING MEANINGFUL OPPORTUNITIES WITH AND FOR CHILD/YOUTH AND FAMILY Several teams tested the use of parent or youth partners as mentors or guides to those currently involved with the child welfare system. Such tests were often initiated by parent and youth team members, who also offered their own experiences and expertise as testers of the practices. Some specific practice improvements in this area included:
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Parent Partner Program Third-Party Supervised Visits Family Visitation with Youth Mother Youth Partner Programs Biological Parents Tell Their Story
Fresno County, CA San Francisco, CA Buncombe County, NC Fresno County, CA Pasadena, CA Pomona, CA Stanislaus County, CA Catawba County, NC
IDENTIFICATION OF RESULTS MONTHLY MEASURES This BSC emphasized the importance of improved family engagement by including four different monthly measures related to this issue: Family participation in meetings Family participation in safety plans Family inclusion in decision making Respectful treatment by agency staff
Inclusion in decisions and respectful treatment were both measured through monthly family surveys. Although most teams experienced challenges in collecting representative survey samples, a number of teams did observe improvement in families participating in meetings and safety planning: Nine out of fifteen teams reported an increase in the percentage of families participating in meetings over an average of 15 months. Some of these changes were rather dramaticCarver County, MN, increased the percentage of meetings attended by families from 5 percent to 71 percent. Three teams showed no increase because they started and remained at 100 percent attendance. Six out of sixteen teams reported an increase in the percentage of families participating in safety plans. Eight teams were already completing safety plans with families, so they remained at 100 percent throughout the collaborative. Although these measures did not demonstrate improvement in family engagement across the Collaborative (or even for the majority of the teams), these intermediate process measures did allow teams to begin or continue analyzing how they were including and engaging families in
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decisions and case planning. For example, the Pomona team was able to administer their survey to a representative number of families and use the monthly results to determine the difference between participation and true inclusion and engagement. The team consistently reported that 100 percent of families were attending meetings and participating in safety planning, but only about 70 percent of families reported that they were included in decision making and were treated respectfully. This discrepancy between the two measures showed that inviting families to the table did not always succeed in engaging them as true partners in ensuring their childs safety and well-being. Pomona used this information to guide their tests of change and practice shifts during the BSC. As the system improves its ability to engage families, long-term outcomes should include decreased out-of-home placements, lower recurrence of abuse/neglect, and fewer re-referrals. SELF-ASSESSMENTS Teams looked at three questions in assessing their practice around Family and Youth Engagement: How well does the agency solicit input from families/youth when assessing for safety or risk factors? How well does the agency prepare the child/youth and family to participate? How well does the agency create opportunities with and for children/youth and families to play meaningful roles? The average selfassessment score for the key area of Family and Youth Engagement increased from 5.3 at LS1 to 7.9 at LS4. Ten teams saw their self-assessment score improve by 3 points or more over the course of the project, with three teams reporting an increase of 6 points or more. One of those teams was Fresno County, CA, whose scores rose from an average of 2.0 to an average of 9.0. Growth and continued challenge were illustrated by the following quotes from teams on their final self-assessment: We are speaking to family members individually and establishing a rapport with them. We are explaining to them before we assess them what and how the assessment will be used. We are taking the time to speak with children by themselves to establish a trusting relationship with them. Florida Circuit 18 Parents are asked directly what they wish to accomplish. Staff leave an open invitation to parents for the parents to assist with developing the case plan in regards to what they feel are their needs and strengths. Parents decide if they want substance abuse counseling. Parents have the option to go with peacemaking, and social workers remain out of the peacemaking sessions. Parents decide which relative (Ke) will care for their
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children. Parents are encouraged to ask questions, especially medical and mental health terms, and the case manager will provide that in Navajo. Parents understand the need for consistent medical or mental health appointments, and that includes medication. Navajo Nation, Shiprock Although our intentions to include families in the decision-making process are good, we have gained additional awareness from our birth parent and youth representatives as well as from surveying families that, at times, it still may come across as our agenda versus the familys agenda. Utah QUALITATIVE SOURCES Most teams recognized the extent to which their work in the area of Family and Youth Engagement had the potential to improve their systems, and 10 of the 21 teams indicated in their final impact statements that increased family engagement was a major improvement. The following quotes from learning session evaluations and team engagement surveys demonstrate the impact of family engagement on teams and their jurisdictions: I think the greatest success has been moving the department toward giving parents more access to information and getting their feedback about the process. I think that the members of the department realized that things are not done consistently in the department and [they] are working to make responses more consistent. Taking the time to discuss decision-making processes with families enables them to more fully participate and attend meetings with their support systems. [We have learned that] putting more decision-making authority in the hands of parents has proven positive in both parent buy-in and follow-up.
Community Partners
INTRODUCTION Child safety is not solely the responsibility of the child welfare system. While families and the child welfare system have critical roles in keeping children safe, the support of the community other public and private agencies, non-profits, formal and informal organizations and groups contributes to the safety of individual children as well as children as a class of citizens in special need of protection. Every phase of the continuum of safety services, from prevention through safe, timely permanency, depends on cross-system and community partnerships who work with families and agencies. In this BSC, the focus of community partnership work was specifically on the role these partners take in connection with safety and risk assessments, both individually and globally. As stated in the Collaborative Mission, child safety...
can be attained byidentifying roles and responsibilities for the public child welfare agency and the community, in order to eectively assess both safety and risk of maltreatment for the families who come to the agencys attention; and implementing strategies, policies, protocols, and practices that respect and actively engage families and communities, while providing workers with support for ongoing learning and practice improvement through data and case analysis, training, supervision, resources and supports necessary to complete thorough, accurate, child-focused safety and risk assessments to support an informed process of clinical decision making.
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All teams were required to include a community partner (of their choice) as a core member. For the most part, these team members came from local service-providing agencies, which provided a range of activities, including prevention efforts, support for families of children with medical and developmental challenges, counseling and treatment, foster care, resources for at-risk youth, mental and behavioral health care, parenting skills, and American Indian tribal communities. One team included a representative of their family court; another, a U.S. Army employee. Teams were also encouraged to bring a variety of additional community and cross-system partners to the table by including them on their extended teams. STRATEGIES AND PRACTICE IMPROVEMENTS EDUCATING PARTNERS AND THE COMMUNITY/ENLISTING A SHARED RESPONSIBILITY FOR THE SAFETY OF CHILDREN In order for partners outside the agency to participate at either the individual case level (e.g., hosting or facilitating family team meetings, or providing child and family services) or at a systems level (e.g., contributing to debates on policy or legislation, or helping the agency target prevention messages to the public), it is essential that all parties have a joint understanding of the language, concepts, practices, and goals of the agency. This education begins with the creation and spread of terminology that is understood by everyone and has the same meaning for all. (See the discussion of distinguishing between safety and risk and related practice improvements under Making Sound Decisions and Using Safety and Risk Assessment Tools above). Teams also worked at educating their partners and communities about the shared responsibility of all for child safety. Focused on the large army base in their jurisdiction, the Texas team promoted cross-system training with military social services. Additional education efforts centered on the community-partner role in creating and maintaining safety networks for children, and on providing information about specific subjects such as mandated reporting, differential response, and structured decision making. Several teams also made outreach to the community-at-large, seeking to increase knowledge and understanding about both child safety and the work of the agency. Such efforts included publishing a series of articles in the local newspaper on topics such as screening guidelines and safety networks; placing an article in a church newsletter; creating a brochure describing the countys approach to safety; publishing a handout explaining how to keep a social worker from knocking on your door by attending to child safety; and providing well-being information to families. Some specific practice improvements in this area included:
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Defining Safety and Risk with Community Partners Educating Communities about Safety Networks Cross-Training for CPS and Military Services Providing Child Safety and Well-Being Information for Families Sharing Risk and Safety Assessment Tools with Family Resource Centers
Pomona, CA Carver County, MN Texas San Francisco, CA Buncombe County, NC Wyoming San Francisco, CA
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INCLUDING APPROPRIATE PARTNERS IN SAFETY- AND RISK-ASSESSMENT CONVERSATIONS AND DECISIONS When agencies ask community partners to share responsibility for child safety, they must also release some of the responsibility (and power) in agency interactions with families and partners. This was tested by several teams by bringing new voices into agency staffing and family team meetings. Some specific practice improvements in this area included:
GAL Partnership and Attendance at Agency Meetings Community Partners Participating in Team Meetings Active Collaboration with Law Enforcement Specialized Staff for Military Families
Utah Pomona, CA Pasadena, CA Philadelphia, PA Pomona, CA Texas
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DEVELOPING A COLLABORATIVE SUPPORT NETWORK OF RESOURCES Community partners can also contribute to good practices in child safety and risk assessments by providing services other than their facilitation or engagement in actual assessment meetings. Several teams experimented with using community facilities to hold meetings with families or with including community partners in meetings other than those involving safety and risk assessment. Some specific practice improvements in this area included:
* *
Holding Team Meetings at Community Organizations Community Collaboration Meetings Extended Family Visit Planning and Preparation
Pomona, CA Stanislaus County, CA Chippewa Cree Tribe Fresno County, CA
IDENTIFICATION OF RESULTS MONTHLY MEASURES The only BSC measure that related to community partnerships asked teams to choose one of four possible options for well-being. Three of those options (physical health needs, mental health needs, and educational needs) are generally supplied via community or inter-agency partnerships. However, the measures themselves did not specifically call out the contribution of community partners, and no conclusions about the success of efforts to improve partnership efforts can be drawn.
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SELF-ASSESSMENTS Teams rated their work with community partners in four areas: Educating partners about safety and risk assessments Including partners in risk-assessment conversations and decisions Developing a collaborative support network of resources around the assessment of safety and risk Enlisting a shared responsibility for the safety of the children in the community The overall collaborative average for the Community Partners score on the self-assessment improved from 6.4 (out of a possible 12) at pre-work to 8.3 at LS4. Five teams showed improvement of 3 points of more, with two teams showing improvement of over 6 points. Florida Circuit 18, a jurisdiction with a system of community-based care, rated its collaborative efforts at 3.0 at the beginning of the BSC, with improvement to 9.8 at the end. While none of the teams reported small tests of practice change were categorized in this key area, the teams impact statement prepared for the final LS indicated that enhanced collaboration around safety and risk assessments had become a focus of work in other ways: Recently, we began using the Danger Assessment created by Jacquelyn Campbell, Ph.D., as recommended by one of our community partners, the Florida Coalition against Domestic Violence.We have also implemented the Wizard and the Fairy Child Assessment tools, which were posted on the extranet by Carver County. We not only have had success with this tool but have also spread this to the Seminole County Sheriffs Office Child Protect Services Investigators. It is this systemic change, embracing contributions of and sharing improvements with collaborators and cross-system partners, that is reflected in the teams selfassessment results. QUALITATIVE SOURCES Of the 21 teams, 10 teams pointed to increased and improved collaboration with community and cross-system partners in the team impact statements at the conclusion of the BSC. Several teams, including those whose self-assessment scores were fairly high even during the pre-work and who did not prioritize this key area during the BSC, recognized that they had undergone a shift in the way they engaged with the community and their partners:
We sponsor regular town hall meetings, health fairs, and public service announcements. Our presentations have been changed to focus on safety. We established a parents network. School and medical collaterals are included. Providers have been trained in the safety model. Family support services and other support services were implemented. Administrators met with some police captains. Providers met with some school personnel. Philadelphia
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And there was recognition of the importance of community efforts in assisting the agency from Fresno County, CA, which experienced significant difficulties related to state and county funding cuts during the course of the BSC:
The support and collaboration of and with our community and cross-agency partners has been essential in moving through some challenging times.
And finally, those team members who were themselves representatives of community partners reflected on some of the changes they saw for themselves and for their organizations:
My participation has been impacted in so many ways. As a cross-system community partner, I felt that the BSC initiated a dierent platform overall for how people view outside providers. I feel valued more because my team was open to many ideas and the perspective that was brought to the table. My advocacy skills have been improved as welladvocacy in my work and within my agency to bring new ideas, perspective, and the ability to transition to a new way of thinking. Finally being able to model to others that change can take place in a small way that can ultimately aect the larger system. Community Partner, Philadelphia
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SECTION THREE:
APPLYING THE METHODOLOGY
Successful Application of the Methodology

INTRODUCTION The improvements achieved by participating teams vary across many practices and areas of agency functioning, from partnerships with parents to supervision to case transfers to collaboration with community partners. The practices and strategies described in Section Two were created and tested within the framework of the BSC methodology for systems improvement, and while they can be described without it, this context is vital to a full understanding of their development and impact. Several questions stand out regarding team development and success within the BSC methodology: Howand whydo teams vary in their application of various aspects of the methodology throughout the life of the Collaborative? How does previous participation in other BSCs impact a teams success? How does the participation of teams with such varying degrees of previous experience affect the interactions between/among individual teams as well as the Collaborative as a whole? What, if anything, can Collaborative staff do to assist all teams in moving themselves further along the continuum of successful application of the methodology for improvement? This section seeks to address these questions in describing how teams functioned in the BSC, what factors helped them successfully apply the methodology, and areas of significant challenge in doing so. THE ARC OF A BSC The arc of activities and content that constituted the basic structure of this child welfare BSC assumed that teams would learn and apply the aspects of the methodology in a logical order. In outline, the stages of the BSC and associated team tasks were as follows: Pre-Work: Each team was to finalize its membership; complete its first self-assessment, which also served as an introduction to the scope of the BSC; establish (by consensus) working priorities based on self-assessed strengths and challenges; determine how to handle the Collaboratives data requirements; and establish a baseline for monthly measures. Team members, from constituents through senior leaders, were to contribute and listen on an equal footing, and to begin Collaborative interactions such as conference calls and use of the extranet. Learning Session One (LS1): Teams were to meet and interact with one another and with Collaborative staff and faculty; experience team-building activities, sessions on safety and risk assessment, disproportionality, and constituency engagement; learn the Model for Improvement, the core of the BSC methodology, in an experiential activity coupled with didactic teaching; and plan to conduct at least one small test of change (PDSA) soon after returning home. Action Period One (AP1): Teams were to apply their pre-work and LS1 learnings to small tests of change (PDSAs) within their target sites. They were expected to use regular team
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meetings to review their progress and plan new tests of change, while learning the importance of incorporating family and youth voices into all aspects of their work. Teams were to collect and post data each month, and they received feedback on both their work and their data from BSC staff in monthly reports. All team members were invited to participate in monthly conference calls that addressed successes and challenges around PDSAs being tested as well as content areas. By the end of this action period, teams were to test multiple PDSAs and work on new tests (Cycle 1) in some areas as they made refinements (Cycles 2+) in others. There was no right number of PDSAs, but teams who had tried fewer than five (5) different PDSAs at this point were thought to be having some challenges in their engagement with the BSC. Learning Session Two (LS2): Teams were to embrace collaborative learning and build more intensive partnerships across teams and within affinity groups (cross-team groups where participants of similar roles came together, e.g., social workers, birth parents, youth, etc.), moving past the initial meet-and-greet aspect of LS1. They were to take part in activities that encouraged them to both share their own experiences and learn from others. At the same time, individual teams were to continue to strengthen their internal bonds and enhance their understanding of, and ability to apply, issues of constituency engagement and disproportionality as well as contribute to their work within the content area of the Collaborative. They were asked to reexamine their priorities based on their second self-assessment and data collected over AP1. Teams learned the basic methodology involved in the spread of practice changes and created action plans around spreading practice improvements and developing new PDSAs. Action Period Two (AP2): Teams were to continue their Action Period 1 activities, including sharing during monthly conference calls and posting work on the project extranet, bolstered by stronger ties both within their teams and with other members of the Collaborative. They were to work on PDSAs while beginning to think about how successful changes could be spread throughout their jurisdictions. As they received guidance from BSC staff and faculty on their work, they were to refine their ability to conduct small tests of practice change. In some cases, their success in engaging constituents in the BSC work and applying that engagement to practice changes began to expand beyond the limits of their eight-member (core) team. Learning Session Three (LS3): Teams were to develop their understanding and application of the methodology more deeply. Teams received focused instruction and practice in planning the specifics of spreading a successful practice change, and they were introduced to the concept of sustainability as an additional step in successfully employing the methodology to achieve broad systems improvement. Individuals and teams were to continue to strengthen their internal and external relationships, using those relationships to further improve their practice. Action Period Three (AP3): Teams were to continue to develop and test new PDSAs based on their priorities and data results as well as to focus on spreading and sustaining successful practice changes. Teams were now much more experienced with developing and testing PDSAs, and this aspect of the methodology was to be shared with others, such as extended team members and other staff in the agency. Learning Session Four (LS4): Teams were to take ownership of the methodology for themselves. Their ability to test practice changes was to be solid so that it would take hold within the jurisdiction as an accepted quality improvement technique. Teams were to employ the steps needed to ensure successful spread of at least one practice change. Team leadership was to be aware ofand ready to take onthe processes needed to sustain practice change over time.
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In actuality, no team in this BSC completed every task described above in every stage in order. Many teams struggled to implement some aspects of the Model for Improvement, with some succeeding overall by the end of the Collaborative and others still challenged by basic concepts even at the conclusion. FACTORS CONTRIBUTING TO TEAM SUCCESS What were the factors that made it possible for a team to successfully use the BSC methodology to improve practice in its jurisdiction? Observation and reflection by staff yielded the following as potential contributors. PREVIOUS BSC EXPERIENCE Team success may have been enhanced by the presence on the team of at least one individual with previous BSC experience. A team with past experience, particularly one in which the senior leader reprises that role, may come to the pre-work period and LS1 with an already-developed understanding of some aspect(s) of the methodology and some experience in implementing them. Further, teams are often asked to suspend their disbelief at the start of a BSC and to take as faith the idea that small tests of change can lead to systems improvement. Those who came to the Collaborative with previous experience and first-hand knowledge of this process may have been better prepared to move into action than those for whom a bottomup approach to change was antithetical to their working experience. While several of the Safety and Risk Assessments jurisdictions had participated in past BSCs and had experience with the methodology going back as far as Recruitment and Retention of Resource Families (2002-2003), others were essentially unfamiliar with the whole concept of the BSC and the methodology involved. Thus, this Collaborative began with a relatively wide range of team readiness. When teams have participated in previous BSCs, there can be an assumption that they have mastered the Model for Improvement and will be using it as a tool to identify, test, measure, and spread improvements in their agencys practices and procedures. However, many factors can affect whether that assumption actually applies: the degree to which the jurisdiction successfully mastered the methodology in the past; changes in team membership between Collaboratives; changes in jurisdiction leadership; intersection of the work with other initiatives being undertaken; and external pressures such as budget cuts, legislative mandates, and media exposure. But mastery of the methodology may take considerably more time than that allotted by the timeframe of any one Collaborative experience. For example, Carver County, MN, has been using PDSAs since their participation in the BSC on the Recruitment and Retention of Resource Families in 2002. Their application for this BSC indicated that their core team members had a good understanding of the PDSA methodology by 2004, at which time they began to spread it across our organization to address concerns in other areas. Even when the senior leader on a team repeats his or her role (or moves up from another role, such as day-to-day manager), there are generally few if any other team members who have had prior BSC experience, thus making the team as a whole only slightly more prepared than those with no prior exposure. What seems to have the biggest impact is a senior leader in a past Collaborative who has brought the methodology to his or her jurisdiction as a way of doing business. When this happens, the new team has at least observed, if not participated in, systems changes that arose from small tests of change tied to agency priorities.
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Since 2001, Catawba County, NC, has participated in four national BSCs. During this BSC, Catawba County was undergoing major changes in administration because of the retirement of their director of 30 years. To assure continuity of system improvements and commitment of leadership, Catawba County requested co-senior leaders and paid the way of their assistant director to attend BSC learning sessions. In their application, the agency indicated that the BSC methodology and interaction with communities across the country has promoted major learning and innovation in our agency. BSC has jumpstarted several long-term quality improvements that we believe are good for children and families. Not surprisingly, PDSAs generated by this team tended to be in line with the methodology right from the start of the Collaborative; measures were reported regularly, and their work on spreading the improved practice of holding early Child and Family Team Meetings is an excellent example of a well-planned approach to systems change advocated by the Collaborative. ALIGNMENT WITH EXISTING INITIATIVES Several of the teams in this BSC entered the Collaborative seeking ways to implement an existing system-wide initiative. In these cases, the answer to the first Model for Improvement question (What are we trying to accomplish?) may be at least partially imposed on the core team from outside. For example, Fresno County, CA, came to the Collaborative while in the process of implementing the use of Structured Decision Making tools in all of its family reunification units, while at the same time focusing on the family-to-family strategy of fully implementing family Team Decision-Making. In their application, Fresno included integrating the Structured Decision-Making tools and processes fully with Team Decision Making as a specific goal of their participation. When teams are able to employ small, bottom-up tests of change to implement or tweak these large initiatives in ways that work well in their specific environment, they can use the methodology to enhance their success in the larger initiative while achieving success within the Collaborative structure. Another example is the Oklahoma team, who joined the Collaborative at the same time that the State was developing a new family-centered practice model as well as revising its safety assessment tool. The team used their BSC experience and PDSA development as a laboratory for testing that tool as well as practices that could operationalize practice model standards. Perhaps because of their clear focus on these two efforts, the team was able to test a number of PDSAs that had the potential to change practices with children and families. The team itself was initially reluctant to take credit for their practice successes, because they were connected to the larger practice model. However, by the conclusion of the BSC, the core team (with encouragement from the staff) was able to include the following in their impact statement.
During the course of this BSC, we were in a unique position in that the State [of] Oklahoma was going through signicant change with regard to the way child welfare services were delivered. As the BSC was unfolding, so was the new child welfare practice model for OKDHS.Due to our participation with the BSC, our sta was on the forefront of designing, piloting, implementing, and ultimately rening this tool (safety assessment) for statewide use. Opportunities to test change have been plentiful, and the guidance of the BSC has assisted us in optimizing the roll-out of new ideas in an organized and methodical manner.
CONNECTION TO MULTIPLE KEY AREAS FOR PRACTICE IMPROVEMENT At LS1, as teams were immersed in the key areas for practice improvement through large group sessions as well as smaller breakout sessions, they were also introduced to the Model for Improvement.
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The key to using the Model for Improvement for teams was to directly connect the first question of the ModelWhat are we trying to accomplish?to one of the key areas for practice improvement. The key areas were intended to serve as the explicit foundation for each change that would be tested. During the course of each action period, teams concentrated on conducting multiple small tests of change through successive cycles. From a methodology perspective, the goal is for teams to initiate changes on an unusually small scale in order to focus on the learning that occurs in each cycle. Most teams focused their work on a small number of strategies within a few of the key areas. As might be expected, they often found themselves conducting different PDSAs that were similar or closely related. But while each teams work may have started with a fairly narrow focus on a single key area, as the PDSAs developed into broader strategies, the work naturally crossed over to other key areas. For example, almost every team documented and shared tests of change in the key area of Family and Youth Engagement. Each test began with a narrow focus on engaging children, youth, and families in a very specific practice related to safety and risk assessments, but as each small test unfolded, the scope naturally expanded until it affected other key areas, as shown in these examples:
Strategy to Engage Child/Youth/Family Other Key Sub-Area Impacted
Call families before initial visits
Making sound decisions on safety and risk Using safety and risk assessment tools Making sound decisions on safety and risk Race, ethnicity, and culture Community partners Services and supports Race, ethnicity, and culture Making sound decisions on safety and risk
Include parents in safety planning meetings
Develop peer mentor programs for parents
Engage fathers
This interplay among multiple key areas was articulated by some of the teams in their final impact statements:
[Our] experience can be best summed up in a few key words: increased communication and collaboration across all partners in the change process around safety and risk assessment. We believe the BSC model has allowed key partners to discuss and explore genuine family and youth engagement. We have seen that in cases in which families are allowed their voice, profound change happens not only for the family but also for CPIs, family care managers, and other community partners. Florida Circuit 5 Our team has examined ways to decrease disproportionate representation and disparate outcomes for African American families, [develop] strategies to engage and increase the involvement of fathers, and [take] steps to increase the voice and satisfaction for all of the families we serve. We expect these positive changes will spread and sustain over time, ultimately increasing child safety, well-being, and permanency for [the] children and families we serve. Olmsted County, MN
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PERMISSION TO INNOVATE Most bureaucracies have entrenched hierarchies where ideas and implementation plans begin at the top and work their way down. This BSC required the opposite to be true, with the ideas and implementation plans bubbling up from the field. Thus, team members could only successfully test new ideas when they knew they had the full support of a senior leader who would provide opportunity and permission for innovation. Early in this BSC, Carver County, MN, participant Michelle Selinger shared this view of the power of the methodology to impact a child welfare system:
Workers feel empowered to try new things and spread the word when they work. Countless system changes have actually occurred from individual workers ideas, and [they] have impacted our agency in a creative, energetic way. We have learned to think in small, achievable steps to obtain success. Instead of being an authoritative system, it has changed our mindset in that workers know they have the capacity to impact a governmental system and that they are not simply one cog in a much larger wheel. It is our belief that through PDSAs, we have been able to impact our whole systems change.
STAFF AND FACULTY FLEXIBILITY Just as one of the foundational principles of good social work practice is to meet the client where he or she is, it was important for BSC staff to take into account the totality of each teams experience. The ability of individual team members as well as the team as a whole to embrace the Model for Improvement; test and study small practice changes tied to jurisdictional priorities; focus their work in circumscribed key areas; make full use of opportunities to collaborate with, learn from, and teach others; collect and use data; spread successful practice changes; and sustain those changes over time naturally fell along the bell curve continuum. Staff needed to make themselves aware of the many factors that were influencing each teams progress, which included (but were not limited to): Previous experience of the jurisdiction and/or team members with other BSCs Specific composition of the team and interplay among team members Ability of the team to fully engage all members Cultural expectations that might run counter to some BSC expectations Agency expectations and initiatives that might either support or challenge the teams ability to participate actively External factors such as budgetary issues and media exposure During the course of this BSC, staff learned that flexibility was another key to supporting teams success. As a result, the BSC staff conducted what amounted to its own PDSAs in the practices they used to working with teams. Learning sessions were testing grounds for innovation in experiential activities, team sharing, and conversations on race, ethnicity, and culture. Forms were tweaked, adapted, or developed as needed to help teams frame and report their work. Reporting forms were developed and revised given the expansion of the type of information conveyed to teams each month. Measures were revisited and, in the case of one team, staff helped create a different set of measures that fit the tribes needs and ability to collect data. At points throughout the Collaborative timeline, staff found themselves continually asking, What mechanisms for our work with teams and their work in practice improvement are already built into the methodology? What remains to be developed? In these respects, the BSC staff found themselves modeling the overall BSC methodology of collaboration, flexibility, listening to constituents (the teams in this case), and testing
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improvements continuously. It was precisely these attributes that supported the teams in achieving their own success.
Challenges in Applying the Methodology

INTRODUCTION Almost all teams struggle initially with aspects of the methodology. Everything about itthe bottom-up approach to improvement; the questions that guide the teams thinking about potential strategies; the use of small tests of change; the collection and use of data for improvement; the organic spread of simple improvements; the planning for broader spread and sustainability of improved practiceschallenges the customary bureaucratic processes that protect hierarchy and encourage conformity and caution. These areas presented difficult transitions for teams in this BSC: Applying the concept of small tests of change (PDSAs) Collecting and using data for improvement Transitioning from PDSAs to spreading and sustaining improvements SMALL TESTS OF CHANGE (PDSAS) As described in the introduction to this report, teams in this BSC were able to test small changes related to safety and risk assessments using the Model for Improvement through Plan-Do-StudyAct (PDSA) cycles. The first learning session provided teaching and coaching on the mechanics of PDSAs, and additional support was provided over the course of the action periods and at subsequent learning sessions. These PDSAs, while quite simple in the abstract, often require a great deal of coaching when it is time to apply them to concrete practice. Beginning with the development of the first PDSAs, it was often difficult for teams to concentrate on practice changes and narrow their tests to one small step that could be taken by next Tuesday. While most teams left LS1 with what seemed like a plan for testing a practice change, within a short time extranet postings revealed a general difficulty in applying this aspect of the methodology in the intended fashion. Tests were too large, addressed agency processes (meetings, surveys, trainings), or were unrelated to key areas that had been identified as needing improvement. The study phase might not have been completed, not used to revise the plan and try a new test, or resulted in premature abandonment of the idea. Some teams leapt directly from a successful first test to the desire to spread a new practice throughout their jurisdiction. As in other BSCs, it took much of the first action period for many teams to implement appropriate PDSAs, study the results, fine-tune them through multiple cycles, and learn something useful about how their system could be improved. Some teams continued to struggle with this into the second action period and even beyond. WAYS IN WHICH CHALLENGES WERE ADDRESSED Besides instruction on PDSAs, faculty and staff supported teams with prompting questions designed to help them scale down their tests of change, align them with team priorities, connect them to the key areas for practice improvement, and focus them on practice rather than process. During the course of the BSC, various tools were developed specifically to help faculty in that coaching role. Faculty also participated in conference call training sessions in which they practiced coaching teams toward successful PDSAs.
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Monthly feedback reports from staff to teams addressed the team struggles to develop and test PDSAs, focusing on the positive and making suggestions for potential improvement. Every month, all-Collaborative calls as well as the Collaborative newsletter provided tips and reminders. Especially good examples of tests that both adhered to the methodology and showed potential for systems change were highlighted in these venues as well as in separate extranet announcements. In these ways, teams received regular reminders to focus their work on their self-described priorities and to adhere to the bottom-up, small-tests-of-change methodology. Often, it was an outsidera parent, youth, community partnerwho grasped the PDSA concept most quickly and posited a viable PDSA, possibly because they had the least experience with agency procedure. Family and youth voice and engagement played a powerful role at LS1. Consequently, many teams left that meeting with at least one PDSA tied to this area, and within a month 12 teams had posted at least one such test to the extranet. Many of these, prompted by ideas from family and youth team members, were good examples of small and specific actions that would result in a change in practice, could be accomplished quickly, would not require buyin, and could be easily replicable. A STORY OF SUCCESS The experience of the Catawba County, NC, team, which had previous BSC experience, as they completed one test and went on to a second cycle, is illustrative of how effective the PDSA process was when youth and parents were directly involved in developing and testing PDSAs. The worker (J) tried the first cycle with a youth information sheet he had created. The youth (S), however, created an in your own words document for the second cycle, which was more youth user-friendly.
PDSA Title Youth Input during Assessment
Plan: What are we going to do? (What is the change being tested?) Who is going to do it? When will it be done? Hypothesis (what do we expect to happen?) Do: What happened?
Use the Youth Information Sheet in an interview with a youth during an investigation/assessment. The youth can complete the form on his or her own by writing the answers or the youth can complete the form with his or her social worker by answering the questions verbally. S (youth), J (worker), and a family
S (youth), J (worker), and a family
We will gain more information and insight into the case and into what may best serve the youth. Also, the youth will be given a voice.
S developed questions for youth involved in an investigation to help engage the youth. J gave the questions to a youth in a new case. The youth answered the questions but felt that the questions were not particularly helpful. However, he did not mind answering them.
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PDSA Title (cont)
Youth Input during Assessment (cont)
Study: Did what we expect to happen actually happen? What was different from what we expected? What did we learn? Act: What learnings will we apply to our next PDSA cycle? What will be our next PDSA?
We expected that the questions would help engage the youth and give the youth a voice. In this case, the youth indicated that he did not feel the questions were that helpful. However, the youth may still have felt empowered because the social worker wanted to learn more about him, even though he did not verbalize this to the social worker.
In our next cycle, we will modify the questions, with Ss help. Then J will test our modified questions on a new case.
COLLECTING AND USING DATA FOR IMPROVEMENT Measurement occurs on many levels in a BSCthrough quantitative monthly measures to selfreported self-assessments to the study part of a PDSA cycle. All of these data sources were intended to provide important insight to teams about their progress in improving safety and risk assessments. The quantitative monthly measures in particular were intended to help teams gauge the impact of their changes in close to real time. And while some teams were able to use some of the monthly measures in this way, others struggled. The ability consistently to collect and report data on a monthly basis varied greatly across teams. A few teams were able to work cooperatively with the data staff in their jurisdictions to pull clean, complete data each month, but most teams struggled due to a lack of data infrastructure. Teams from large, urban jurisdictions found it difficult to gather data for a small target site, while teams from rural or tribal agencies were hand-counting tallies kept by individual caseworkers. Teams also struggled with the required family and youth surveymost were unable to gather more than a few surveys each month, which did not give them any representative information. The utility of the measures also varied across teams. For example, some jurisdictions did not conduct meetings without a parent present and reported 100 percent every month for family participation in meetings. Consequently, that measure did not reveal anything about how their system was improving over the course of the BSC. Teams were encouraged to adapt the measures to meet their needs, but such modifications often entailed delays that in turn meant the data sets were incomplete. For some measures, the target site was simply too small to provide useful data. This was especially true for permanency measures, which should be impacted by improved safety and risk assessments and decision making, but are better observed on a long-term, system-wide level. Most jurisdictions, for example, only had a few children attain permanency each month, so the percentage of children who achieved permanency in 12 months could jump dramatically without reflecting real changes in service. Similarly, tracking whether children had two or fewer moves in care on a monthly basis meant that the same basic population was counted each month, making changes difficult to discern.
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WAYS IN WHICH CHALLENGES WERE ADDRESSED During the initial pre-work period, teams were presented with a broad list of measurement categories as well as some general guidance about how the data might be captured in their jurisdiction. Teams were then encouraged to have one-on-one conversations with the BSC project staff to best determine what these data would look like in their individual jurisdiction, knowing that data definitions, collection, reporting capacity, and quality vary dramatically from agency to agency. While these individual conversations around data to be reported were sufficient to provide some teams with the framework they needed to begin tracking at least some of their measures, it was more often the case that teams continued to struggle with measurement processes. Staff continued to work with team members (generally but not always the day-to-day manager), seeking ways to facilitate regular reporting without imposing an undue hardship on each systems ability to track data within their target site. Descriptions of measures on the extranet were tweaked several times in an attempt to make them as clear as possible. Staff developed a monthly measures guide to help teams connect their measures with their data plans. This spreadsheet was individualized for each team and provided a correlation between the general monthly measures and the team-specific data plans to describe exactly what number or data point should be entered for each measure. Each month, teams received a summary report that displayed their reported measures in both tabular and graphical formats, with questions for consideration. Mid-way through, the BSC staff developed an overall measures report that provided a look at how teams across the Collaborative were progressing on each separate measure. Assistance in collecting and reporting measures was provided on a continuous, asneeded basis, as well as offered at every learning session and on some conference calls. Monthly newsletter articles addressed some aspect of measures, with tips for teams on definitions, collection, and posting. A STORY OF SUCCESS Perhaps one of the most important outcomes related to monthly measures was the level of growth that occurred around data collection and using it to improve service delivery. Most of the day-to-day managers on the BSC teams did not have much prior experience collecting and using data, and the monthly measures process was intimidating for them at the outset. However, after teams got into the practice of posting their data and receiving their monthly reports, they began to see first hand how the data painted the picture of their progress. Ultimately, the most hesitant day-to-day managers became some of the most enthusiastic advocates of the importance of using data to guide planning and progress. One day-to-day manager described it this way: I better understand now...the benefit of how data can be used to help in the change process. And the Navajo Nation, Southwest Region team, who had many early challenges but found success with identifying and collecting data that would be helpful to them, noted in their Team Impact Statement: Acknowledging our limitations and using the data through the monthly measures has prompted us to make reliable decisions, which are in the best interest of our consumers. Additionally, many senior leaders were able to describe how their agencies use data at all levels, from the agency decision-making level all the way down to the individual supervisory/caseworker level. Several teams had begun posting BSC and other monthly data in staff break rooms or hallways to promote excitement about the improvements they were seeing.
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SPREADING AND SUSTAINING PRACTICE IMPROVEMENTS The core of the BSC methodology is the Model for Improvement and its very first question asks, What are we trying to accomplish? The answer to this question is never simply a small test of change. Instead, it is always a practice that has been spread across a jurisdiction such that improvements are realized. Spreading improvements are the ultimate goal of a BSC; thus spread as a formal, concrete, and intentional set of activities was introduced briefly at LS2, taught more fully at LS3, and finally reinforced at LS4. As the Collaborative proceeded, teams tested, studied, and began to spread practice changes at various times. As with other aspects of the methodology, understanding and implementation of the theory and mechanics of spread varied greatly from team to team. Some teams wanted to jump immediately from a few small tests to system-wide implementation, while others were unable to identify specific practice changes to be shared with others in their jurisdiction. Concepts to spread were in some cases too broad (father engagement, creatively looking at each familys situation); in others they lay outside the key areas for practice improvement that were the subject of the BSC (discuss emancipation and independent living concerns). Perhaps because the initial introduction of the methodology at LS1 emphasized the way in which promising practices would organically spread once co-workers observed their benefits, teams had difficulty determining not only when a practice was ready for spread but also any systematic means for making that happen. Interestingly, teams who grasped the concept of readiness for spread and who were able to plan and implement concrete spread activities were not necessarily the same as those who demonstrated mastery of the use of PDSAs. Thus, a team might have developed a plan to spread a practice they had been working on for some time, but not necessarily stemming from PDSAs as the methodology would describe them. WAYS IN WHICH CHALLENGES WERE ADDRESSED Staff noticed that an increasing number of teams were identifying PDSAs as ready for spread about mid-way through AP2 and realized that there was no yardstick against which teams could easily measure their true degree of readiness. As a result, a series of instruments were prepared and tested with teams to provide them with a framework for determining whether a given practice truly was ready to spread within their jurisdiction. The final instrument became both the basis of a teaching activity used to emphasize the importance of a planful approach to spread (at LS3) and a reporting form for teams to use as they identified practices they believed would lead to improved outcomes. Once teams began using this reporting form, staff began providing feedback and assistance in the decision-making process that the form framed. Employing the extranet form interactively, staff were able to ask specific questions about various aspects of spread plans, helping teams to concentrate on areas they might have neglected or found challenging. Feedback on spread plans was also added to monthly team feedback forms. Discussions about spread were added to conference calls at all levels, and monthly newsletter articles provided tips and reminders. A STORY OF SUCCESS The Navajo Nation, Shiprock team posted a very limited number of PDSAs; only one of those tests was an actual practice with families (a traditional Peacemaking session with a family). The remainder of the work they reported to the Collaborative consisted of processes they had set in place to bring Peacemaking back to their community (e.g., training in the Peacemaking process;
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creating and sharing a memorandum of understanding with the community about the process; creating a video explaining the process). This focus on Peacemaking was decided fairly early in the BSC. While the individual PDSAs did not correspond to the small test of change concept, the team was clear that they had identified what they wanted to accomplish (use traditional Peacemaking as an alternative to the court system in the resolution of family problems). The team was unsuccessful in finding a way to collect and report any measures, yet their spread plan laid out a very clear path for restoring this practice within their region through the development of curricula, workshops, and staff trainings; identification of multiple audiences (foster parents, community resources, staff); and the use of forms, brochures, practice guides, and memoranda of agreement to implement the practice going forward. While they have placed their spread plan on hold for the time being due to organizational strictures, they did successfully incorporate the BSCs planned approach to spread into their thinking about how to undertake systems change.
Success and Challenges in the Tribal Context

The participation of three American Indian tribal teams, Navajo Nation, Shiprock; Navajo Nation, Southwest Region; and Chippewa Cree Tribe, in this BSC represented opportunities and challenges, both anticipated and unexpected. Often the Collaborative and the teams struggled to adapt to each others cultures. Some core BSC values like collaboration and cooperation mesh well with values encountered in many American Indian cultures. Other BSC practices, like rapid cycles of innovation, bottom-up change in which anyone can have an idea and test it, moving forward without consensus, and breaking practice down into small parts, conflict with aspects of the world view shared by many American Indian tribes, where traditional approaches, lengthy deliberations, holistic problem solving, and the constancy of time would seem to make participation in a BSC challenging. Other Western values, such as impatience, competition, self-determination, assertiveness, and scientific evidence, are at odds with perceived Native values, such as patience, cooperation, fatalism, passivity, and story-telling. With good reason, tribal peoples are often distrustful of European Americans and have had particularly disastrous experiences with child welfare systems. During the application process for this BSC, the planning team reached out to tribal communities, believing that well-supported tribal participation would provide a platform for significant learning about how tribal child welfare systems could benefit from a learning collaborative originally developed using a Western medicine-based framework and designed to counter common qualities of Western systems. It was also anticipated that the Collaborative would benefit from tribes experiences and perspectives as well. The planning team made efforts to ensure that the concerns and needs of American Indian participants would be met. A tribal faculty member with extensive experience in consultation between federal and state child welfare agencies and tribes was enlisted to serve as a guide and liaison. Planned activities were examined with an eye toward how they might be perceived and experienced by tribal teams. Before the first learning session, the tribal faculty member and a BSC staff representative made site visits to each of the tribal teams, which served to increase mutual trust and cultural understanding and lay the groundwork for successful participation in the Collaborative. Mutual learning between the tribal and Western cultures was evident at the first learning session, where teams participated in an experiential activity designed to demonstrate the power of
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collaboration and the usefulness of small tests of change. As it unfolded, teams competed with one another to conduct the activity more quickly and with fewer mistakes; one aspect that was often short-changed was to engage all team members in a cooperative effort to complete the task. Watching one of the tribal teams in their efforts, it was clear that they had elevated the cooperative aspect of the activity to the top and were unconcerned about the time factor. In the activity debriefing, a team member identified the quality of the helping relationship between team members in completing the activity safely as more important than speed, which immediately gave both staff and other teams not just an insight into the tribe but a reminder that all teams can benefit from intra- and inter-team helping. Over the course of the first action period, it became clear that these teams were having some very distinct challenges around technology, data, and implementation of various aspects of the BSC methodology, such as conducting small tests of change and participating in Collaborative activities including conference calls and extranet exchanges. Staff and faculty made additional site visits to each tribal team, which enhanced these teams ability to engage more fully in the work of the BSC. Site visits provided teams and staff with opportunities to develop relationships and personally address the challenges faced by the tribes. Meeting with the tribal teams face to face allowed staff to adapt the methodology and measures as well as to brainstorm solutions to fit the unique needs of the teams. For example, the Navajo Nation, Shiprock team was able to develop a data reporting framework that more accurately reflected their work than the measures established prior to the start of the BSC. Tribal teams were engaged in a way often seen at conferences: Each team was asked to lead opening or closing prayers at a learning session. Instead of what sometimes seems like a cultural demonstration at such events, each of these was profoundly moving, as the tribes permitted other participants to experience rather than just observe. Without understanding the words of the blessings, other teams, faculty, and staff were clearly drawn into the emotive power of the prayers, and they gained a holistic, rather than a particular, understanding of that small piece of the cultural experience. Throughout the Collaborative, tribal teams experienced some of the same kinds of challenges that other teams often struggle with: staff changes, intra-team dynamics, personal tragedy, and even the dissolution of the Navajo Nation region represented by the Navajo Nation, Southwest Region team. Through it all, these teams displayed the same commitment and perseverance as the other 18 teams, who themselves suffered their own budget and staff cuts, negative media attention, and high-profile crises. What stands out in looking back is not the ways in which these teams were different from others, but the ways in which they are similar: in their commitment to the project, yes, but more importantly in their commitment to improving the ways in which they work with the children and families for whom they have child welfare responsibility. At one learning session, a tribal team member said that it was very helpful to know that other child welfare systems, even large urban systems that seem so different from theirs, were experiencing similar challenges. One area of anticipated challenge was around data collection. Tribal systems are often not equipped with the resources, technology, and personnel to collect, maintain, and report data. Just as tribes may be suspicious of federal and state involvement in their child welfare systems, there may also be distrust of the motives of those who seek to gather quantitative data about them. But as trust grew, particularly between each of the tribes and the BSC staff person tasked with coordinating data collection, expectations were far exceeded.
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One telling example comes from the Navajo Nation, Southwest Region team that had never had the infrastructure to collect and analyze case data before the BSC. They asked case managers to keep track of the monthly measures on individual spreadsheets. After looking at the data on the individual worker level as well as the regional level, the team was able to pinpoint exactly where cases were getting backed up in the system, which was leading to longer out-of-home placement than necessary. Monthly data was used in supervision as well as monthly agency meetings, and staff began to be invested in watching the data, and thus the outcomes for families and children, improve. When case managers saw they were fulfilling visitation plans for only 40 percent of children in the region, they became more motivated to improve that outcome for children on their own caseloads. By the end of the BSC, 90 percent of children were visiting their parents according to their plans. The day-to-day manager for this team reported that tracking and using data in this way had transformed their system from one that was putting out daily fires to one that strove for better outcomes for the children and families they serve. Staff were particularly concerned that the Collaboratives emphasis on disproportionality and disparate outcomes would be off-putting to teams for whom all children and families they work with are members of their own ethnicity. Large-group discussions on race, in particular, could have become focused strictly on concerns about disparities between Caucasian and African American children and families. For some, these discussions did seem to be irrelevant. (One tribal member said, This appears to be more of a dominant culture concern. For us, it is more of Christianity versus traditional ways or colonized versus decolonization of the mind.) Yet tribal members made insightful comments about both racial issues that didnt necessarily affect their own systems as well as some that reminded all of the oneness of the human experience (I think the BSC staff went beyond all expectations in having a larger discussion on this important issue and I support your efforts. Empathy and understanding is desired and at least a sincere effort to begin addressing it. If our profession is having difficulty, I could imagine the enormity of this issue nationwide. I hope we have a presentation on this again.) At the conclusion of the final learning session, in an open discussion about the journey both teams and individuals took in relationship to this issue over the course of the BSC, the supervisor of the team from the Navajo Nation, Shiprock offered this reflection:
Most of you have an idea of what it is to see an Indian. We live on a reservation where you put rare species. How do we deal with our cultural biases? We are more similar on the reservation. We ght over the very same issues you deal with; do we love our neighbor or not! We can whine about all that happened to us you took our land, our feathers, etc. We deal with it at home. We have learned from you that your struggle is no dierent from ours. We will keep taking small steps, no matter what. Keep watching us, we are unique. We deal with our history; sometimes it seems like an excuse. We nd that the underlying current is loving our neighbor. Hope that happens across the borders. We have a concept in Navajocompassion. How we do that is by trying to implement the concept into a complex system. It is what makes us dierent, but also the same as you. You have it in your hand, like jellotry to squeeze it and it doesnt quite work.
What unfolded as a result of the active participation of these three tribal teams was a testament to the commitment of all parties to learn from one another, expanding understanding of both culture and safety and risk assessments across both value systems. The tribal teams, similar to all teams in this Collaborative, served as both learners and teachersand many of their teachings were critical to the progress made by the Collaborative as a whole.
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Using the Methodology beyond This BSC

In this BSC, most teams regularly presented their work to other units or partners as a way to spread and sustain their efforts. But at the conclusion of this BSC, several teams made plans to conduct their own more formal internal BSC-like improvement efforts as a way to spread and sustain its work. While some teams expressed interest in applying the entire BSC methodology in their agencies, others were interested in replicating specific elements, such as the collaborative learning environment or the Model for Improvement. FLORIDA CIRCUIT 5 Florida Circuit 5 consists of five counties, the largest of which was chosen as the target site for the BSC. Florida has a privatized child welfare system, where the state conducts investigations and private agencies provide case management and permanency services. The Florida Circuit 5 core team for this BSC was a partnership between the lead agency in Circuit 5, Kids Central, and the State Department of Children and Family Services (DCFS). Based on the work of this BSC, DCFS and Kids Central have continued to partner in continuing the work of the BSC after LS4. They have each hired a program manager in Circuit 5, and part of their job duties will be to facilitate a mini-BSC in the five-county region. The mini-BSC will focus specifically on spreading successful practices related to family engagement, such as family group conferencing, but it will also be used to encourage county teams to test additional PDSAs to continue to improve practice. In addition to these plans for a mini-BSC, Circuit 5 of DCFS has also adopted learning methods used over the course of this BSC. At a recent regional meeting with supervisors, they introduced speed sharing, a quick round-robin presentation format that was very popular at BSC learning sessions. Eight supervisors participated in making presentations, and participants enjoyed learning practice ideas from each other in such a concise and fun manner. By using both the methodology as well as specific collaborative strategies, Circuit 5 is hoping to keep improving their safety and risk assessment work along with moving toward becoming a more collaborative agency. PHILADELPHIA Philadelphia Department of Human Services (DHS) is the county-administrated child welfare system for Philadelphia County, PA. During the BSC, the Philadelphia team focused its work on the section of the department that addresses repeat maltreatment. Since the conclusion of the BSC, the county has begun to explore the possibilities of using the BSC methodology with each of the regions at DHS. The goal would be to use the methodology, including learning sessions, faculty, and the Model for Improvement (PDSAs and measuring outcomes), to support the roll-out of the countys new Model of Practice. This practice model is focused on both family teaming as well as allowing safety to drive decision making throughout the life of all cases. As they are two years into implementation of a new safety assessment process and beginning to incorporate family teaming, this BSC would help serve as a transfer of learning to clarify, reinforce, and provide support following the more formal training on the model. This is still in the development phase, but Philadelphia will continue to work with others in the county to try to make it a reality in 2010. Simultaneously, a voluntary workgroup known as the Empowerment of Change group began in October 2009, immediately following the final BSC learning session. This workgroup was charged with continuing to test PDSAs around safety assessments. The vision for the department is to have a similar group doing this work in each region of the county over the course of 2010.
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Additionally, at the state level in Pennsylvania, Philadelphia is also sharing aspects of the BSC methodology. The Sustaining Change/Quality Improvement group at the state level is focused on rolling out quality service reviews in January 2010 using a tool from Indiana as a pilot. As they review 36 cases from across the state and adjust the Indiana tool in the process, they expect many recommendations to be made that are both county-specific as well as statewide. Philadelphia hopes the state will consider dividing up into regions and possibly have mini-BSCs focused on testing and implementing improvements based on the various recommendations made. Philadelphias goal for all of this work is to continue to learn, as well as to find ways to share learnings across the county and state. CHIPPEWA CREE TRIBE The Chippewa Cree Tribe on the Rocky Boys Reservation has its own child welfare system led by the tribes social services unit. The BSC core team included several staff from this unit along with partners from some of the other human service agencies on the reservation, including TANF and a federally supported project to restore cultural and traditional practices as a way of strengthening families and the community. Throughout the BSC, the Chippewa Cree Tribe team focused on increasing the understanding of staff, partners, and the community of the differences between safety and risk, primarily with the TANF agency. They recognized that when there was a common understanding around these terms, both agencies were best equipped to serve and support families, and families were best equipped to use and integrate the services from both agencies. By the conclusion of the BSC, the team decided that the Social Services Unit/TANF partnership they had developed was so successful that they began to craft a plan in which they would conduct a BSC-like activity across the entire reservation to focus on collaboration, integration, and communication. Similar to the experience they had in the national BSC, they hoped to focus their reservation-wide BSC on collaboration and communication as well as to bring together all social service agencies on the reservation to develop a common understanding of safety and risk. Ultimately, the team wants to plan and take action to determine how the responsibilities for supporting families can be shared as collaboratively and clearly as possible. FRESNO COUNTY The Fresno County Department of Children and Family Services has participated in several BSCs over the last few years. By the conclusion of this BSC, Fresno County DCFS had developed a plan to conduct its own internal BSC-like activity focused on engagement with family and community. Deputy Director Andrea Sobrado, senior leader for the Fresno County team, is planning a series of 2010 learning sessions on engagement and safety and risk. The quarterly sessions will be designed and led by staff as well as members of the main constituent group that is the focus of the session. The January session was to concentrate on engaging resource providers, the April session on engaging youth, the July session on engaging parents, and the October session on engaging community partners. Sobrado hoped that the learning sessions would be interesting and interactive, and push people out of their comfort zones, just like this BSC did for us. She planned to follow each learning session with an action period during which staff who lead the learning session will review relevant agency policies and develop new ones that better reflect and guide the practice-level work being done. The overall goal is to involve the whole agency in the engagement effort, with policies that integrate and support the goal of improving practices and sustaining them.
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Conclusion
These four agencies are small examples of how the work that occurs in a Breakthrough Series Collaborative goes beyond the 18-month time limits of the project itself. While the overall mission of this BSC was to improve safety and risk assessments, tertiary benefits included helping agencies experience the power of making improvements in non-traditional, non-bureaucratic ways. Whether it is by continuing to deepen and spread improvements related to safety and risk assessments or it is by finding ways to implement aspects of the BSC methodology to address other challenges in child welfare, the opportunity for those teams that participated in this BSC to improve outcomes for children and families remains great. Time will tell what they are able to accomplish.
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SECTION FOUR:
ORGANIZATIONAL CULTURE CHANGE
The Buncombe County team has seen positive and transformative practice shifts, heightening our cultural competency in conversing with and engaging families during the safety and risk assessment process. We have also increased our knowledge of safety and risk dierences in all stages of our work with families, from screening through well-being and permanence. We have met with families, schools, community partners, and judges to dierentiate safety versus risk and to solicit their input as our practice transforms. Our PDSAs were meaningful and involved input from sta and families to promote and sustain these practice changes. Our team learned how to think small and tinker as you go, resulting in sustainable change. Our agency practice truly has moved from the ordinary to the extraordinary as a result of our participation in the Breakthrough Series Collaborative on Safety and Risk Assessment!
Introduction
While the overall purpose of a Breakthrough Series Collaborative is to improve a defined practice or body of practices, the elements that comprise the methodology are designed to encourage shifts in organizational culture as well as an ongoing focus on continuous improvement. Often when agencies want to change their culture, they create a new mission statement or develop a visible set of values or agency principles. But to create meaningful and lasting changes that truly improve the way agencies, families, and communities work together, those involved must experience new ways of thinking and acting. In many respects, acting your way into new thinking describes the essential experience for many participants and teams in this BSC. By welcoming the perspectives of workers, parents, youth, and community partners and by testing small changes primarily in front-line interactions, the BSC began to influence the beliefs and processes that govern interactions between families, communities, and agencies. These shifts helped achieve the third concrete step of the mission statement for the BSC: providing workers with support for ongoing learning and practice improvement. But they also supported the larger goal of advancing the evolution, already underway in many jurisdictions, from top-down, compliance-driven bureaucracies to learning organizations. As one participant remarked, the BSC provided teams with real-life tools that have and will continue to change lives and improve the quality of [life for] families. More than that, the BSC had the power to change the mindset of the system as a whole. This section outlines some of the major challenges to organizational culture change, identifies elements of the BSC that supported such changes, and describes plans by participating jurisdictions to continue BSC-based innovation throughout their agencies.
The Culture of Child Welfare Organizations

Edgar Schein, one of the originators of the term organizational culture, noted that [organizational] culture can be defined as the pattern of learned basic assumptions that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to the problems of survival and integration.9 Studies and analyses of organizational culture also tell us how hard these cultures are to change. Not only are they typically deeply embedded in the day-to-day workings of an organization, but they are taught and reinforced in bureaucracies (whether consciously or unconsciously) through training, policy, regulation, data management, supervision, and staffing.
Schein, E. H. (1990). Organizational culture. American Psychologist, 45(2), 109-119.
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Chief among the unconscious reinforcements in child welfare are the parallel processes between agencies and the families they serve. Decision making without input from those most affected, lack of communication, standards that shift, a gotcha mentality, power imbalancesall are familiar to families who experience one-sided and confusing agency practices. But they are just as familiar to staff in agencies subjected to a steady stream of direction and critique from federal and state auditors, legislators, reviewers, community stakeholders, policymakers, executives, and the media. Often agencies respond to these pressures by developing a deeply ingrained reactivity. As one observer remarked of an agency involved in this BSC, They have no strategic plan, are constantly reacting, and follow an agenda set by external stakeholders. Leaders faced with sudden, severe, and unpredictable scrutiny about different areas of the agency find themselves propagating these siege-like pressures. The result is that survival in the agency has become dependent on being most comfortable in crisis. BSC Co-Chair Harry Spence pointed out that this pattern replicates the core issue of child protection, betrayal by authority. Just as the child experiences in abuse or neglect a failing of the caregivers in his or her life, so workers in an agency can feel betrayed when they are blamed in high-profile cases, overexposed to the secondary trauma endemic to the work, or confined to a culture of compliance that, like poverty in families, makes it nearly impossible to grow and succeed. Glen Casel, senior leader of the team from Florida Circuit 18, noted that the more you look at the system of child welfare, the more you realize that the things we try to overcome with our children and families, things like victimization, are reflected in the way we do business, from the federal government all the way down. You find everything that we dont want represented in our families represented in our systems. Beth Brandes, senior leader of the Catawba County team, is acutely aware of the cycles of victimization that affect families, staff, and leadership. Her agency encourages efforts to make these unconscious patterns conscious: Our staff has begun to own their own victimization. When morale is abysmal, they start talking about what is making them feel victimized, and then what is one strategy theyre going to do to move themselves to the next level. And it has shifted the ownership. Brandes applies the same principles in her own work: Every time we go through a federal review, I have to admit I have this moment where I think, I cannot believe how victimizing it feels. So how do we [leaders] move our system to a different mindset? Because we do set the tone.
Supporting Organizational Culture Change through the BSC

Such deeply ingrained attributes raise the question of how a project only 18 months in duration could result in any shifts in organizational culture, let alone sustainable ones. Clearly, a single BSC team can neither initiate a significant shift in agency culture on its own nor bring it to completion in a single BSC. But a review of the progress and work of teams over the course of this BSC reveals five key elements of the methodology that were linked to organizational culture changes observed in various stages by participants: Agency readiness and team composition Embedding improvement in daily work Collaboration and interaction between participants Focus on family engagement and cultural responsiveness Focus on spread and sustainability
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AGENCY READINESS AND TEAM COMPOSITION Each participating agency in the BSC was asked to identify factors that made change possible and collaboration likely. To make the best use of what the BSC could offer, each jurisdiction needed to demonstrate an understanding of the principal challenges it faced, describe past efforts at improvement, and identify staff and partners capable of independent, innovative work. The application process helped identify these initial elements of an environment conducive to growth. Its purpose was not only to provide information to the BSC planning team about prospective participants, but to help applicants evaluate their own readiness for a BSC. Some jurisdictions identified other efforts that the BSC would complement or for which it would provide a testing ground. One agency, for example, found that the training it had received in another improvement area was insufficient and planned to use the BSC to develop the concrete practices for its new framework. Others struggled to find a focus, and at least one agency went through the applications process only to realize that it could not make the commitment necessary to succeed. Because the team would introduce novel and rapid experimentation where the agency norm might have been cautious and gradual protocol, proposed team members needed to have the ability not only to innovate but also to take risks, make mistakes, and learn from failure. Senior leaders from several jurisdictions reported that younger workers adapted more easily to the new thinking than some veteran staff, and the same has been true of some parents, youth, and community members. Over the course of the BSC, intentional sessions and activities at learning sessions underscored the importance of working in egalitarian ways that honored all voices equally. Those team members who were typically on the lower end of the agencys power dynamic felt empowered to bring forth ideas based on their own clinical wisdom. As one worker explained, I feel motivated and inspired to speak up for what I believe in and changes I would like to see. This experience has helped me to come out of my shell and come into my own as a worker. Another agency worker said, The experience has helped me become more aware of the power I possess for change to occur. Perhaps not coincidentally, many teams began to shift the way they worked together. In many ways, this cross-sectional team served as a microcosm for the desired shift in the agency overallmoving from a bureaucratic hierarchy to an agency focused on attaining the best end result possible for children and families. A day-to-day manager reflected after the fourth learning session, It seems to have empowered each member of the teamthe community has become willing to stand up and take a more active role in creating safety. And a community partner described the experience by saying, The team is very supportive of everyones input. There are open, honest conversations that occur around the table [that] then allow the team to move forward in creating PDSAs that will best serve the needs of the children and their families. And with these youth and families at the table for the planning and testing phases of practice, they were no longer simply the recipients of change; they were the initiators of improvements. Agency staff as well as the youth and birth parents themselves consistently reiterated the importance of these voices. One birth parent said, DCFS has included me in the discussions at all meetings and made me feel part of the team. The team listens to my comments, suggestions, questions, etc. I feel that is very important because its coming from me as a birth parent [who] has dealt with the system. These team members in particular also impacted the overall way in which teams focused on youth and family engagement in practice.
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Having parents and youth on these BSC core teams resulted in bringing these perspectives into other planning processes for some participating agencies, furthering their moves toward authentic engagement of youth and parents at multiple levels. This was described by a team member following LS4, This has been such an empowering and rewarding process to be involved in. It has not only allowed growth within my agency but also personal growth. It has also been a blessing to have a parent and youth on the team and their desire to make it better for the families who will have child welfare experience. They have truly become a voice in our organization. EMBEDDING IMPROVEMENT IN DAILY WORK The major shift that teams and agencies had to make to effectively use the Model for Improvement was from viewing the work of improvement as separate from their day-to-day work and responsibilities. This shift had to take place in two arenas: the personal and the organizational. At first, most participants approached the BSC in general, and the execution of PDSAs in particular, as a burden added to their existing workload. One supervisor identified the issue early in the BSC: One of the biggest challenges is in encouraging [workers] to continue to try [PDSAs] and do them on top of what their daily work requirements are. Initially, the BSC did require significant additional work; before they could make improvements, participants had to learn the methodology, and in the meantime, existing work continued unchanged. Once the basics were mastered, however, many participants recognized the simplicity of the core elements because many good practitioners were eager to try new practice ideas. One line worker described her experience, Now I see and feel creativity as a tool [thats] incorporated in my work, as opposed to the old way of just meeting mandates. Even so, she pointed out, One thing we know from IHIand I think everyone in child welfare would agree with thisis [that] there has to be an element of replacement. If we keep adding on more practices, new practices, better practices, and dont take anything away or replace somethingit actually, in fact, is more work. While quantity can come nowhere near telling the full story about the scope of changes that were tested, over 350 PDSAs were documented in this BSC. Each PDSA was connected to the key areas for practice improvement, making it easier to communicate about them with other teams. PDSAs represented the acting your way into new thinking shift. For example, several teams tested PDSAs around scheduling initial meetings with families rather than making unannounced visits. Some participants (including those within the teams wanting to test this practice) expressed concerns about legality and safety. Was this allowed? What would parents do if they knew child protection was coming? These questions are at the core of many child welfare agencies traditional model of professional expertise. But by testing the practice and experiencing the results in daily work with families, the changes were profound. This example of a single small test of change helped front-line workers in many agencies change their beliefs, and ultimately their relationships, with families and communities. Organizationally, crises represent the greatest early threat to embedding improvement in agency culture. Embedding the ability for workers at various levels to test improvements is especially important when emergent issues of any kind absorb the attention of the organization: high-profile cases, budget cuts, leadership changes, etc. For BSC Co-Chair Harry Spence, such crises are to be expected and the BSC can be viewed as an exercise in keeping our focus on improvement while managing crisis.
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Early in the BSC when Texas faced a case that garnered the national spotlight, BSC leader Jen Agosti reminded senior leaders they were responsible for crisis management, and for creating a safe space for staff so that its okay to continue the work of the Collaborative while crises are managed at higher levels. As the Collaborative sought ways to support the Texas team, Philadelphia Senior Leader Brian Clapier recognized that most of us will be going through a crisis at some point during this BSC. He was right. Teams faced high-profile cases, personnel issues, budget crises, staff tragedies, reorganizations, conflicts with key partners, major layoffs, and changes in top agency leadership. None of the teams withdrew during the 18-month project. Overall, the potential that many teams saw in using the Model for Improvement and these small tests of change were summed up by a day-to-day manager: [The BSC] helped me and my team make change at a smaller level, rather than feeling like we have to move a mountain. So this concept brings a sense of hope. COLLABORATION AND INTERACTION BETWEEN PARTICIPANTS The majority of child welfare agencies in this country are rooted in fairly solid tribal, county, or state bureaucracies. These bureaucracies are reliant on policies and procedures, rules and regulations, and standardization and rigidity. The BSC methodology turns much of this way of thinking on its head. It pushes agencies to shift their focus from policies, procedures, rules, and regulations and look directly at practicewhat happens when a social worker meets a family. While the PDSA is often regarded as the core of the BSC, success also depends upon a teaming atmosphere that fosters innovation and an environment of permission and support that allows participants to overcome organizational and internal barriers. For example, innovation introduces new possibilities for making mistakes. Each element of the BSC plays a role in helping to manage these risks. PDSAs, for example, were designed to be very simple and small enough to be accomplished by next Tuesday. While this helped jump-start the improvement process and make it efficient, it also helped contain the hazards. One team reported that an early attempt to discuss race and ethnicity with a family annoyed the family but was small enough in scope that the worker could recover and continue building rapport with family members. Another team noted in its final team impact statement, The PDSA model allowed us to test ideas, demonstrate what works and what does not, and to not be afraid to take risks. Similarly, the BSC methodology teaches that anyone can test a new, creative idea, and that small ideas can lead to big system change. One community partner commented on the freedom this created for her team: The idea that we do not have to have consensus to move forward has really helped our team to not hold back on trying new ideas for PDSAs. Among the BSC elements most capable of neutralizing agency bureaucracy is this introduction of different perspectives. Jurisdictional isolation, to paraphrase Hubert Humphrey, breeds jurisdictional neurosis, and the essential collaborative experience of a BSC breaks the hermetic seal that reinforces the isolated thinking and self-sustaining culture in an agency under siege. This BSC provided participants access to a diversity of thought and practice approaches that seldom exists within any single agency. They encountered systems with different standards, cultures, policies, structures, target populations, and partners. They received expert advice from faculty. They vetted their own ideas with others, and exposed them to study and inquiry by others through the extranet, all-Collaborative conference calls, calls with others in the same team roles, workshop presentations, and speed sharing. A line worker described her introduction to tribal agency culture through this BSC, I would like to have more of an opportunity to hear more
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about the tribes and how they have done their work; it appears they have a very different way of working with one another based on how they see the world, and I could benefit from that. Meeting others in like situations can be a validating experience as participants recognized that they were not facing unique challenges alone. A supervisor from one of the tribal teams described this opportunity as a refreshing look and positive outlook knowing that there are others struggling as we are. This refocuses us to address change with broad shoulders know[ing] that change is possible. These interactions were also eye-opening and empowering experiences. As one worker said, My participation in the BSC has helped me see that our agency is not the only agency struggling to make positive changes. The experience has helped me become more aware of the power I possess for change to occur. At the same time, many participants found it liberating to have contact with those in widely differing roles or positions. At learning sessions, participants were immersed for a few days in an environment of collegial, non-hierarchical discovery and could experience a true learning culture. A line worker from Indiana described her experience at the second learning session: We have specific roles and purposes on our teams, but the people I connected with are a broad range of people. It was just interesting and enlightening that I could sit down at a table with everyone. The cross-pollination that results supports the relentless sharing and shameless borrowing so vital to learning in a BSC. FOCUSING ON FAMILY ENGAGEMENT AND CULTURAL RESPONSIVENESS Every BSC begins with a detailed Change Package that carefully defines the scope of the BSC and provides the general themes that teams must address to improve their systems. It is essentially the BSC policy guide, providing rationales and explanations for every aspect of the changes that ultimately will be tested by teams. As family group decision making, partnering with parents, and other engagement practices have become more prominent in child welfare, and as the field has become increasingly aware of disproportionality, the BSC model has evolved to include Family and Youth Engagement, and Race, Ethnicity, and Culture as key areas of practice in nearly every Collaborative regardless of the specific topic of focus. Their inclusion is not just a reflection of practice developments; both areas are integral to any solution to systemic issues in the field. To the extent that an agencys systemic characteristics counteract its mission, it will find itself in conflict with the core values of social work: respectfully to help others and challenge social injustice in a relationship context. Attempts to address systemic issues without addressing that conflict are unlikely to succeed. By focusing on family engagement and cultural responsiveness as overarching themes, this BSC sought to leverage a natural bridge between casework and culture change. Contrast, for example, an improvement that made a procedure more efficientsay, having a face-to-face meeting between workers at case transition pointswith one that shifted the inherent power dynamics, such as allowing families to interview social workers and select the one they think will work best for them. The first improvement produced improved outcomes for families but had a smaller chance of contributing to a shift in the basic attitudes that express the culture of the agency. The second clearly did. This is not to say that family engagement and cultural responsiveness in practice automatically lead to parent partnerships and undoing institutional racism work; the gaps between practice and system must still be bridged. But the principles of the practice work and of the systems work were fundamentally the same in these two areas, making the leap much smaller. One
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senior leader described this intentional focus as having broadened my knowledge [about] family engagement, culture responsiveness, and the importance of bringing families to the table, one of the most rewarding experiences in my career. SPREADING AND SUSTAINING IMPROVED PRACTICES The final element of the BSC methodology that supports culture shift is the intentional focus on spread and sustainability of improved practices. While the spread of practices actually necessitates a move back towards more standard ways of doing business (such as establishing agency policies), it also presents an opportunity to introduce the methodology more deeply into the organization, and to embed it in ongoing continuous quality improvement efforts. In this BSC, based on the learning from prior BSCs about the challenges of helping teams in this area, American Humane and Casey Family Programs extended the project timeline by six months and increased the number of learning sessions from three to four. Improvements in teaching the Model for Improvement also allowed the planning team to introduce the concept of spread earlier, to provide tools and coaching on the mechanics of spread for nearly half the project, and to present the fundamentals of sustainability before the projects conclusion. Applicant agencies were encouraged to recruit team members who were not only innovative but who were opinion leaders among their peers. Strictly speaking, if the goal of a BSC were merely to improve practice, there would be no need to recruit members who were both innovative and influential. Good practice, once tested, could be spread through the usual agency channels: policy changes, trainings, and so on. But participants who could straddle the boundary between the team and the agency, who could champion innovative improvements to their peers, were essential to spreading and sustaining successful practice improvements. Articulating the practice change accurately during agency spread efforts was essential to training and policy efforts. Just as importantly, the credibility of the peers who endorsed the new practices was critical to their adoption. Since a practice to be spread had been tested and validated for limited and specific circumstances (those prevailing in the pilot site), its success depended on continued refinement by other sites that adopted it. Practice remains alive if it is passed on as viable but evolving. This notion of continuous improvement was addressed by a day-to-day manager at the final learning session, The BSC has reminded me of why our work in [child welfare] is important. [We are encouraged] to push forward and not just accept the status quo. And a supervisor discussed the connection between both the personal and organizational aspects of continuous learning, [The BSC] energized me to continuous learning about becoming the best supervisor in child welfare and assisting my staff to become the best vessels of child safety, well-being, and permanency. During the spread process, many teams found themselves working on spreading the methodology as well as the practices. BSC team members had experienced the value of trying creative new ideas in their daily practice, and they wanted to share the methodology with their peers. However, while some individuals may continue with aspects of continuous improvement, an organization-wide shift toward embracing components of the BSC methodology cannot be expected from the work of a single 8-person team. Realistically, the initial spread effort and its concomitant introduction of the methodology represent the limit of effectiveness for a single team in a single BSC. Without further support from upper administration, the methodology may linger in fragments, most often reduced to continued use of the term PDSA.
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But sustaining the methodology allows an organization to continue to learn regardless of who is at the helm and which way the political winds blow: a learning culture independent of climate, or at least less dependent on it. Without this culture, sustainability of practice eventually leads back to the same conditions the agency faced when it entered the BSC: the current status quo generally being the best thinking under previous circumstances. If an agency establishes a few practice improvements in a BSC and acquires a kernel of the methodology in a few units, how can a BSC contribute to long-term organizational change? Most jurisdictions that begin to incorporate the methodology in their standard way of operating return for several BSCs, allowing them successively to spread the improvement model to new areas of the agency. Having leadership that remains consistent and consistently supportive during this period of institutional learning greatly increases the odds that improvement becomes embedded in practice and operations. (Senior leaders are perhaps the only team members who have influence over the broad fate of practices and methods in the agency.) Under Susan Ault, Ramsey County, MN, participated in four BSCs. During a presentation to the senior leaders in this BSC, Ault stressed the importance of using the methodology in the agencys daily work: I found that the power was at the unit level, that it was important for workers to be given permission to be creative, to try new things. We also built accountability around that. Good ideas were discussed with supervisors, things were formally tried, not just informal experimentationthe PDSA process became a very natural part of the culture at the unit level. Olmsted County, MN, has incorporated continuous quality improvement into administrative as well as practice areas. During this BSC, the Olmsted County team found itself working at the edge of the methodological capacity, introducing truly innovative PDSAs like having families select their caseworkers but also testing improvements that were more administrative- than practiceoriented. One PDSA tested a reward for staff caught being creative/self-motivated; another tested ways to clarify agency values for all staff. In essence, these PDSAs tested methods of spreading and sustaining improvement itself. To ensure continuity of improvement efforts, the BSC methodology has to be integrated with other work with foundations, new practice models, practice improvement plans, etc. Ault noted that its really good anytime you can connect with something that already exists. If you have a major effort going on and can marry the methodology of the BSC with that, you are in a really powerful position to move both things forward. Once the agency has adopted the improvement concepts, they tend to spread to other systems engaged through partnerships. Ault said that in her jurisdiction, the methodology became ingrained in the broader culture, and even a county council member who had no BSC training began to use the approach.
Conclusion
Breakthrough Series Collaboratives are intended to apply specific continuous qualityimprovement tools and techniques to address intractable problems. And while participating teams focus quite narrowly and specifically on that defined intractable problem over the course of 18 months (safety and risk assessments in this case), there are many other outcomes that often emerge.
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The outcomes are sometimes hard to defineand even harder to evaluatebut from the perspectives of the participants as well as the observers of the process, they are quite real. As public child welfare agency staff begin to think and talk about families and communities in new ways; as they engage in authentic and courageous conversations about race, bias, and decisionmaking; as they move outside of the standard hierarchies to make changes; and as they test changes quickly and outside of the usual agency bureaucracies, these changes can be seen. Moreover, as youth, parents, and community partners find themselves in new roles related to systems change efforts with their child welfare agencies; as they are used less as warm bodies and more as true partners; as they become active participants in informing and directing and sometimes leading change efforts, these changes can be seen. And as agency leaders learn to adjust to their new role as partner rather than leader; as they explore new ways to maintain the momentum started by this work; and as they entertain opportunities to use the methodology to address other issues, these changes can be seen. This Breakthrough Series Collaborative provided a unique opportunity for 21 teams from across the country to come together to focus on safety and risk assessments. In doing so, this collective of 21 teams not only improved the way they conduct safety and risk assessments, but they also improved the way they engage youth and families; the way they address race, ethnicity, and culture; and the way they work with communities. Last, but certainly not least, these 21 teams found ways to make improvements in their agencies in which each individual, regardless of role or title, is a leader and plays a pivotal role.
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APPENDICES
APPENDIX A
BSC Model for Improvement The BSC uses a method designed to help teams make dramatic improvements in a focused practice topic over a short period. The intention of a BSC is to fill the gap between what has been identified as best practice and what is actually practiced in the field. Often, policies already reflect these best practices, but for many reasons, these practices are not always being implemented in the field. The key to a successful BSC is using a variety of techniques to bridge this gap between what is known and what is done. There are several critical characteristics of the BSC methodology that help agencies quickly test and then fully implement these practices.
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1) Rapid Plan-Do-Study-Act (PDSA) cycles are used. PDSA cycles are one of the keys to the rapid changes in a BSC. Instead of spending weeks, months, or years planning for massive changes, teams are encouraged to test an idea as soon as it occurs. 2) Anyone can have and test ideas. Ideas for practice and system improvement do not come only from management. Workers throughout the agency, supervisors, managers, young people involved with the system, birth families, caregivers, community members, and everyone involved in the system have a great deal of experience and knowledge, and thus all have good ideas they can test. 3) Consensus is not needed. Instead of spending time trying to convince one another of a better way of practice, the BSC encourages team members to test their ideas in the field instead of simply talking about their ideas in a meeting room. Team members do not need to agree with one another for an idea to be tested; instead, the convincing comes naturally once people start to see the results of the tests. 4) Changes happen at all levels (not just at the top). All people have valuable knowledge and expertise, whether they are the senior leader of the project or a young person on the team. As each person involved tests changes, the impacts occur at all levels. from individual case-level clinical practice all the way through system-wide policies. 5) Ideas are shared generously. This methodology is entitled the Breakthrough Series Collaborative for a very distinct reason. Each participating team in the BSC can benefit greatly from the successes and learnings of all others. In-person meetings, a project extranet site, and monthly conference calls present opportunities for teams to capitalize on the successes of others as well as to learn from efforts that were not as successful. 6) Successes are spread quickly. Many pilot projects begin and then remain in a pilot site; in other instances, the pilot disappears once the project is completed. The BSC method prevents this from happening. Once a change has been tested successfully and fully implemented throughout the target site, the team is responsible for spreading that specific small change immediately throughout the entire jurisdiction. 7) Measurement is for improvement, not for research. Measurement is a critical aspect of the BSC methodology, as the BSC strives to gauge improvements over time. In this BSC, each participating team will be required to select, track, and report on a body of measures. Some will be standardized across all teams and required; others will be siteselected and specific.
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Appendix B
Change Package The Challenge The public often believes that child welfare agencies have a simple job: keep children safe. But the families who are the subject of reports, their children, and the individuals who work with them all know that safe is often quite difficult to define. Further, childrens need for safety does not exist in isolation; they also must have permanency and stability. Take the case of the Jordan family:
The Jordan Family: A Case Example A year ago, the local public child welfare agency accepted a referral when three childrenRachel (age 5), Anna (age 4), and Joey (age 2)were found home alone. Their parents, Michelle and Rodney, could not be located. Hannah, their 72-year-old maternal grandmother, was willing to take the children overnight but had returned them to their mother by the time the worker made contact the following day. During the initial investigation, the worker reviewed the risks to the children, including lack of food in the house, unaddressed healthcare needs, and what appeared to have been developmental delays in Rachels speech. Michelle demonstrated a very loving relationship with the children and was welcoming of help, both to provide for their basic needs and to address concerns for Rachel. The case was closed after the lack of supervision issues were addressed and the family received in-home services through a community service provider to address the childrens and familys needs. Six months ago, police were called to the home on a domestic disturbance, where they found Rodney battering his wife and the children cowering in another room. Rodney was arrested, but Michelle dropped the charges when he agreed to move out of their house. The children remained with Michelle. Based on new assessments of safety and risk, the worker concluded that the childrens overall developmental needs were being met and their safety would not be compromised if Rodney was no longer in the home. Currently, police have responded to Michelles home on a tip from a neighbor and found what they believe to be a methamphetamine lab. Michelle was at home with the three children and was arrested. Due to the dangerous environment and the lack of an available caregiver, the children were determined to be unsafe. The worker, seeking a placement for the children at 4:00 in the afternoon, sees her immediate choices as: Place all three children with Hannah again. While she is very connected to the children, she lives in a small apartment and has voiced to the worker the difficulty in being strong when her daughter begs for the children back. Furthermore, she has health problems that make it difficult for her to keep up with three small children. Place two of the children in a recently licensed foster home that is of a different racial and ethnic background but can take two toddlers (but not a baby), and place Joey, the youngest, in a separate home on the other side of town. Allow Rodney to take the children to his home. Beyond the immediate placement decision, the worker needs to gather additional information
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to better understand the Jordan family to ensure that the children achieve emotional and physical permanence while remaining safe from maltreatment. All of these questions must be considered in the context of the familys protective capacities and each childs strengths and needs. The children have lived in a dangerous environment, and they have been neglected and exposed to violence. The workers response must include a focus on the childrens safety and risk of future maltreatment, current developmental needs, medical and mental health needs, needs related to attachment, and permanency. While the children were not safe in the home when Rodney was battering Michelle, has anything with Rodney changed to make him a safe resource? Do protective capacities now exist that alleviate the risks of serious harm to the children? While the children would not be safe living in a meth lab, what would it take for Michelle to find and maintain a permanent safe place for the children? What are the real and perceived risks of maltreatment to the children in returning home to at least one of their parents, compared to the impact of living with their overtaxed grandmother or compared to being separated from one another, living in foster care with strangers who may have limited cultural understanding? What are the impacts on the children of the maltreatment they have experienced and what appropriate interventions and services can be put in place to address the concerns and engage and support the family in meeting their childrens needs? Because of all of these unanswered questions, the worker needs to continuously gather and synthesize information in a way that can help her develop an immediate, short-term safety plan, and a long-term case plan with the Jordan family to best achieve safety, permanency, and wellbeing for the children. This information gathering and synthesis must be grounded in the use of assessment tools, processes, and collaborative decision making that engage the Jordans, their family members, and members of their community in identifying the best possible solutions. Background and Overview Federal law requires public child welfare agencies to work toward achieving positive outcomes for children and youth in three areas: safety, permanency, and well-being. As the case above illustrates, these are woven tightly into a complex fabric that strives to support and strengthen families and children whenever possible while simultaneously ensuring that children and youth are safe from abuse and neglect and that risks of future maltreatment are identified and addressed. When children cannot remain safely in their homes, the agencies work toward emotional and physical permanency for children while continuing to ensure they remain safe from abuse and neglect. It is a delicate balance, and one in which missteps can have severe consequences for children and families. Effective child welfare services require assessments of child safety and risk of future maltreatment, as well as assessment of family functioning and well-being, and sound decision making resulting from these assessments. In order to assess safety and risk and make appropriate decisions, an agency employs quality safety and risk assessment practices with families while remaining free to establish the instruments, policies, and practices that best respond to the needs of its individual community. However, while jurisdictions have many unique and individual needs that must be met, they ultimately do need a common grounding in how safety and risk are defined, identified, and addressed.
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Assessment of safety and assessment of risk are two distinct yet integrated critical functions in child protection. These assessments and subsequent decisions are made while considering the childs need for permanency and well-being and occur throughout the life of the case, specifically at critical decision points including, but not limited to, initial referral to the child welfare agency, change in family circumstances, a childs move or change in placement, reunification, and case closure. Safety assessments determine whether a child is in immediate or imminent danger of serious harm and shape the interventions currently needed to protect the child. A child is deemed safe when consideration of all available information leads to the conclusion that the child in his or her current living arrangement is not in immediate or imminent danger of serious harm. If the child is not safe, immediate interventions must be taken to assure the childs safety. Safety interventions are responsive to the immediate and imminent danger of harm to the child and are not expected to impact identified risks of future harm. Risk assessments address the likelihood of future maltreatment. While safety concerns require immediate interventions to ensure that children are protected, risk of future harm can be addressed overtime with services that result in long-term positive behavioral changes. By clearly distinguishing between safety and risk assessments, we can judge the sufficiency of the proposed interventions and services to address the potential harm in each of these two domains. This change package rests on the belief that every child has the right to be free from abuse, neglect, and exploitation and needs to be safe in the care of stable parents, kin, or other caring and committed adults. The purpose of this change package is to identify the core principles and components that describe an effective system of safety and risk assessments and decision making. This change package further recognizes that, in the work of the agency, decisions regarding safety and risk cannot be isolated from permanency or well-being, and that work on safety and risk assessments are key elements in an integrated approach to achieving positive outcomes for children and families. Collaborative Mission The mission for jurisdictions participating in this Breakthrough Series Collaborative (BSC) is to increase the capacity of their public or tribal child welfare agency, of their community, and of the families they serve to conduct assessments and make related decisions that keep children safe from imminent danger and protect them from future maltreatment, Concretely, this can be attained by: Defining and creating a common language and understanding of child safety and risk of future maltreatment within the context of child welfare Identifying roles and responsibilities for the public child welfare agency and the community, in order to effectively assess both safety and risk of maltreatment for the families who come to the agencys attention Implementing strategies, policies, protocols, and practices that respect and actively engage families and communities, while providing workers with support for ongoing learning and practice improvement through data and case analysis, training, supervision, resources, and supports necessary to complete thorough, accurate, child-focused safety and risk assessments to support an informed process of clinical decision making Integrating safety assessments and risk assessments in an ongoing and continuous way throughout the life of the case
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Philosophy, Values, and Principles The work of this Collaborative will be rooted in nine key foundational principles. These principles express the overarching values that must guide all policies, programs, practices, services, and support for children, youth, and families. They are interrelated and work together in a dynamic, synergistic way. Each principle is critical and should be reflected in all policies, programs, practices, services, and support of the agency. 1. The most desirable place for children to grow up is in their own safe, nurturing, and caring families. 2. Most parents want to and can provide a safe and nurturing home for their children. 3. The legal mandate of child welfare intervention by state, county, tribal, and community agencies is to assure the safety, permanency, and well-being of children. 4. The child welfare agency recognizes and honors the fact that parents, children, youth, kin, communities, and tribes have strengths, resiliency, and their own natural support, which are used in increasing safety and reducing risk of maltreatment, and that children are inextricably connected to their families and communities, both cultural and geographic. 5. Active engagement of birth parents, children, youth, and their kin with child welfare agencies, tribal agencies, and community service providers is fundamental to: Assessing safety and risk Making sound decisions Maintaining ongoing focus on permanency and well-being Developing and implementing appropriate interventions and services to increase safety and reduce the risk of maltreatment Ensuring consumer involvement and choice Effectively evaluating outcomes Holding public child welfare agencies accountable for genuinely serving child, family, and community needs 6. The agency understands and respects the varying beliefs, values, and family practices of different cultural, racial, religious, and ethnic groups. Culturally responsive services and support are child-focused, family-centered, community-connected, and strengths-based. 7. Partnerships with the diverse communities and tribes in which children and families live are essential to increasing safety and reducing potential risk of maltreatment to children. 8. The agency provides leadership within the community and institutionalizes safety and risk assessment strategies that recognize and address issues related to disproportionality and disparities in outcomes for children and families of color in the child welfare system. 9. The agency provides leadership within the community and institutionalizes safety and risk assessment strategies that recognize and address issues related to poverty as distinct from safety and risk. Components The nine key principles can be translated into practice through ten component areas of the work
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of the agency. Work done in each component should reflect the core values defined by the key principles. In order to develop an effective and integrated system of safety and risk assessments and decision making that ultimately supports the permanency and well-being of children, child welfare agencies should address all of these components. 1. Sound clinical decisions focus on the safety and risk of maltreatment to the child and result in optimal child safety. They are child-focused, strengths-based, family-centered, and community-connected. Such decisions are rooted in evidence-informed, promising, and emerging practices as well as individual and institutional practice wisdom. A. Conceptual frameworks, clear criteria, decision support guidelines, and integrated strategies are used for valid and reliable decisions. B. Decisions are transparent, open, and grounded in the comprehensive, specialized, and integrated tools that are used to gather and assess information. C. Decisions are focused on child vulnerability, family strengths, family dynamics and needs, child development needs, and protective capacities. D. Practices to address initial and ongoing safety and risk issues are focused on identifying natural resources and supports, and are culturally responsive to the family within its own community/tribe. E. Decisions to optimize safety and lessen or eliminate the risks of maltreatment to the child are made while supporting and maintaining focus on permanency and wellbeing. F. All staff recognize the individual, systemic, and societal factors related to safety and risk assessment decisions that result in disproportionality and disparate outcomes for children of color and mitigate those factors by employing culturally responsive practices and approaches. G. Decisions are made in ways that respect, honor, and validate sexual orientations, culture, class, and religion of the children, youth, and families served. 2. Tools provide a structure for organizing and consistently rating risk- and safety-related information that results from child-focused, strength-based, family-centered, communityconnected practice. A. Tools are used to facilitate assessment and decision making regarding safety. B. Tools are used to facilitate assessment and decision making regarding risk of child maltreatment. C. Tools are applied in ways that actively engage youth and families as partners in the assessment processes. D. Clear, written protocols exist on the use of safety and risk assessment tools to ensure that the tools are used consistently and continuously by all staff. E. Clear and sufficient documentation is required to support the use of tools and ensure fidelity and integrity. F. Tools facilitate responsiveness to race, ethnicity, and culture of families in the community and do not contribute to disproportionality or disparate outcomes for children of color in the child welfare system.
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3. Assessment of safety and assessment of risk are continuous and ongoing and are integrated with the agencys comprehensive assessment framework that supports permanency and well-being. A. Tools that are used to assess either safety or risk are integrated with each other in intentional and specific ways to ensure the tools are consistent, complimentary, and minimize duplication for families. B. Child welfare practices focused on safety and risk assessments and decision making are holistic and seamless by continuously collecting and integrating up-to-date information into the ongoing processes of assessment and decision making. C. Protocols exist to provide consistent guidance on the dynamic nature of both safety and risk and to assist social workers to collect all available information. D. Protocols exist to assist social workers in making sound decisions that consider a familys situation in its entirety, with a continuous eye toward permanency and wellbeing for the child. 4. Parents, children, youth, and kin are actively engaged as true partners in assessment, decision-making, and intervention, with the agency respecting their voices and valuing their input and solutions. A. Authentic engagement is established with each family. B. Every communication between the agency and the family is in language that is clearly understood by and meaningful to the family. C. Contact with the family is respectful, culturally responsive, and strengths-based while focusing on the safety of the child. D. Clear information about agency and family roles and responsibilities is shared openly and agreed upon. E. Parents, children, youth, and kin are intentionally prepared to participate in discussions and decisions. F. Parents, children, youth, and kin are invited, included, and given meaningful roles in the design, selection, and evaluation of programs, policies, and services. G. Decision-making is inclusive, direct, and transparent. H. Parents, children, youth, and kin are involved in ways that respect and honor their race, ethnicity, and culture. 5. A broad range of services and support are available and accessible to the families in the communities and tribes in which they reside. These services and support are put in place to control for and maintain safety, reduce the likelihood of future maltreatment, and stabilize at-risk families in times of crisis. A. Services and support, including those that meet the familys basic needs, are available and accessible in the communities, neighborhoods, and tribal communities in which families live. B. Interventions are focused on increasing safety, reducing risk of maltreatment, and increasing family protective capacity, and they are targeted to specific, identified child or family needs.
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C. Families identify their own informal networks of support and these individuals and groups are actively engaged to care for and protect children in their own communities. D. Services are culturally responsive and provided in ways that do not result in disproportionality or disparate outcomes for children, youth, and families of color. E. Families are connected directly to community or tribal-based resources in their own neighborhoods that are culturally responsive and available. F. Services are customized to meet the needs of the individual child, youth, and family in response to assessment and continuous reassessment. G. Services are provided in ways that engage families and their natural, self-identified support in the least intrusive ways possible. 6. The agency and agency leadership fully support the integrated system of safety and risk assessments and decision making across the life of the case in the context of child permanency and well-being. A. There are clear statements, definitions, and understanding at all levels of the agency of safety and risk assessments and decision making. B. Workers caseloads and workloads are manageable, allowing for and encouraging the accomplishment of clearly defined criteria for quality assessments. C. Managers and supervisors consistently ensure that tools are being used as intended and are supporting and guiding appropriate decisions made by workers. D. Agency leaders maintain a sustained and prominent focus on safety, risk, permanency, and well-being regardless of internal or external controversies that may emerge. E. Agency leaders coordinate the implementation and support processes for quality assurance and continuous quality improvement related to safety and risk assessments and decision making. F. Agency leaders consistently consider the impacts of practice changes and improvements across worker, managerial, and systemic levels. G. Agency leaders ensure the availability of extensive data, both quantitative and qualitative, to guide practice and policy improvements related to safety and risk assessments. H. Agency leaders are committed to continuous learning and improvement in safety and risk assessments in the agency, and support the continuous learning and practice improvement activities of all staff. 7. A qualified, competent, and well-trained workforce, committed to continuous learning and practice improvement, is recruited, prepared, and retained. The workforce has the attitudes, knowledge, skills, and organizational support to do the work of the child welfare agency and reflects the communities and tribes from which the families, children, and youth come. A. The agency establishes a learning environment that supports workforce development (recruitment, hiring, training, learning, and retention) and has family feedback as a core component.
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B. The agency has well-defined criteria for qualifications and expectations of staff. C. The agency recruits, hires, and retains sufficient qualified staff who reflect the communities and tribes from which the families, children, and youth come to assess safety and risk of maltreatment throughout the life of a case. D. The agency continuously assesses its own staffing needs and requests, advocates for, and obtains additional staff when needed, based on reasonable workload standards. E. Staff receive comprehensive training in the philosophy, values, and mission of the agency as well as the specific processes to assess safety and risk within the context of permanency and well-being. Staff are supported and encouraged to engage in continuous practice improvement through PDSA-like activities. F. Supervisors and managers ensure that state-of-the-art practices and approaches on safety and risk assessments and decision making in the context of permanency and well-being are disseminated throughout the agency and use this learning to support the staffs continuous improvement activities. G. Supervisors and managers provide consistent, high-quality, and supportive supervision (modeling and coaching) to staff that allows for shared decision making, professional growth, and increased safety and reduced risk of maltreatment for children. H. As a component of individualized or team performance review and individualized or team learning, the agency gathers family feedback related to safety and risk assessments and decision making for inclusion in its data distribution and analysis. 8. Data are used in partnership with families, communities, tribes, provider agencies, staff, universities, courts, and other stakeholders to review worker, managerial, supervisor, and agency performance at key decision points in which safety and risk are assessed. A. Systems are designed to ensure that data are collected easily and in a timely way and can be shared appropriately between partners and stakeholders. B. High-quality safety and risk data exist and include self-reported information on race, ethnicity, and culture. C. Data related to safety and risk assessments and decision making are connected to permanency and well-being indicators and outcomes to ensure that overall outcomes for children and families are improving. D. Safety and risk assessment data are presented in a timely way and in formats that are easily accessible to a variety of audiences, including families, tribes, the community, staff at all levels, and other partners and stakeholders. E. Staff and stakeholders receive training in reading and interpreting these data. F. Open forums are held to discuss the meaning of these data and what they say about the agencys performance. G. Continuous quality improvements and changes are recommended and implemented based on these data-based discussions.
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9. The agency actively collaborates with communities and tribes to support children, youth, and families in their communities and tribes to build shared responsibility and accountability to increase child safety and reduce risks of maltreatment. A. The agency uses language that is relevant, easily understood, and meaningful to the community and tribes in oral and written communications about child safety and risk assessment and decision making. The agency maximizes efforts to understand the language and concepts used by community members and tribes in their context. B. The agency works with the community and tribes to raise awareness about child safety and the need for practical family support to increase safety and reduce the risk of maltreatment. C. Community and tribal members have the opportunity to participate in conversations about safety and risk assessments and decision making. D. The agency, community, and tribe work together to develop activities, projects, and services that support families and keep children safe from maltreatment. E. Community members and tribes are invited, included, and given meaningful roles in the design, selection, and evaluation of programs, policies, and services related to child safety and risk assessments and decision making. F. Community members and tribes are invited, included, and given meaningful roles in safety and risk assessment decisions and planning over the life of a case, as appropriate. 10. Cross-system partners, including courts, schools, the medical community, law enforcement, the mental health community, substance abuse and domestic violence and other key public and private agencies are actively engaged as key partners in increasing child safety and reducing the risk of child maltreatment. A. The child welfare agency uses language with cross-system partners regarding child safety and risk that is easily understood and meaningful to them. B. The child welfare agency works collaboratively with cross-system partners to raise awareness about the importance of child safety and the role of the partners in ensuring safety for all families. C. Cross-system partners are educated about safety and risk assessments and associated decision making, including tools used to conduct these assessments, and provided with continuous opportunity for learning. D. Roles and responsibilities in ensuring child safety are clear; all cross-system partners explicitly acknowledge their roles and responsibilities and agree to assume the same. E. Case-specific discussions and decisions include cross-system partners to ensure child safety.
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Appendix C
Glossary This glossary is intended to clarify what the BSC staff and faculty mean when they use certain words and terms. We recognize that different places and people may have different meanings for some of these words. This glossary is by no means intended to be the final word on what these terms mean or how they feel in action. We encourage individual teams to work together to develop their own definitions that best meet their needs. Assessment: Gathering, examining, and using the facts of a situation to make decisions. In child welfare, assessments may be made to: Decide if the agency needs to take action to protect a child (safety assessment) Decide the chance that a child may be hurt or neglected in the future (risk assessment) Understand the strengths and needs of a family, parent, child, or community We use assessments to identify the services that are needed and to make a plan that will reduce the risk of child abuse and neglect. Breakthrough Series Collaborative: The joining together of teams who are all working on improving their work in a particular area. It involves trying many small changes in practice to see if they produce better results for larger change. Teams measure their work so that they can continue with changes that work and stop doing those that dont. Child-focused: Putting the needs of the child, especially safety, before everything else. Culturally responsive: This is a way of interacting with other people in which we: Are aware of differences Accept those differences Use each others cultural strengths to improve results Community: People and families who live near each other or who have something else in common. Cross-system partners: Other groups who work with the same children and families as child welfare does. This includes schools, doctors and hospitals, and courts. Disparity: When people in one group are treated differently from others. Disproportionality: Exists when the percentage of a group of children, such as African American, Latino, American Indian, Alaska Native or white children, who are involved with child welfare is different from the percentage of children in this same group who live in a specific community, city, county, state, or other area. Family-centered practice: The family is the key to the childs well-being. We work to make them stronger and include them in everything we do. Family-driven: Families make decisions about their children as well as about the work of the agency.
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Imminent danger: The child may be hurt if something does not change. Life of the case: The time from the initial report of abuse or neglect to the time when the agency is no longer involved, and everything in-between. Maltreatment: Child abuse or neglect. Safety: Absence of harm. Participating jurisdictions: Public or tribal child welfare agencies that take part in this BSC. Permanency: Having people care about you for a lifetime. Risk: The chance that a child will be abused or neglected in the future. Risk assessment: Looking at the chance a child might be abused or neglected in the future. Safety assessment: Deciding if a child is in danger of being hurt right now. Strengths-based: Looking at a persons or familys strengths, not their weaknesses. Well-being: How well a childs schooling, health, and mental health needs are being met.
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Appendix D
Key Areas for Practice Improvement Teams participating in this Breakthrough Series Collaborative (BSC) can use the seven areas of practice improvement identified below to guide the development of potential strategies and PlanDo-Study-Act cycles (PDSAs). These key areas simplify and narrow the more detailed change package by focusing exclusively on those critical components of a comprehensive system of safety and risk assessment that relate most directly to practice. Within each of these broad areas is a brief list of strategies from which teams can determine what specific practice changes should be tested within their unique environments. Strategies and the PDSAs used to test them (based on these seven key areas of practice) will be the work of the agency and other key stakeholders throughout this BSC and beyond. I. Responding to Race, Ethnicity, and Culture A. Using culturally respectful and responsive practices B. Ensuring decisions are free of racial and ethnic biases II. Engaging the Child/Youth and Family A. Agreeing on roles and responsibilities B. Preparing the child/youth and family to participate C. Making it possible for the child/youth and family to play meaningful roles III. Making Sound Decisions on Safety and Risk A. Distinguishing between safety and risk B. Maintaining transparency and openness C. Providing workers with adequate resources and supports IV. Using Safety and Risk Assessment Tools A. Following protocols B. Contributing to and documenting decision making V. Practicing with an Integrated and Comprehensive Assessment A. Integrating the use of and information collected from various tools B. Assessing continuously C. Ensuring seamless transitions between and among workers VI. Maintaining Focus on Permanency and Well-Being A. Respecting a childs sense of time B. Ensuring well-being when making assessment decisions C. Maintaining family and community connections VII. Collaborating with Cross-System and Community Partners A. Educating partners and the community B. Including appropriate partners in safety and risk assessment conversations and decisions C. Developing a collaborative support network of resources
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Appendix E
Themes for Spreading and Sustaining Practice Improvements One of the most important aspects of a Breakthrough Series Collaborative (BSC) is the ability to spread and sustain changes made in practice. There are four key themes that emerge as critical to spread and sustainability. Within each of these broad areas is a list of strategies from which senior leaders as well as all team members can draw to ensure that successful practice changes will be spread and sustained over time. I. Maintaining and Supporting a Qualified, Competent, and Well-Trained Workforce A. Recruiting staff from the communities of the children, youth, and families B. Training and supporting staff in culturally responsive skills and competencies C. Training and supporting staff in effective safety and risk assessment practices D. Providing consistent, quality, supportive supervision and management for safety and risk assessments II. Using Data with Diverse Audiences to Ensure Improvement A. Collecting and sharing timely data on safety, permanency, and well-being B. Sharing data widely and in ways that are meaningful C. Implementing continuous quality improvements based on data III. Providing Agency Leadership around Safety and Risk Assessments A. Maintaining a focus on safety, risk, permanency, and well-being B. Creating a shared understanding across the agency of safety and risk C. Providing the resources needed for good practice IV. Ensuring Appropriate Services and Supports Are Available and Accessible A. Identifying and engaging informal networks of support B. Employing services that are available and accessible in the community C. Avoiding disproportionality and disparate outcomes in services/support
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Appendix F
TEAM IMPACT STATEMENTS BUNCOMBE COUNTYTEAM THINK FAST The Buncombe County Team Think FAST has seen positive and transformative practice shifts, heightening our cultural competency in conversing with and engaging families during the safety and risk assessment process. We have also increased our knowledge of safety and risk differences in all stages of our work with families, from screening through well-being and permanence. We utilized the three questions to focus staff on safety, risk, and protective factors. Our use of tools shifted away from rote completion to partnering with families in completing the tools to help better identify safety and protective factors that guide our decision making. We have met with families, schools, community partners, and judges to differentiate safety versus risk and to solicit their input as our practice transforms. Our PDSAs were meaningful and involved input from staff and families to promote and sustain these practice changes. Our team learned how to think small and tinker as you go, resulting in sustainable change. Our agency practice truly has moved from the ordinary to the extraordinary as a result of our participation in the Breakthrough Series Collaborative on Safety and Risk Assessments! CARVER COUNTYGO TEAM SAFETY The Carver County team believes that the safety of children in Carver County has improved through our participation in this BSC on Safety and Risk for several reasons. Our biggest change is that our work together has forced us to focus our efforts and align ourselves with our administrators, community partners, and social workers. We now realize that Signs of Safety is clearly the direction we want to go and by mapping out our agency on the Bell Curve of Change at the second learning session, we realized that over 50 percent of our agency had adopted Signs of Safety as a way of practice. As a result, we established common language and understanding of critical concepts such as safety, safety planning, and safety networks. We began to engage children in safety planning and even established agency expectations around safety plans including danger statements. We also became clear that the remaining people who were not on board had shared the same supervisor and direction. As a result, our agency established bottom lines in the way of implementing a policy and actually restructured to assist the facilitation of a process that we believe enhances families functioning while increasing the safety to children. In addition, we were able to work together with our community partners to discuss the spread of our practice. This took us in so many directions, [which] include obtaining feedback from our families, getting the word out through meetings, church services, and even online newspapers as well as regular newspapers. We know that we are dedicated to the continual improvement of our child protection system and [that] our work together will not end at the last learning session. Collaboration is a key and we cannot resolve our issues or improve our work alone, just as families cannot resolve their issues without the support of others and clearly established bottom lines. CATAWBA COUNTYCATAWBA BUILDERS Catawba County has very much enjoyed the Risk and Safety BSC and has gained a variety of new insights, practices, and policies due to our involvement in this project. Catawba County has identified three practice changes that have developed from our involvement with this Casey project.
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The first is called Engaging Families First. This practice shift includes early Child and Family Team Meetings, using the Structured Decision Making Tools with the families or going over them in detail with families. We have also found several ways to include other youth and families voices in helping us explain how Child Protective Services involvement with a family may benefit them. The second practice shift is better transitions from Child Protective Services through Adoptions Services. We have transitioned our unit into blended teams including Child Protective Services, In-Home Services, and Foster Care with links to CPS Intake, Adoption Services, and Specialized Foster Care. This change is still very new but we have already begun to see how workers are pulling together to bridge gaps and think creatively about how we can use the least restrictive means to create safety planning and easier transitions for children in our system. The third practice change includes a change in philosophy. This philosophical shift is looking at risk factors, safety factors, and protective factors in every case. We have created new forms and new ideas around this innovative way of thinking. This change is still in process but we have seen some real benefits in how we look at cases and how decisions are made around families strengths and needs. We hope to continue to build on all of these practices now and into the future. CHIPPEWA CREE TRIBETEAM BEAR PAW The Chippewa Cree-Bear Paw teams participation in the BSC has greatly improved our collaboration with our service systems here on the Chippewa Cree reservation. Through our PDSAs, we have identified the need to develop a common definition of safety and risk within our tribal service departments. Our participation in the BSC has opened up our eyes to a whole new perspective and providing adequate care for our children and families. FLORIDA CIRCUIT 18THE INNOVATORS Through the Breakthrough Series Collaborative, the Innovators at Florida Circuit 18 have improved practices and implemented key practice changes that have enhanced our vision of child welfare practices. A few of our best successes have been our improved ability to engage families, to assess and monitor the risk and safety of children and protective factors of their families, to provide a forum for teens to have a voice in the dependency system, and to provide for the well-being of children we serve. Engaging families in a timely and appropriate way and improving our case managers ability to do so has been a central feature of Seminole Countys community-based-care child welfare system. To further improve the engagement skills of our diversion and dependency staff, Florida Circuit 18 implemented PDSAs to bring parents to the table early and consistently. Supervisors now introduce themselves to parents at shelter hearingsproviding them with a Parent Folder, which includes materials to educate parents on the Dependency process and to obtain information about their children to help them adjust to new caregivers. Additionally, parents have been invited to Early Service Interventions, which occur early in the Dependency process, and parent attendance at Family Services Team meetings (FSTs) has increased. FSTs occur every 90 days and are a valuable forum for parents, caregivers, case managers, supervisors, the lead agency, and community providers to assure we are all on the same page. We have also made strides in focusing on strength-based models for case planning and Family Team Conferencing. Developing assessment tools through the use of the PDSA process has improved the functionality of our assessments. Florida Circuit 18 has developed new assessment tools that are better at assessing risk and safety factors and are more culturally sensitive: Initial Family Assessment, Initial Screening Assessment, Domestic Violence Lethality Assessment, and Foster Child Placement Assessment. Recently, we began using the Danger Assessment
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created by Jacquelyn Campbell, Ph.D., as recommended by one of our community partners, the Florida Coalition against Domestic Violence. Furthermore, our case managers are now safety planning with both adults and children on all domestic violence cases. The Foster Child Placement Assessment is in the development stage. The assessment will take place within 24 hours of removal to ensure that the child is matched appropriately with a foster parent, when no appropriate relative or non-relative is available. We have also implemented the Wizard and the Fairy Child Assessment tools, which were posted on the extranet by Carver County. We not only have had success with this tool but have also spread this to the Seminole County Sheriffs Office Child Protective Services Investigators. Not only has Florida Circuit 18 improved our ability to identify the needs of our foster children through assessment but we also have developed our Youth Advisory Board. The Youth Advisory Board is a forum that allows the youth to have a voice. Not only have they been heard, but they have initiated their own mentor program and changed teen plans that are more specific and functional for both the teens and their caregivers. The Youth Advisory Board has been spread over two other counties so far. FLORIDA CIRCUIT 5RAYS OF CHANGE The Rays of Change, Florida Circuit 5s Breakthrough Series Collaborative (BSC) experience can be best summed up in a few key words: increased communication and collaboration across all partners in the change process around safety and risk assessment. We believe the BSC model has allowed key partners to discuss and explore genuine family and youth engagement. We have seen that in cases in which families are allowed their voice, profound change happens not only for the family but also for CPIs, family care managers, and other community partners. The PDSA model allowed us to test ideas, to demonstrate what works and what does not, and to not be afraid to take risks. The Rays of Change have had many successes and challenges in implementing and spreading our PDSAs. The improved communication and collaboration of the BSC model encouraged and allowed us to celebrate the successes and make significant changes in our system. The communication and collaboration also encouraged openness, trust, and honesty in addressing our challenges. We are committed to sustaining communication and collaboration and to continuing to use the PDSA process to improve outcomes for children and families. FRESNO FUEL The PDSA methodology in concert with our systems ability to respond and reorganize our campaign for engagement and a culture that embraced accountability and support helped transform Fresno County Department of Children and Family Services into an agency geared towards improving permanency outcomes for our children ages 0 to 6. INDIANATHE LAKE EFFECT The BSC has made a powerful impact on Indiana Lake Effect mainly due to the fact that it allows for creative ideas to be pursued in alignment with policy. Safety and risk assessments are ongoing factors that need to be implemented at all points of contact throughout the life of a case. The BSC motivated and allowed staff working directly with children and families to highlight the areas in practice where safety and risk may not be considered. Furthermore, the creation of the BSC team allowed for diverse input and ideas, and ultimately for the practice of teaching/ coaching safety and risk assessments to the families and children we are assessing.
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LARIMERROCKY MOUNTAIN FAMILIES Through working with the BSC, the Larimer County team has improved practices around safety and risk assessments through using the PDSA model. Larimer County workers now engage families differently through use of the Signs of Safety framework. Caseworkers are acquiring better information using the three houses model, scaling questions, and taking a strengths-based approach whenever interactions with families occur. Because of this, families feel less victimized and more empowered. There has been a 24-percent reduction in the filing of court petitions as well as a 27-percent reduction in out-of-home placements in the past 12 months. For the same timeframe, our Recurrence of Abuse in our pilot site (Paired Team 6) has remained at 0.0 percent. Larimer County DHS has discovered that the group supervision model now in place increases consistency in decision making and empowers caseworkers as well as families. The community surrounding the Larimer County team has a significant role in making the change successful. The team strives to engage community partners through new programs such as family visitors, mentors, and coaches. At this time, the team has worked to achieve stakeholder buy-in by increasing communication with mandated reporting parties and using cross-trainings that have solution-focused content. Looking at cases with an emphasis on safety has allowed the team, as well as the community, to seek innovative possibilities for families. NAVAJO NATION, SHIPROCKTOOHNII The BSC learning sessions and the e-mail communications reaffirmed the merit and value of taking small steps to make improvements. This experience coached us to focus on improving the risk and safety assessment tasks. We see not only consistency in doing the assessment but improvement in the quality of how we did them. Examples shared by the Collaborative groups at the last session in Tampa were extremely helpful. The value of keeping tasks simple and direct proved not only to be very informative but were very helpful when integrated them into our own work at home. We had high interest in assessment tools because we have to integrate these into our traditional values and how we measure problems. NAVAJO NATION, SOUTHWESTSUSTAINERS OF LIFE Our participation in the Breakthrough Series Collaborative (BSC) has greatly improved the utilization of safety and risk assessments by creating PDSAs (Plan, Do, Study, Act) to address our shortcomings. Acknowledging our limitations and using the data through the monthly measures have prompted us to make reliable decisions, which are in the best interest of our consumers. The PDSAs have identified areas of shortcomings, which have been addressed by providing staff development trainings, educating our consumers, and incorporating our parent/child input into our system changes. Overall, our participation in the BSC has enlightened our perspective in providing a quality child welfare system. OKLAHOMA KEEPS CARING During the course of this BSC, we were in a unique position in that the State of Oklahoma was going through significant change with regard to the way child welfare services were delivered. As the BSC was unfolding, so was the new child welfare practice model for OKDHS. We were also in the process of developing a new Assessment of Child Safety. Due to our participation with the BSC, our staff was on the forefront of designing, piloting, implementing, and ultimately refining this tool for statewide use. Opportunities to test change have been
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plentiful, and the guidance of the BSC has assisted us in optimizing the roll-out of new ideas in an organized and methodical manner. We want to not only express our gratitude to Casey Family Programs and American Humane but to our fellow participants for the ideas we have gleaned from them. OLMSTED COUNTYPATH FINDERS The Breakthrough Series Collaborative on Safety and Risk Assessment, along with the PDSA methodology, has assisted the Path Finders in improving our agency practice. The relationships we have built among our team members and across jurisdictions have been a catalyst for change. Collaboratively, our team has examined ways to decrease disproportionate representation and disparate outcomes for African American families, to create strategies to engage and increase the involvement of fathers, and to take steps to increase the voice and satisfaction for all of the families we serve. We expect these positive changes will spread and be sustained over time, ultimately increasing child safety, well-being, and permanency for the children and families we serve. Additionally, well take with us a valuable lesson from the BSC: the lesson that small steps lead to big change. PASADENACITY OF ROSES The BSC on Safety and Risk Assessment along with the PDSA methodology has assisted with laying a foundation for improving current practices around safety and risk by the following: As a team, we have identified full disclosure as a key methodology for practice change. One of the key areas of improvement has been the creation of definitions for risk, safety, protective capacity, and purposeful visitation (Signs of Safety). We have clear definitions and guidelines for staff and the community that bring about uniformity and consistency in how families are assessed for abuse and neglect, as well as the fact that families have an understanding of what is necessary to demonstrate their ability to provide a safety environment for their child(ren). Our team is committed to continuing work to improve risk and safety assessment practices throughout the life of a case, as well as spreading lessons learned throughout Los Angeles County. PHILADELPHIAEMPOWERMENT OF CHANGE Participation in the BSC has proved to be a significant support for the Philadelphia Department of Human Services as we transition to a new Safety Model of Practice. It has been exciting too for the members of our core team get to know each other in a richer and deeper way. We have also enjoyed getting to know and being able to learn from the members from the other jurisdictions. Our target area was our Repeat Abuse Section. Throughout the 18 months together, this section has been very successful in significantly improving both the quality and the consistency of their safety assessments and safety plans. The work accomplished within this section has been able to be spread across the other 7 investigative sections. As a result of the work with the BSC, data are now gathered across all DHS sections (Investigation and Ongoing Services) through a randomized case review process. We are now able to better quantify where sections are in regards to the quality of safety assessments and plans. Data gathered from this case review process have been used to drive decisions towards creating positive change in the organization. Some of this change included updates to policy as well as changes in procedures.
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The survey process developed in the BSC is also being modeled in work wth 13 Ongoing Service Region sections as well as with the 12 contracted in-home provider agencies. Asking for feedback from outside stakeholders is a terrific step for our organization towards better transparency and accountability for the Department. The focus on input and decision making coming from those closest to the work has also been an exciting component of our participation with the BSC. Some quotes from our core team participants are below. The BSC experience has helped me to get to know my colleagues in a deeper and richer way, while learning together. While we struggled with our roles and outcomes, being part of a committed group and the ability to interact with other jurisdictions provided insight, a chance to recommit to the group while expanding my understanding of safety and risk. I really enjoyed working with a small group and dealing with the joys and challenges of meeting deadlines before our learning session trips. This experience taught me to be a better leader. I am thankful that I had the chance to work closely with outside stakeholders (Samantha, Tara, and Jeff); their insight was priceless. Participation with different layers of management and tiers at DHS has increased my development, my perspective, and my ability to be effective in my work with clients. The Breakthrough Series methodology is vital for our agency to be able to affect change from the bottom up. POMONA 91766 Pomona 91766 has definitely benefited from participation in the Safety and Risk BSC in the following ways. First, weve clarified exactly what we mean by safety assessment and risk assessment. We now perform the assessments more accurately to the safety question and the risk question. We have far less confusion of the two. Second and possibly the most important factor in change, we have discussed safety, risk, culture, and cultural sensitivity in many different office forums, meetings, staffings, team meetings, and unit meetings, i.e., all possible venues for office communication. We have done this continuously throughout the BSC time period. The ongoing discussions have brought renewed best-practice awareness and best-practice social work discussions that have had a specific impact on improving our office outcomes. Third, we have clarified exactly what we mean by cultural sensitivity. We are now able to more accurately assess family culture and not confuse it with preconceived notions about racial or ethnic culture. This impact has been directly experienced in team meetings where safety, risk, and culture are discussed in the process of developing safety plans for families. Finally, our community partners have now seriously begun to understand our internal perspective relative to safety, risk, and culture. They have helped us to establish a common language that describes what we do as an agency so that children and families also understand our involvement in their lives. SAN FRANCISCO BRIDGE BUILDERS Over the past 18 months, San Francisco City/County Human Services Agency has improved safety and risk assessments and decision making in large part due to implementation of the PDSA model. To date, we have identified and tested 21 different ideas for practice change as more ideas continue to come from staff, supervisors, and managers as well as community and parent partners. Two PDSAs in particular have expanded significantly within San Francisco: 1) Parent Partner Involvement at TDMs and 2) Parent Involvement at Case Coordination Meetings. The objective of both PDSAs was to increase parent/family involvement in placement decision making and case coordination and as early on in the process as possible. The underlying goal
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was to increase parent/family awareness about the safety threats and risk factors, so that they could make clear choices and informed decisions. Due to the increased need of parent partners who will be working with parents/families involved in our child welfare system, i.e., Family & Childrens Services, we have hired three full-time positions including a parent coordinator and two lead parent advocates, and five additional parent partners who will be working more directly with families in the local offices. Additionally, the parent/family surveys reflect positive increases in the following areas: 1) I understand the safety and risk concerns identified in my home; 2) I feel that I played a role in assessing the safety concerns in my home/family and had a chance to come up with ideas for how to eliminate problems; 3) the risk and safety assessments fairly assessed possible risk of harm to members of my family; 4) I would voluntarily attend a case planning meeting or TDM that involves me and my family. STANISLAUS COUNTYAMERICAN GRAFFITI The American Graffiti team is grateful for the opportunity to participate in this BSC. It has helped us to start defining safety and risk more consistently when making decisions throughout the life of a case. This process has helped us build a stronger collaborative relationship at all levels of child welfare and with community partners, birth parents, and foster youth. Our community partners, parents, and youth have appreciated the amount of input they have been able to provide for practice and policy improvement. We have been able to introduce new concepts to our social workers and leadership team to make effective changes. Although change is not easy, using the PDSAs has taught us how to take small steps to make changes on a bigger scale. This has been a transfer of learning experience because we now see how difficult it is to change behavior within our own system, and yet we expect families to make drastic changes. Lastly, the involvement of the youth and parent was a very important part of this BSC. It has given us insight to stop and think about what we do and the importance of having family engagement and to communicate more effectively at their level. It has taught us not to take the family for granted and that their perspective is enlightening. Through this BSC, we plan to continue to listen to their voice. TEXASSOUTHWEST THUNDERBIRDS When we were first selected to participate in the BSC, we did not realize the impact and the significant changes that would occur. The selection of military families in the investigation stage was a collective decision based on the increase of our local base, Ft. Bliss. We had a worker who had served in the Army and a program director with vast experience in military culture; this was our core of this idea. We began with one worker and five questions, and as a result of all the hard work and constant communication, we have expanded our Advanced Risk Assessment to all investigators within our region. Our team has committed itself to the improvement of safety and risk and as a result, all our workers have a better understanding of the military culture and can navigate both systems with ease and confidence. Not only has this experience with the BSC changed our system but it has allowed us to work closer with our military counterparts and we are not done. This experience has led us to expand to other stages of service such as identifying military workers within our Family-Based Safety Services Program. Its been a long road we have traveled and like any other journey, weve experienced setbacks and struggles but always stayed firm to the core of risk and
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safety. Without the participation in the BSC, these crucial and necessary changes would not have occurred. UTAHSEA MONKEYS The Sea Monkeys have benefited greatly as a result of being invited to participate in the Breakthrough Series Collaborative on Safety and Risk Assessment. From the beginning, we were able to identify the need to effectively assess (with the family and members of the Child and Family Team throughout the life of a case) the specific and observable threats of harm, child vulnerabilities, and protective capacities of the parent or caregiver. However, in many ways, we found ourselves stuck in the overwhelming task of continuing to develop and spread the concepts of our Safety Decision-Making Model across our entire system. As we involved our youth, birth parents, and community partners more in this process, we gained additional insight about what is really needed to achieve and sustain the success that we were seeing with families. We then began to break down our efforts into small incremental changes of how we gathered and shared critical information related to safety with others. As a result, our focus turned to making smooth transitions for families as they move in and out of services throughout our system. In addition, we wanted them to walk away with the necessary support to sustain the success and safety that they have been able to create. Now, after what seem just a few short months, we find ourselves at the end of the BSC. That notwithstanding, we can definitely identify the newly acquired tools and the connections that we have made with other teams. This experience has provided a meaningful learning opportunity for us to assess and increase our effectiveness alongside of families, as we navigate our way together through what can feel like somewhat unsettling waters. WYOMING COWBOYS The Wyoming Cowboys participation in the BSC has been an insightful and rewarding experience. It has helped our counties (Uinta and South Lincoln) improve our safety planning and risk assessments of children and families brought to the attention of Child Protective Services. By participating with the BSC around safety and risk, we have increased our communications with families and have in turn seen increased working relationships with families. As a smaller area/state, we have been able to share our work with safety planning across the state and it is in the process of becoming part of our daily policy. Overall the BSC has taught us that little changes can result in great gains. We will be able to look at future changes using the PSDA process.
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Appendix G
Faculty and Staff Collaborative Co-Chairs Zeinab Chahine Managing Director of Strategic Consulting Casey Family Programs Lewis H. (Harry) Spence Lecturer Harvard Graduate School of Education and Kennedy School of Government
Collaborative Faculty Debra Conway Birth Parent Parent Partner Lead Division of Children and Family Services Vancouver, WA 98666 Diane DePanfilis Associate Professor, Associate Dean for Research, Director, Ruth H. Young Center for Families & Children University of Maryland School of Social Work Baltimore, MD 21201 Ernestine S. Gray Judge Orleans Parish Juvenile Court New Orleans, LA 70112 Suzanne Lohrbach Supervisor Olmsted County Children & Family Services Rochester, MN 55904 Shantay (Shawn) Mines Alumni Youth New Jersey Department of Children and Families Trenton, NJ 08625 Barry Salovitz Senior Director, Strategic Consulting Services Casey Family Programs New York, NY 10006 Kathy Deserly Director Indian and Child Family Resource Center Helena, MT 59602
Maryam Fatemi Regional Administrator Los Angeles Department of Social Services Pomona, CA 91766
Damon Marco Saunders CPS Supervisor Fairfax County Virginia Department of Family Services/Child Protective Services Tess Thomas Foster Parent Seattle, WA 98118
Tamika Youmans Alumni Youth Massachusetts Department of Social Services Worcester, MA 01605
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Collaborative planning team and project staff Jen Agosti Consultant & Model for Improvement Advisor President, JRA Consulting, Ltd. North Andover, MA 01845 Karl Chan-Brown Consultant 914 NW 96th Street Seattle, WA 98117 Phone: 206-789-6072 karl@chan-brown.com Caren Kaplan Project Leader Breakthrough Series Collaborative on Safety and Risk Assessments American Humane Association Donna Parrish Project Manager Breakthrough Series Collaborative on Safety and Risk Assessments American Humane Association Susan Dougherty Consultant & Model for Improvement Advisor Springfield, PA 19064
Stacie Hanson Project Associate Breakthrough Series Collaborative on Risk and Safety Assessments American Humane Association
Kary A. James Systems Improvement Methodology Advisor Casey Family Programs Washington, DC 20006 Anne Comstock Project Director Breakthrough Series Collaborative on Safety and Risk Assessments American Humane Association
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Appendix H
BSC on Safety and Risk Assessments Teams California: Fresno County Department of Children and Family Services Team name: Fresno Fuel Los Angeles County Department of Children and Family Services - Pasadena Office Team name: City of Roses Los Angeles County Department of Children and Family Services - Pomona Office Team name: Pomona 91766 San Francisco City and County Human Services Agency: Family and Childrens Services Team name: San Francisco Bridge Builders Stanislaus County Community Services Agency Team name: American Graffiti Chippewa Cree Tribe Chippewa Cree Tribe Team name: Team Bear Paw Colorado Larimer County Department of Human Services Team name: Rocky Mountain Families Florida Florida Department of Children and Families - Circuit 18 Team name: Innovators Florida Department of Children and Families - Circuit 5 Team name: Rays of Change Indiana Indiana Department of Child Services Team name: The Lake Effect Minnesota Carver County Community Services Team name: Go Team Safety Olmsted County Child and Family Services Team name: Path Finders Navajo Nation Navajo Nation Division of Social Services: Shiprock Region Team name: Toohnii (River People)
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Navajo Nation Division of Social Services: Southwest Region Team name: Sustainers of Life North Carolina Buncombe County Department of Social Services Team name: Think FAST (Families Achieving Safety Together) Catawba County Social Services Team name: Catawba Builders Oklahoma Oklahoma Department of Human Services Team name: OKC-Oklahoma Keeps Caring Pennsylvania Philadelphia Department of Human Services Team name: Empowerment of Change Texas Texas Department of Family and Protective Services Team name: Southwest Thunderbirds Utah Utah Division of Child and Family Services Team name: Sea Monkeys Wyoming Uinta Department of Family Services Team name: Wyoming Cowboys
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Appendix I
Change Package Measures OVERVIEW OF DATA AND MEASURES The measures included below are a companion to the framework. They should be used by public or tribal child welfare agencies to evaluate their own progress on improving the way they use safety and risk assessments in their work with children, youth, and families. There is not a one-toone relationship between the measures and each of the change package components because the framework breaks down the system into component parts whereas the measures take a global view of the overall system. The change package components describe how each discrete piece of the system will look when improvements have been made; the measures attempt to assess how we will know when the systemas a wholehas improved. We have chosen both process and outcome-related measures to track the work of this BSC. Although there are many outcome-related measures that agencies can use to define and evaluate safety and risk assessments, child welfare agencies are already responsible for many required data reports such as the Adoption and Foster Care Analysis and Reporting System (AFCARS), National Child Abuse and Neglect Data System (NCANDS), and state-mandated reports. In an attempt to help agencies remain focused on the improvements that must be made to practice rather than on additional data collection, the outcome-related measures for this project have been limited and are, as much as possible, derived from data already being collected for these mandatory reports. The process measures may require additional data gathering, but we are hopeful of working with site teams to minimize additional workload or effort. Public or tribal child welfare agencies that expect real and sustainable improvements in the way they conduct safety and risk assessment must track all of these measures. No single outcome or process measure can indicate whether a system is improving. Moreover, sometimes focusing on a single measure will result in an unintended negative effect on another key measure. Thus, the complete body of measures proposed in this document should be used together in a dynamic and holistic way. Additionally, these measures should be tracked on a monthly basis, as this is the only real way to see incremental progress and make adjustments as needed. Even if changes in some measures may not be visible on a monthly basis, it is critical to ensure that changes being tested and implemented are not having negative impacts on outcomes. Collecting the data for these measures is only the first step of using data in this BSC. Discussions that include families, youth, staff at all levels, and other stakeholders and partners must be held regularly to evaluate and interpret these data. Data by themselves do not tell a story; they simply help guide what questions need to be asked. Moreover, looking at data outside of their context may sometimes result in misleading conclusions. For instance, while the long-term goal of improved safety and risk assessments is to reduce the rates and recurrence of maltreatment, initial practice improvements may be reflected in increased rates as identification and re-referrals from the community go up rather than down. This would not be an indication of increased maltreatment, but the rates would make it appear so. The data may help paint a picture, but the discussions around these data are needed to interpret the picture. Finally, it is strongly recommended that all of these measures get tracked by race/ethnicity and age. To identify and address disproportionality and disparities in outcomes for children, youth, and families of color in the child welfare system, all data should be collected and analyzed in this way.
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PROPOSED PROCESS AND OUTCOME-RELATED MEASURES Teams participating in this BSC will track the following key process and outcome-related measures and report them on the extranet on a monthly basis. These measures are for improvement, not research; thus data will not be compared across teams. Instead, teams will review their own progress on a monthly basis, and when seen together with the changes they have tested, they will be able to assess whether their changes are resulting in improvements for children, youth, and families. Teams will be required to track all measures in the first three categories: 1) Family Engagement and Participation; 2) Family Satisfaction; and 3) Child Safety and Risk of Future Harm. In each of the final two categories, 4) Permanency and 5) Child Well-Being, teams will be expected to select or create one outcome-related measure to track monthly, based on their hypotheses of what will be most impacted by the changes that they will be making to the way they conduct their safety and risk assessments. BSC staff will work closely with and support teams in selecting and determining appropriate ways to report these measures.
PROCESS MEASURES Category 1: Family Engagement and Participation These measures are intended to track the extent to which families and youth are actively engaged and supported as they participate in safety and risk assessments and associated decision making. These measures will be further customized by each team based on specific public or tribal agency practices and processes. A. #/% of safety and risk assessments/meetings in which family members participated B. #/% of safety plans in which family members participated C. #/% of families and youth who reported their voices were heard and included in the decisions made about their case Category 2: Family Satisfaction These measures are intended to track the extent to which families and youth are satisfied with the way they are treated and included in the ongoing and continuous assessments of safety and risk. These measures will be further customized by each team based on specific public or tribal agency practices and processes. A. #/% of families and youth who reported their contact with agency staff was respectful B. #/% of families and youth who reported their contact with the agency was responsive to their culture
OUTCOME-RELATED MEASURES Category 3: Child Safety and Risk of Future Harm These measures are intended to ensure that children and youth are safe and remain free from harm based on decisions made by the public or tribal child welfare agency. Each of the first three
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measures will also be tracked by race/ethnicity based on the specific disproportionality and disparity issues that appear in each teams target site. A. #/% re-referrals (another report of alleged maltreatment) within six months of initial report B. #/% of re-referrals of maltreatment (within six months of the initial report) broken down by: 1) Those cases in which the case was opened and services provided 2) Those cases in which the case was opened and closed without service provision (excluding investigation as a service) C. Timeliness of decision-making. Teams can choose one of the following based on agency discretion, priorities, and/or target population. (All timeframes are those established by the individual agency/jurisdiction.) 1) Screening decision timeframe allotted following receipt of the referral (whether or not referral is accepted by the agency) 2) Response time timeframe required to respond to referral that has been accepted by the agency. This may be classified as time allotted for initial face-to-face contact and differ by type and severity of alleged maltreatment 3) Completion of the safety assessment (and, if indicated, the development of a safety plan) 4) Completion of Investigation time period allotted for the completion of the agencys inquiry as to whether maltreatment occurred and the determination of a finding as appropriate Category 4: Permanency This measure is intended to ensure that safety and risk assessments are used to guide decision making in ways that promote and support permanency for children and youth. Teams can select one of the measures listed below or, working with BSC staff, create their own measure based on their target site and priorities. A. #/% of children/youth achieving permanency within 12 months in one of the following permanency options: remain home, return home, adoption, or guardianship B. #/% of children/youth with two or fewer placements within a 12-month period C. #/% children/youth in out-of-home placement who have regular, consistent contact and visitation with their siblings D. #/% of children/youth in out-of-home placement who have regular, consistent contact and visitation with their parents
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Category 5: Child Well-Being This measure is intended to ensure that the well-being of children and youth is considered when safety and risk assessments and related decision making occurs. Teams will only need to select one well-being measure. Teams can select one of the measures listed below or, working with BSC staff, create their own measure based on their target site and priorities. A. #/% of children/youth whose physical health needs, including dental health needs, are assessed as part of the safety and risk assessment B. #/% of school-aged children whose educational needs are assessed as part of the safety and risk assessment C. #/% of children/youth whose mental health needs are assessed as part of the safety and risk assessment D. #/% of children/youth whose family relationships and connections to their neighborhood, community, faith, extended family, tribe, school, and/or friends are maintained
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Appendix J
BSC on Safety and Risk Assessments: PDSA Planning Form
Team: Priority Being Addressed: What are we trying to accomplish? Desired Outcome: How will we know a change is an improvement? Strategy: What change can we test that will result in improvement? Key Practice/Requisite Area: Practice or requisite area most directly connected to this PDSA 1. Race, Culture, & Ethnicity 2. Family/Youth Engagement 3. Tools 4. Sound Decisions 5. Integrated & Comprehensive Assessment 6. Permanency & Well-Being 7. Community Collaboration 8. Ensuring Appropriate Services R1. Maintaining & Supporting a Qualified, Competent, WellTrained Workforce R2. Using Data R3. Agency Leadership 3a. Re-Referrals 3b. Re-Referrals on Closed or Open Cases 3c. Timeliness 4. Permanency 5. Well-Being
Monthly Measure: Monthly measure category most likely impacted by this PDSA
1a. Participation in Meetings 1b. Participation in Plans 1c. Family Inclusion 2a. Respectful Contact 2b. Culturally Responsive Contact
Impact on Disproportionality: The impact we think this will have on disproportionality and disparities PDSA Title: Plan: What are we going to do? (What is the change being tested?) Who is going to do it? When will it be done? Hypothesis: What do we expect will happen? Do: What happened? (briefly) Study: Did what we expect to happen actually happen? What was different from what we expected? What did we learn? Act: What learnings will we apply to our next text cycle? What will our next PDSA be?
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Appendix K
Sample Team Progress Report Below are highlights of your teams accomplishments thus far based on your postings this month on the extranet. The second column provides you with some comments and questions you may wish to use in discussion with your team and planning for next steps. You do not need to respond to the questions posed in any waythey are simply there as food for thought as you plan future PDSAs and PDSA cycles. As you are selecting PDSAs to test by next Tuesday, its best to keep them closely aligned with the areas that were highlighted by your self-assessments and chosen priorities. This process will ensure that your small test of change will result in the desired outcomes to improve your system and you will likely see results in your measures and next self-assessment. Your teams current priorities are identified as: Enhance, empower the staff to complete thorough risk and safety assessments throughout the life of the case with thoughtfulness of permanency and well-being issues. Increase the scope of practice, including race, ethnicity, and culture standards, on safety and risk assessments among staff at all levels. Increase community involvement to determine the risk and safety for children. Empower the staff to actively engage parents, children, youth, and their family members in the decision-making and intervention processes. Decrease the number of re-referrals on open cases by providing guidance and instruction on risk and safety assessments on an on-going basis. Provide and enhance in-depth Structured Decision Making training to all line staff to help them understand the need for risk and safety assessments on a daily basis. Think about continuing to challenge yourselves to make sure that your tests are small enough. Ask one another: What about that idea can you actually test by next Tuesday? Also make sure that each test is building off of what you learned in a previous cycle. Every time you complete a PDSA, ask yourself what you can do next with that learning. In addition, remember that PDSAs should involve tests of practice change. Ask yourself: What will the worker (or supervisor, community partner, or other person) DO differently in implementing this change? Additionally, as you continue to move your PDSA cycles toward implementation and spread, its a good idea to make sure that the practice is becoming more systematic and less dependent upon a single person. This might mean developing guidelines, a checklist, training notes, or other written material to document the practice and allow it to be replicated throughout the agency. These tools might feel bureaucratic, but they will be important resources to ensure that the great practices youre testing through your PDSAs become the way your office does work. (You may even want to develop and test these tools using the PDSA process!) Lastly, think about which measures you expect each of your PDSA cycles to impact. While you wont be able to link each specific PDSA to a change in one specific measure each month, using the measures and PDSAs together will help you assess whether your overall changes are resulting in overall improvements in your office.
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PDSA Title/Summary
Comments and Questions
Community partners in the TDM collaborative process
We love how you are involving your community partner in your efforts to improve your work! However, besides having a community partner present, what will he or she be doing during the TDM process that will change or influence your practice in a different way? Are you simply testing if the location makes a difference or if having the community partner present makes the difference? You may have to tease this out a bit more. If it is the location, how will you know that having the families attend the TDM somewhere else makes a difference? Are there a set of follow-up questions you can ask your test family to justify the change in venue? You were planning to hold this meeting in midDecemberdo you have any Study results you can post as you think about your next cycle? Love this test! What a wonderful way to incorporate your youth representative in the work, which resulted in a wonderful outcome for these two young women. It is exciting to hear that you will be starting a support group in the future. How will this support group influence the safety and risk for those kids who attend? It will be important to interweave the safety component into the group before it starts. What are the specific goals for the group? How can youth take an active role in ensuring/maintaining their safety and understanding of what it means to be at risk of future harm? Is there a way you can build in a follow-up that assesses current safety or risk of harm?
Youth partner
Defining culture in the safety/ Having a shared mental model of terms and definitions is a key risk assessment process component to good practice. How will you now incorporate these definitions into practice shifts for your workers? Now that you all have decided on what cultural sensitivity looks like, how will you ensure that this definition will result in practice changes in your work with families? How can you test the effectiveness of these definitions with one family? Are there a set of questions you can ask to help direct workers on how to ensure they are getting information related to the cultural practices of families? Once they have the information, what will they be doing or saying to demonstrate that they are culturally sensitive in their efforts with families? This is an excellent strategy; however, your challenge will be to scale it down into small testable steps that will influence your practice with families. We love that your senior leader was involved in the creation and support of this definition. How did he solicit input from others to ensure that it was a workable definition? Have you tested to make sure that your birth partner, youth, and community partner feel that these are useful definitions from the point of view of non-agency individuals?
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Sample Monthly Measures Guide for Extranet Data Entry

Title Family Participation in Assessment Meetings Cell Label A B Family Participation in Safety Plans C D Family Inclusion in Decisions E F Respectful Treatment G H Culturally Responsive Treatment I J Re-Referrals K L White Children Re-Referrals M N Measure # 1a. Number 1a. Total 1b. Number 1b. Total 1c Number 1c. Total 2a. Number 2a. Total 2b. Number 2b. Total 3a. All Children ReReferrals Number 3a. All Children Referrals Total 3a. White Children Re-Referrals Number 3a. White Children Referrals Total 3a. Children of Color Re-Referrals Number (African American) 3a. Children of Color Referrals Total (African American) 3b1. Re-Referrals Open CasesAll Children 3b1. ReReferralsAll Children Total 3b1. Re-Referrals Open CasesWhite Children 3b1. Re-Referrals White Children Description Comments Number of families participating on safety assessment documentation tool Total Safety Assessment documentation tools completed that month Number of respondents reporting positive answers on related questions on family survey Total number of surveys completed and returned Number of respondents reporting positive answers on related questions on family survey Total number of surveys completed and returned Number of respondents reporting positive answers on related questions on family survey Total number of surveys completed and returned Number of respondents reporting positive answers on related questions on family survey Total number of surveys completed and returned Number of children with more than This number should be the same as Cells R and one referral in the past 6 months. X. Total number of children referred during the past 6 months Number of white children who had a This number should be the same as Cells T and Re-Referral in the past 6 months Z. Total number of white children referred during the past 6 months Number of African American children who had a Re-Referral in the past 6 months Total number of African American children referred during the past 6 months Number of children with a ReReferral who had an open case in the past 6 months Number of children with more than one referral in the past 6 months. Number of white children with a ReReferral who had an open case in the past 6 months Number of white children who had a Re-Referral in the past 6 months Number of African American children with a Re-Referral who had an open case in the past 6 months Number of African American children who had a Re-Referral in the past 6 months Number of children with a ReReferral whose past referral had been closed without services Number of children with more than one referral in the past 6 months. Number of white children with a ReReferral whose past referral had been closed without services Number of white children who had a Re-Referral the past 6 months Safety and in Risk Assessments Number of African American children with a Re-Referral whose past referral had been closed This number should be the same as Cells V and BB.
African American Children Re-Referrals
O P
Re-Referrals on Open Cases
Q R
This number should be the same as Cells K and X.
White Children Re-Referrals on Open Cases
S T
This number should be the same as Cells M and Z. (White Children Re-Referrals)
3b1. Re-Referrals Open Cases-African American U 3b1. Re-Referrals African American Total V 3b2. Re-Referrals Closed Cases-All Re-Referrals on Closed Children W Cases without Services 3b2. Re-Referrals All Children Total X 3b2. Re-Referrals Re-Referrals on White Closed Cases-White Children Closed without Children Y 3b2. Re-Referrals Services White Children Z series casey family programs | breakthrough collaborative | African American ReReferrals on Open Cases Re-Referrals on African 3b2. Re-Referrals Closed Cases-
This number should be the same as Cells O and BB (African American Children Re-Referrals)
This number should be the same as Cells K and R. (Total number of Re-Referrals) This number + Cell S should equal Cell M. (total number of white children referrals) This number should be the same as Cells M and T. (White Children Re-Referrals) This number + Cell U should equal Cell O. (total number of African American children Re-
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Re-Referrals Number children who had a Re-Referral in (African American) the past 6 months 3a. Children of Color Total number of African American Referrals Total children referred during the past 6 (African American) months P 3b1. Re-Referrals Number of children with a ReOpen CasesAll Referral who had an open case in Re-Referrals on Open Children the past 6 months Q Sample Monthly Measures Guide for Extranet Data Entry 3b1. ReCases ReferralsAll Number of children with more than Title # Description Children Total one referral in the past 6 months. Cell R Label Measure Number of families participating on 3b1. Re-Referrals white children with a Resafety assessment documentation Open CasesWhite Referral who had an open case in White Children Re-Referrals Family Participation in tool A 1a. Number S Children the past 6 months on Open Cases Total Safety Assessment Assessment Meetings 3b1. Re-Referrals Number of white children who had a documentation tools completed that White Children Re-Referral in the past 6 months T month 1a. Total B Number of African respondents reporting 3b1. Re-Referrals American positive answers on relatedwho had Open Cases-African children with a Re-Referral Family in African Participation American Requestions on family C 1b. Number U American an open case in the survey past 6 months Safety Plans Referrals on Open Cases Total number of surveys completed 3b1. Re-Referrals Number of African American and returned 1b. Total African American children who had a Re-Referral in D Total the past 6 V Number ofmonths respondents reporting positive onwith related 3b2. Re-Referrals Number answers of children a ReFamily Inclusion in questions on family E 1c Number Closed Cases-All Referral whose pastsurvey referral had Decisions Re-Referrals on Closed Total of surveys completed W Children been number closed without services Cases without Services returned 1c. Total 3b2. Re-Referrals - and Number of children with more than F All Children Total one referral in the past 6reporting months. X Number of respondents positive on related 3b2. Re-Referrals Number answers of white children with a ReRespectful Treatment on family G 2a. Number Re-Referrals on White Closed Cases-White questions Referral whose pastsurvey referral had Total number of surveys completed Children Closed without Children been closed without services Y and returned 2a. Total 3b2. Re-Referrals Number of white children who had a H Services White Children Re-Referral in the past 6reporting months Z Number of respondents positive on related Number answers of African American Culturally Responsive questions on a family survey whose I 2b. Number children with Re-Referral 3b2. Re-Referrals Treatment Total numberhad of surveys completed Re-Referrals on African past referral been closed Closed Casesand returned 2b. Total J American Children Closed AA African American without services. 3b2. Re-Referrals American without Services 3a. All Children Re- Number of African children with more than African American children who had Re-Referral in K Referrals Number one referral in thea past 6 months. Re-Referrals Total the past 6 months 3a. All Children Total number of children referred BB Referrals Total during the past 6 months L Number of investigations completed Completion of Investigations within assigned CC 3c. Number 3a. White Children Number of whitetimeframe children who had a Total number investigations White Children Re-Referrals Re-Referrals Number Re-Referral inof the past 6 months M completed in the given month. 3c. 3a. Total White Children Total number of white children DD Referrals Total referred the past 6 involving months N Number during of investigations white children completed within White Children Completion 3c. Number timeframe EE 3a. Children of Color assigned Number of African American Total number of investigations of Investigations Re-Referrals Number children who had a Re-Referral in African American Children involving white children completed (African American) the past 6 months O Re-Referrals in thenumber given month. 3c. 3a. Total Children of Color Total of African American FF Referrals Total children during the past 6 Number referred of investigations involving (African American) months American children P African completed assigned 3b1. Re-Referrals Number of within children with a ReAfrican American GG 3c. Number timeframe Open CasesAll Referral who had an open case in Completion of Investigations Total number of investigations Re-Referrals on Open Children the past 6 months Q involving African American children 3b1. ReCases completed the given month. 3c. Total ReferralsAll Number of in children with more than HH Children Total one referral in the past 6reunified months. in R Number of children who the given month reunified 3b1. Re-Referrals Number of white who children with a RePermanencyReunification II 4 Number within 12who months Open CasesWhite Referral had an open case in within months White 12 Children Re-Referrals Total number of children reunified in Children the past 6 months S on Open Cases the given month 4 Total 3b1. Re-Referrals Number of white children who had a JJ White Children Re-Referral inof the past 6 months T Total number assessments of Well-BeingMental Health physical/mental health and Needs 5 Number education KK 3b1. Re-Referrals Number of African American 5 Total Total Cases LL Open Cases-African children with a Re-Referral who had African American ReAmerican an open case in the past 6 months U Referrals on Open Cases 3b1. Re-Referrals Number of African American African American children who had a Re-Referral in Total the past 6 months V 3b2. Re-Referrals Number of children with a ReClosed Cases-All Referral whose past referral had Re-Referrals on Closed Children been closed without services W Cases without Services 3b2. Re-Referrals - Number of children with more than All Children Total one referral in the past 6 months. X 3b2. Re-Referrals Number of white children with a ReRe-Referrals on White Closed Cases-White Referral whose past referral had Children Closed without Children been closed without services Y 3b2. Re-Referrals Number of white children who had a Services White Children Re-Referral in the past 6 months Z Number of African American children with a Re-Referral whose 3b2. Re-Referrals Re-Referrals on African past referral had been closed Closed CasesAmerican Children Closed without services. African American AA 3b2. Re-Referrals | Number of African without Services | breakthrough series casey family programs collaborative Safety and Risk American Assessments African American children who had a Re-Referral in Total the past 6 months BB African American Children Re-Referrals O
This number should be the same as Cells V and BB.
This number should be the same as Cells K and Comments X.
This number should be the same as Cells K and R. (Total number of Re-Referrals) This number + Cell S should equal Cell M. (total number of white children referrals) This number should be the same as Cells M and T. (White Children Re-Referrals) This number + Cell U should equal Cell O. (total number of African American children ReReferrals) This number should be the same as Cells R and This X. number should be the same as Cells V and O. This number should be the same as Cells T and Z.
This number should be the same as Cells V and BB.
This number should be the same as Cells K and X.
This number should be the same as Cells K and R. (Total number of Re-Referrals) This number + Cell S should equal Cell M. (total number of white children referrals) This number should be the same as Cells M and T. (White Children Re-Referrals) This number + Cell U should equal Cell O. (total number of African American children ReReferrals) This number should be the same as Cells V and O.
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Appendix L
BSC on Safety and Risk Assessments: Spread Readiness and Activities
Team: Practice Being Spread: Briefly describe the key practice or strategy that is being spread Key Practice/Requisite Area: Practice or requisite area most directly connected to this PDSA Race, Culture, & Ethnicity Family and Youth Engagement Tools Sound Decisions Integrated & Comprehensive Permanency & Well-Being Community Collaboration Services & Supports Workforce Data Agency Leadership
Link to PDSAs: PDSAs that have resulted in this practice Disproportionality Implications: Area for Spread: Entire unit Entire target site Entire county Entire region Entire state
LeadershipCommitment: Who has top-level commitment for this change? What is their role? LeadershipAlignment with Priorities: How is this aligned with other priorities and plans? Making the CaseBSC Data and Measures: What do BSC data/measures show in terms of improvements you can use to make the case for spread? Making the CaseOther Data: What other quantitative (numbers) or qualitative (including stories/anecdotes) data show improvements you can use to make the case for spread? Set-UpPeople: Who will have primary ownership and responsibility for managing the spread of this practice? Who are the key champions and messengers in spreading this practice? Do: What happened? (briefly) Set-UpLogistics: What is the overall timeframe for spreading this practice (dates for roll-out, steps for roll-out/training)? What do you need to have in place from an infrastructure standpoint to spread this practice?
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Communication: Who are the audiences you will need to reach to spread this practice? What messages will you use to reach them? How will you reach them? SustainabilityDocumentation: How will this practice be documented to ensure that it occurs consistently and with the desired intent? How will leadership and others in the agency know that this practice is being sustained over time? How will progress be monitored and reported? SustainabilityNew Way Is Better: In what way is this new way of doing work (the process) better or easier than the old or usual way? Anticipated Challenges: Where do you think your challenges remain as you spread and work to sustain this practice? Spread Status: Moving forward with spread as described above Need to do more PDSAs before spreading Not currently focused on spreading this practice (on hold)
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Appendix M
Practice Cards Appendix M contains individual Practice Cards based on actual practice changes tested by BSC teams. The Practice Cards were designed to provide information for child welfare agency staff who would like to try or implement these ideas in their own jurisdiction. They are divided into four practice areas: Community Partners, Family and Youth Engagement, Safety and Risk Decisions and Tools, and Responding to Race, Ethnicity, and Culture.
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COMMUNITY PARTNERS This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
AcTiVE CollaboraTion WiTh Law EnforcEmEnT Overview Have a joint meeting early during the investigation phase (and whenever court action is indicated) that includes the family, child welfare agency staff, representatives from law enforcement, and/ or representatives from the courts. The multiple roles and involvement of law enforcement, the court system, and child welfare staff are often confusing for families. Moreover, each system often has its own definitions of safety and risk. Having representatives of these systems meet with families together provides a single definition of safety and risk that helps reduce the confusion for families as well as for the multiple systems involved. Invite a police officer (or representative from the court system) to one team meeting in which the family is present early in the life of a case. Oklahoma: The presence of the CW worker [with the police] has enhanced the relationships between local law enforcement, and trust in joint decision making has improved as well. When meeting with multiple systems, agency jargon is often used that can be isolating and exclusive for the family. Some families may feel more threatened, rather than supported, by meeting at a police station. Location of this meeting matters in terms of true family engagement and support. Oklahoma Pomona, CA
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CommuniTY CollaboraTion MEETinGs Overview Include partners from other agencies and the community when meeting with families prior to court intervention. Meeting at the beginning of the case will help engage the family early on. By engaging multiple community partners, families will receive support from many places, duplication will be minimized, and roles and responsibilities across agencies will be clear. Invite a family to a meeting prior to court intervention that includes all agencies that areor could beconnected with the family for support and/or prevention. The worker felt much more connected to the family. The family was much more willing to calmly discuss the situation and put the needs of the children first. Scheduling meetings with multiple agencies is a challenge, particularly when there is not much notice. Building upon existing meetings or agreeing on a standing meeting time could help address this challenge. Chippewa Cree Tribe
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CommuniTY ParTnErs ParTicipaTinG In TEam MEETinGs Overview Community partners are invited to attend and participate in team decision-making meetings that involve families and the child welfare agency. This provides additional support to families as well as brings additional perspectives to the meeting and the decisions that result. Families will be more likely to use their voices and feel supported if community partners participate in team meetings along with them. Invite a community partner to a team decision-making meeting where a family is present. Pasadena: We were able to make more informed decisions with the additional input from the community partner, and their explanation of how they would/are delivering services to the family around the case plan goals. Pomona: The community partner learned that it can be done! A dialogue can occur with [an agency social worker], parents, and community partners to understand better the safety and risk factors. Transparency became more real. Things to Think about Agency jargon is sometimes used that can be isolating and exclusive to families and community partners. Facilitation needs to respect and honor different perspectives and ensure that all voices present are being used and heard. There may be legal considerations about when GALs can attend family meetings based on decisions being made and information being shared. Pasadena, CA Pomona, CA Philadelphia, PA
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DEfininG safETY and Risk WiTh CommuniTY ParTnErs Overview Improve communication between community partners and child welfare agency staff by creating a clear understanding of the definitions of child safety and risk. Having a common understanding of safety and risk between the agency and the community will result in shared responsibility for supporting families and increased collaboration around minimizing risks for families while increasing child safety. Engage one community partner in a discussion about the agencys definitions of safety and risk, the tools that are used to assess them, and how safety and risk decisions are made. It began with a negative discussion; however, it created the opportunity to listen to each others point[s] of view and agree to start at a common baseline language as it would be discuss[ed] in the process of assessing and providing services to the children and families when [the agency] is involved. The initial conversations with communities may be uncomfortable and/or negative based on historical relationships between child welfare agencies and communities. Communication issues will need to be addressed at multiple levels of agencies and community partners, not only at the leadership level. Pomona, CA
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EducaTinG CommuniTiEs AbouT SafETY NETworks Overview Provide community members with information about the agencys approach to child safety in a variety of ways. Specifically, Carver County, MN, used videos, brochures, and a newspaper article to educate the community about safety networksa term used to describe the network of family, friends, and other community members that can help ensure child safety. By providing information to community members about safety networks in a variety of ways, community members will understand their role in child safety and will be better equipped to support families in the community. Develop information about the agencys safety approach and share with one family and/or community member. Information has been expanded to focus on the agencys overall approach to safety and risk (Signs of Safety) and is being distributed to agency staff, community members, and families as they become involved with the agency. Ensure that a community partner or layperson participates in the development of information to be distributed so that language related to safety and risk is easily understood by nonagency staff. Ensure information is culturally and linguistically responsive to the communities being served. Carver County Safety Network Guidelines Carver County, MN
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Carver County Safety Network Guidelines Introductions Introduce professionals; ensure all members have contact information. Explain workers role in case. Have each member introduce themselves and how they know the family. Thank everyone for coming; obviously there are many people who care about the children and want to help keep them safe. During this meeting we may have to discuss some difficult or uncomfortable topics and I want to respect everyone here by allowing people to let me know if you need to take a break, use the bathroom, step outside for fresh air, so on.
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Break down the meeting agenda. Explain safety networks and the roles and expectations of SN members; discuss initial allegations; move into strengths of the family; agencys worries; worries of the network; agencys danger statement; agencys bottom lines; and the creation of safety plan to address agencys danger statement and bottom lines. Safety Support Network The agency asked the family to come up with people they feel support them to be on a Safety Network. The definition of a Safety Network is: o The relatives, friends, neighbors, and community members who have responded positively to a familys request and made a commitment to the agency to do specific things to help ensure the childrens safety during the case and when Carver County Social Services (CCCSS) is no longer involved. Almost every case in CC is now expected to have some form of a safety network in place before the case will be closed. The idea is that the network will appropriately intervene if significant safety concerns arise to ensure the safety of the child. The hope is that the network will appropriately intervene and address the concerns (remove the child from the home, remove the person not following the plan, so on), which would prevent future involvement by the county but also continue to keep the child safe. The roles and expectations of a safety network include: Someone the child can go to or call if he or she is feeling unsafe or worried. A group of people who will appropriately intervene if they feel the child is unsafe and appropriately address any concerns before the child returns to the care of his or her parents. Members of the network must be able to honestly share their concerns with the family and if this is not a commitment they can make, the family needs to be aware now so they have the opportunity to find people willing to make this commitment. The SN is expected to create a plan to address the agencys worries that can be agreed upon by the SN, the family, and the agency to ensure child safety. The SN does not mean the people on the network will then call the SW to report concerns or worries, but they make a commitment to the family that they will communicate future worries to the family when CCCSS is no longer involved to keep the child safe without involving the county. If the child is in severe danger, we do expect the agency to be contacted. Our best hopes are that safety networks will protect the children and not just report new concerns to the agency. Safety plans work best when created by the network and the family together, and we have found families are more likely to follow a plan they have created themselves than a plan that the county has created for them. Establish SN Rules: 1. Respect all SN members (no interrupting, put downs, swearing, so on). 2. The focus is on SAFETY. If it doesnt relate to safety, I may cut you off. 3. Focus on the future, not on past incidents, issues, so on. 4. This will work best if everyone participates!
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Initial Report Discuss the initial allegations that were received by the agency and how a case came to be opened with the agency. Strengths: Ask all members of the SN what they think is going well for the family, including the family and all professionals. What would the family say the agency is worried about: Agencys worries: Discuss as honestly and straightforwardly as possible the worries of the agency. Do not use general terms like physical abuse; instead say I am worried that Dad has hit the child on the butt and thigh with a belt and has left welts and bruising. *By the agency worker discussing his or her worries as openly and straightforwardly as possible, this will encourage other SN members to honestly share their worries as well. Networks worries: Example: I realize that confronting a good friend or neighbor about your worries regarding their child is not an easy thing to do, and I have worked with other networks in the past that are hesitant to confront the family due to worries that the family will no longer talk to them or engage with them so the Network cannot see what is really going on. However, we have found that when SNs are willing to talk openly about their worries to the family, the children are safer because more people than just the agency and family are aware of the situation. We have found that the more people who are aware of the situation and openly discussing concerns with the family, the safer the children are. Familys worries: Discuss the childs worries and wishes (using 3 Houses or Fairies/Wizards if possible): Agencys danger statement or worst fear of what may happen: The agencys bottom lines for safety: Parents: What are your expectations of your network? -What role do you want them to play? Safety plan to address the danger statement and bottom lines: 1. 2. 3. 4. 5. To prevent this from happening, we will: If this does happen, we will: This is what the family will do: This is what the SN will do: This is what the child will do:
Parents: How confident are you that the network will report their worries to you? 0-10
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Network: How confident are you that you will be able to discuss worries with the parents? 0-10 Family: How confident are you that the SN will follow this plan? 0-10 SN: How confident are you that the family will follow this plan? 0-10 SN and Family: How confident are you that the child will follow this plan? 0-10 Parent If someone on your network has a worry in regards to the childs safety, how would you like them to respond? Network What do you need to see to be confident that the child will be safe with the parents? SN and Family: What do you need to see to know the case will not be reported to CCCSS again?
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GAL ParTnErship and ATTEndancE AT AGEncY MEETinGs Overview Why Try This? Include Guardians ad Litem (GALs) in agency meetings related to families to ensure common understanding of the familys situation. When GALs have a more up-to-date understanding of the familys status at any given time, they are better able to assess current safety status. The GALs will also have more input, based on current information, in critical team decisions. Invite a GAL to an agency staffing to discuss a familys situation, strengths, and needs. [At the Child and Family Team Meeting, it was clear that] the family did not understand the GAL role, and the GAL was able to clarify and answer all questions. The GAL also was able to set clear expectations for the parents as to what had to occur before the GAL would agree to the kids returning home. A child and family team was established, and communication opened up very early in the case. Parents and childrens attorneys sometimes oppose GALs playing this role Agency workers sometimes do not invite GALs to participate in meetings. GALs sometimes do not wish to attend agency meetings in this way. Utah
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HoldinG TEam MEETinGs AT CommuniTY OrGaniZaTions Overview Conduct team meetings that include families in locations that are away from the child welfare agency office and are more convenient and accessible to families. Families will be more likely to participate in team meetings if they are held outside the child welfare agency and in a more neutral setting, such as a community-based organization or neighborhood setting near their home. Conduct one team meeting with a family in a community-based family-friendly agency. Stanislaus County: The social worker supervisor felt the families participation was much higher because they didnt have to travel to [another city]. Also the community providers were able to attend the TDM since they didnt have to travel an extra 45 minutes each way to the agency. Communication needs to be clear about the scheduling and location to ensure that the desired setting is available and accessible and that all participants have consistent information. Pomona, CA Stanislaus County, CA
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SpEcialiZEd STaff For MiliTarY FamiliEs Overview Where there are large numbers of military families, develop a specialized child welfare worker who focuses on working with these families. A specialized child welfare worker for military families will result in better investigations, easier transitions between agencies, better communication, and families engaging more during the investigation process. Assign a worker to focus on a specific cross-agency population (e.g., military) with a goal of understanding that agencys internal culture and developing relationships and coordination with that agencys staff. We have noticed a significant change in the way the military are handling abuse and neglect of children. We are receiving calls at the outset of the incident when before we would receive the call after the fact or not receive a call at all. Our military worker is receiving calls from Military Police and Social Services prior to calling in an actual intake. They are requesting guidance and information to properly call in a report.We expected that the communication would improve between both agencies. What we saw was a great increase in the number of cases being called. Agencies have very different organizational cultures, some of which are not complimentary with child welfare culture. Texas
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FAMILY AND YOUTH ENGAGEMENT This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
Call BEforE You KNock Overview Workers call to make an appointment and explain the process prior to making an assessment or investigation visit with families designated as low to moderate risk. By breaking the ice over the phone, workers are better able to engage with families. Families are more responsive when they have time to prepare for the assessment and are more willing to provide information that will help the worker make better safety and risk decisions. Calling ahead sets up a more cooperative dynamic between parents and workers that will ultimately lead to better working relationships and more informed safety and risk assessments. Have one caseworker call a family who has been reported for a low to moderate risk issue, explain the concern, set up a home visit, and encourage the family to have support people present for the visit. Oklahoma: Family was responsive and prepared for the assessment. Worker was able to focus the attention on the actual assessment instead of having to spend time explaining the purpose of CPS, the allegations, and dealing with the parents initial reaction to CPS being involved in their lives. Worker was able to convey all of this information to the family during her phone call. Worker got a sense from the family that they felt the worker was there to assist them and was not there to investigate them per se. Some jurisdictions may require unannounced visits on all initial investigations and/or assessments. Talk to your supervisor about whether calling ahead is allowed. If it isnt, talk to management about how to change this policy! Oklahoma Wyoming Larimer County, CO
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EarlY TransparEnciEs wiTh FamiliEs Overview Engagement with families in the assessment or investigation process should start from the first visit. Initial home visits or decision meetings should include full disclosure of the agencys process, a clear explanation of the safety and risk concerns, a review of the familys referral history (if applicable), and a discussion of family strengths and needs. Many families find the child welfare process confusing, and the use of jargon often means that families are unclear about the safety and risk concerns of the agency. Full disclosure and early transparency from the agencys first contact will help ensure that families and workers can better work together to address safety and risk concerns, hopefully keeping children safe in their homes. Keeping the focus on clear definitions and goals of safety for kids increases transparency between the agency and families and leads to achieving concrete goals. Before your next initial assessment or investigation visit with a family, outline the agencys safety and risk concerns and use guided questions to talk to the family about their strengths and needs. Create a Parent Fact Sheet that clearly outlines your agency process and system for families. Pasadena: Facilitator discussed risk and safety issues relative to allegations using standardized definitions each. These definitions were visible during the TDM process. Facilitator felt it created a more constructive and purposeful meeting. The family and CSW were fully engaged and remained focused on purpose for the meeting. This led to the creation of a comprehensive safety plan with input from all parties. Many BSC teams found that their agency was not using clear, consistent definitions of safety and risk. Creating standardized definitions for staff will lead to increased transparency with families. FL5 Parent Fact Sheet Florida Circuit 5 Pasadena, CA Utah
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Florida Circuit 5 Parent Information Sheet You have recently become involved in Floridas child welfare system. Someone called the Department of Children and Families and expressed concern for the well-being of your child(ren). Safety and risk assessments are very important in determining how safe your children are with you in your home. The investigator will ask you questions, and your participation and cooperation is very helpful in creating a safe solution. We want to know the good things that you and your family do to take care of each other. We also need to know the things that can put your children at risk and how we can help to improve the situation. Through the safety assessment, we need to evaluate the risk to your children and identify the things that could help your family/children. The Investigator will ask you questions about: The allegation The previous criminal history of all household members over the age of 12 Prior experience with the Department of Children and Families Friends, family, employers, neighbors, etc., who could provide helpful information How you manage your home/family, including food, clothing, money, management, sleeping arrangements, transportation, etc. Complicating factorsany issues that impact your best ability to care for your children The investigator will also look around your home to make sure the environment is safe and decent. If you and the investigator identify safety or other needs, the investigator will make recommendations and can help locate services. Some interventions include: In-home services that help with parenting and household skills Asking someone in the household who may be posing a risk to move out Suggesting your children move in with family or friends until the situation improves In some cases, children are removed from their familys home due to immediate danger. If that happens, you can still help make a plan for your children to return home. The court and a social worker will oversee the process and help you to make improvements. A comprehensive behavioral assessment will be completed on your child. You and others will be asked to participate in the information-gathering process. This information will be used to identify the strengths and needs of your child and family. Once the assessment is complete, your childs case manager will review the results with you and seek your input. Although we recognize this can be a very stressful situation, your cooperation and assistance can make a big difference in coming up with solutions. We encourage you to participate in the safety plan and ask questions so that you understand the process. Thank you.
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Family and Youth Engagement This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
EnGaGE FamiliEs DurinG AssEssmEnT And CasE PlanninG Overview Ask open-ended questions that elicit information from families about the strengths and challenges they see in their own lives. Use the answers to develop a case plan that meets the needs of the family. When parents identify barriers to child safety and permanency, a case plan can be crafted that addresses those challenges. Concrete barriers (e.g., resources, housing, employment, safety issues) that may not have occurred to the worker may be identified. Ask parents two questions during an initial meeting with their reunification worker. What do you believe the strengths in your family are that will help you reunify? What do you believe the concerns are that are keeping your family from being together right now? Interviews with three families surprised us. Having the option to answer open-ended questions put the contact into a more engaged conversation. Home calls lasted longer as clients shared more. [Workers] felt their initial contact with the family was more meaningful and initiated the case-planning process. Both felt they were engaging rather than prescribing what needed to be done especially around the concerns or risks. Location of the contact and amount of time spent may affect the quality of engagement. Caseworkers must be open to questioning their own usual way of viewing challenges and developing a case plan. Fresno County, CA
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ENGAGING FaThErs INITIATIVE Overview Identify, locate, place, and support the placement of children with their fathers. The goal is to engage fathers from the beginning of the case (in the investigative process) and to look to them first for potential placement if needed. Locating and engaging a non-custodial father in the life of his child increases the likelihood that the child will either not be placed into care or be placed with paternal kin rather than unrelated foster parents. To the extent that these are children of color, their disproportionate representation in the system may be decreased. Fathers and paternal kin may also be able to provide additional information that will improve the safety and risk assessment processes. Ask a child to tell you about his or her dad. Draw a genogram with mother and child. Florida Circuit 5: One immediate result from last month is that in every case in which children were sheltered, the father was located and noticed. This allowed him to begin engagement in the dependency process and have equal representation in the process. Mothers may be reluctant to name non-custodial fathers. Children and other relatives may be able to identify and locate fathers. Issues may arise around legal paternity issues. National Quality Improvement Center on Non-Resident Fathers and the Child Welfare System: http://www.fatherhoodqic.org/ Florida Circuit 5 Olmsted County, MN
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FamilY MEETinG PrEparaTion Overview Meet with families and youth before meetings (such as Child and Family Team meeting or Team Decision Making meeting) to prepare them for the process and their role as well as the goals of the meeting. Agency meetings can be overwhelming, especially when there are multiple professionals present who have all attended many of these meetings before. There can be an assumption that families already understand the process and the professional jargon being used. Prior preparation with families will allow them to bring support people, better advocate for their childrens needs, and effectively participate in safety and risk decision making. Create a brochure explaining meeting goals and process and use it to have an in-depth discussion with parents before a meeting. Stanislaus County: The worker found the current TDM brochure to be very helpful as it includes all the info for the family. He shared the information about the purpose of the TDM and support persons to bring in advance. The family was therefore quite prepared. The parents brought many support persons, including relative caregivers that they would want to take placement of the baby. They were able to be screened immediately and the baby went directly into relative care. It was more helpful to have the indepth discussion with the family. They were very prepared and the childs initial placement in care was with a relative. If you have a neutral meeting facilitator, it may be more effective for this person to meet with the family ahead of time rather than the assessment or investigation worker. Think about the language you are using, ensuring that it is strengths-based and free of child welfare jargon. Catawba County, NC Pomona, CA Stanislaus County, CA
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Third-ParTY SupErVisEd VisiTs Overview The agency engages substitute care providers in supervising visits between children and birth parents. Frequent visitation contributes to child well-being and permanency, but supervised office visits can be awkward and too infrequent for families. Engaging foster parents in the visitation process can allow for more frequent visits in a home setting and decrease child and birth parent anxiety about foster care. Talk to an experienced foster care provider about their willingness to facilitate visits. Fresno built permanency teams around families that included parents, foster care providers, youth, and other service providers all focused on the goal of permanency for the children. Third-party supervised visits were one aspect of the permanency teaming. Engaging foster parents and birth parents in the visitation process broke down barriers between families, allowed for increased visitation, and helped children transition between the two families. Birth parents found an additional source of support in foster care providers, and this open communication supported increased child safety in the placement and during future unsupervised visits. Both foster parents and birth parents may have misgivings about engaging with each other. Individual preparation with both parties prior to visitation is critical for successful visits. National Resource Center for Permanency and Family Connections: Birth and Foster Family Partnerships at http://www. hunter.cuny.edu/socwork/nrcfcpp/fewpt/partnerships.htm Fresno Permanency Team Flowchart Originally Tried Fresno County, CA
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Family and Youth Engagement This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
ParEnT ParTnEr PROGRAM Overview Parent partner programs can help parents navigate the child welfare system. These are usually volunteer parents who have successfully gone through the child protection system. Fresno County, CA, began conducting joint assessments with a worker and a parent partner, and San Francisco used parent partners to prepare parents for Team Decision Making meetings. Buncombe County, NCs birth parent team member created an advice sheet for parents just starting to deal with the child welfare system. The child welfare system and its demands can be overwhelming for parents. They may be more willing to engage at first with a peer than a professional, and it is helpful to recognize that others have been successful in similar circumstances. If your agency currently has a parent partner program, think about the different ways these volunteers can help families attending meetings, supervising visits, being available for family consultation, or participating in assessments. If you do not have a program in place, talk to management about starting one. Start by speaking with successful parents to learn what they would have found helpful in working with your agency. Fresno County: It was more powerful than we thought. The birth parent recognized that a parent partner had been through similar circumstances and had received help. This made her more willing to participate in services. An inadvertent lesson was the parent partners feedback of what it felt like for her to participate in going out on a referral with a worker and how much support she will need as she continues in this work with our agency. Make sure parent volunteers are well-trained, especially when engaging in assessment and other decision-making activities with agency staff. Buncombe County Parent Advice Buncombe County, NC Fresno County, CA San Francisco, CA
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Advice Sheet Buncombe County, NC (created by Buncombes BSC team birth parent representative) Advice from a parents perspective: 1. Dont freak out or panic. 2. Remember that social workers are people and that they are there to do their job and to help you in any way possible that they can. 3. No question is stupid. Ask any and all questions you might have. 4. Keep the social workers phone number and their supervisors phone number at all times if you need to know something or give them any information they might need or if you might have a need they can assist you with. 5. Be honest, keep an open mind, and be open with your social worker about what is going on, if anything. 6. You know your family better than anyone. Let your social workers know your needs. There are a lot of resources that you might not be aware of, and they can let you know about them and may even refer you.
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EarlY FamilY MEETinGs Overview Hold Child and Family Team meetings or Family Group Conferences early in the case to engage families in safety and risk decision making from the beginning of their involvement with the agency. Involving families in decision making and safety planning from the outset of a case can lead to more effective case planning, improved relationships between families and workers, and decreased out-of-home placements. Hold a Child and Family Team meeting within two weeks of case initiation. We expected that the meetings would be successful in helping to bring key players to the table and to begin a dialogue on how to resolve the issues that brought us into the families lives. Several families were able to develop their own safety plans in preparing for the meeting. Overall, the CFTs early in the investigative process have been helpful. Families and staff have benefited from these early CFTs. Scheduling meetings with all family members and other stakeholders can be difficultchild welfare staff should be purposeful about scheduling meetings at times that work for family members. You may want to outline criteria to exclude or include cases for this service. Cases that may benefit from this include those with lots of services and/or family support already in placean early meeting will allow all parties to effectively communicate about family needs and strengths. Catawba County, NC
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RESPONDING TO RACE, ETHNICITY, AND CULTURE This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
CulTural BrokErs/ADVOCATES Overview Cultural broker programs help parents navigate the child welfare system and improve the cultural responsiveness of the agency. Cultural brokers are usually volunteers from the community. The volunteers can be used in a variety of ways throughout the process, such as attending Team Decision Making meetings with families. Using cultural brokers of the same cultural background can help engage families, break down barriers, and provide more culturally appropriate services to meet family needs. If your agency currently has a cultural broker program, think about the different ways these volunteers can help families attending meetings, supervising visits, being available for family consultation, or participating in assessments. If you do not have a program in place, talk to management about starting one. Start by speaking with community-based agencies that serve communities of color. Pomona began inviting cultural brokers to attend Team Decision Making meetings with families, emphasizing the importance of defining safety and risk for families so there is clear communication about the Departments expectations around the safety of children. At first, staff were resistant to the presence of the cultural brokers, but this led to an opportunity for increased dialogue around race and ethnicity and improved awareness of alternative options to out-of-home placements. It took a while, but speaking, listening, and having strong leadership made a difference in the process. Are there certain communities of color in your jurisdiction that are disproportionately impacted by the child welfare system? How can your agency reach out to this community? What communitybased agencies can you partner with? Fresno County, CA Pomona, CA
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Discuss RacE, EThniciTY, And CulTurE WiTh familiEs Overview Caseworker initiates a discussion about race, ethnicity, and culture with families. Questions/topics may include child-rearing and discipline, cultural stories, differences and assumptions, and cultural needs and services. These conversations can be challenging, but it is important for families to have the opportunity to discuss their culture and background. When a worker is of a different culture from a family, acknowledge this openly as a way to begin the conversation. Issues of race, ethnicity, and culture may be impacting the case in ways that workers do not realize until they ask and seek to understand. Use a script to start the conversation with one family during an assessment. See how it goes and think about whether you would change any of these questions for the next family you talk to. Buncombe County: Families began sharing enriching, enlightening, and often humorous responses. When I engage with families, I can feel barriers melting and doors for communication opening, and observe that families are empowered by the fact that I care enough to ask and truly want to understand them better. Make sure workers and families are using the same definitions of race, ethnicity, and culture. Buncombes Cultural Ask Script Buncombe County, NC Carver County, MN Indiana Pomona, CA
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Buncombe County, NC Cultural/Ethnic/Racial Diversity Social Worker Client Narrative In engaging with clientele of different cultural/ethnic/racial diversity, social worker will engage in the following conversations during initiation CPS assessments and investigations: 1) Inquire about and acknowledge any cultural/ethnic/racial differences and if applicable, ask the family members if they are comfortable with Social Worker managing their case if there is a difference. 2) Ask the family if there is anything about their cultural/ethnic/racial background that the family feels SW needs to know. 3) Ask the family if there is anything in general that they would like to know about SWs culture to better understand SWs viewpoint. 4) Advise the family that SW does not want to take for granted that SW understands the family if they are of different backgrounds. 5) Share with all families that SW/agency is trying to better acknowledge and understand cultural/ethnic/racial differences as a whole.
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IncorporaTinG TradiTional Tribal ValuEs Overview Peacemaker uses traditional Navajo Fundamental Law to resolve conflicts, rather than turning to the Western court system on the reservation. The Shiprock region of the Navajo Nation is currently working to incorporate Peacemaking as an alternative response to lowering the risk of families being referred to child protective services. Traditional practices can be used to reduce the number of children removed from the care of their families and facilitate problem solving and healing within the family Use your tribes traditional conflict resolution process to engage a family referred for child maltreatment in a problem-solving process to avoid removing the child from the family. Staff learned that the three programs (Judicial, DSS, DBHS) can come together to collaborate to help a family. Staff were gratified to see the traditional practice work in the child welfare setting. Staff also realized that fundamental law and child protection law sometimes conflict, as child protection is too adversarial. Use of traditional tribal practices within the context of child protection requires careful consideration of the requirements of each. Navajo Nation, Shiprock
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Ask FaMiliEs How ThEY CulTurallY IdEnTifY Overview Ask a family directly how they racially and culturally identify. Its often easy to make assumptions about a familys background based on appearance, language, neighborhood, or the original abuse/neglect referral information. However, even well-meaning assumptions can lead to inaccurate data and inappropriate services. Asking a family directly will ensure that your agency has accurate ethnicity data for the families they serve and will help workers and families plan for culturally appropriate services. Accurate data will help your agency better analyze the impacts of disproportionality and disparities for families of color. When conducting an assessment or investigation, ask the family how they would like to identify rather than filling this out back in the office. Before implementing this practice, the Larimer County team had such a large population classified as unable to determine that it was impossible for them to accurately analyze child welfare data by race and ethnicity. Asking families to identify allowed workers to collect accurate data and be more conscious of how race and culture might impact their cases. Make sure workers and families are using the same race/ethnicity definitions as the assessment tool and/or data system. Larimer County, CO Olmsted County, MN Texas
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SAFETY AND RISK DECISIONS AND TOOLS This practice idea is a result of the work by teams in the BSC on Safety and Risk Assessments. These are practice ideas that you can start doing today that may improve your work with families in conducting effective safety and risk assessments.
CommuNICATING SafETY Vs. Risk Overview Supervisors review safety decisions with social workers in the field to ensure that decisions about in-home service provision, removal, and reunification are focused on the immediate safety of the child. The supervisor will be able to give clearer direction because information will be more targeted in reference to immediate safety factors. One social worker calls his or her supervisor immediately upon completing the assessment and discusses the following questions: 1. Are safety threats (serious harm) present? 2. Do adult protective capacities mitigate or aggravate? 3. Does any child require immediate protection? Social workers knew how to better identify safety vs. risk and supervisors were better able to assess safety from case initiation.
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In some case initiations, just the three safety questions could be answered and communicated when the social worker calls the supervisor from the field, saving time. In other cases, the nature of the report and initiation, for example with a serious injury/ near-fatality, the three safety questions may have to be expanded upon. Buncombe County Safety, Risk and Protective Factors in Case Decision-Making Buncombe County, NC
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Safety, Risk, and Protective Factors in Case Decision Making Buncombe County DSS child welfare professionals are required to make many critical decisions regarding the safety of children. Although these decisions must be made on a case-by-case basis, it is important that the agency have a consistent analytical approach to its decision-making process. The following principles are intended to provide general guidance to that process while recognizing that professional judgment must be applied in individual situations. Background Child welfare services are designed to protect abused and neglected children from further harm and to support and improve parental/caregiver abilities in order to assure a safe and nurturing home for each child. Generally, such services are preventive, rehabilitative, and non-punitive with efforts directed toward identifying and remedying the causes of the maltreating behavior. The foundational philosophy of child welfare services is family-centered practice. The underlying beliefs of a family-centered approach are as follows: Safety of the child is the first concern. Children have the right to their family. The family is the fundamental resource for the nurturing of children. Parents should be supported in their efforts to care for their children. Families are diverse and have the right to be respected for their special cultural, racial, ethnic, and religious traditions; children can flourish in different types of families. A crisis is an opportunity for change. Inappropriate intervention can do harm. Families who seem hopeless can grow and change. Family members are our colleagues. It is our job to instill hope. Critical Factors In family-centered practice, child welfare social workers employ the least intrusive approach to safety intervention and remain involved with the family only for as long as the childs safety is threatened. In making critical case decisions, the CPS social worker must separately identify and balance risk factors, safety factors, and protective factors. The balance should be assessed based on the number, degree, and interaction of these factors. Risk, safety, and protective factors must be assessed throughout the life of a case. The following definitions do not replace child welfare policies and laws; they are used to define and distinguish key terms and concepts used in critical decision making. They are used to determine the duration of foster care involvement. They are also used to answer the four questions related to Child Protection Services case decisions: Has the maltreatment occurred with frequency and/or is the maltreatment severe? Are there current safety issues? Would the child be unsafe in the home where the abuse, neglect, or dependency occurred? Is the child at risk of future harm? Is the child in need of protection?
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Risk is the possibility of future harm. Harm exists on a continuum from mild to serious. Risk factors are behaviors, motives, perceptions, beliefs, and conditions within a caregiver, the family as a whole, and/or the familys environment that create danger to the child in the foreseeable future. There must be a direct cause or association between the behavior or condition and the possible, harmful consequences to the child. Risk is the possibility of danger in the near, foreseeable future. All families have some level of risk. A conclusion about risk must assess the likelihood of maltreatment and has a timeframe in the foreseeable future and consequences that may be mild or serious to a child. Safety is the reality that a child has received serious injury that appears to be inflicted by a parent or caretaker or is in immediate or immediate near-term danger of serious harm. Safety factors are time-sensitive conditions that are happening now, have just happened, or could happen in the immediate near-term. There must be a direct cause or association between the behavior or condition and an actual or threatened, harmful consequence. Safety is the danger of serious harm in the here and now and must consider child vulnerabilities, including age, physical ability, cognitive ability, developmental status, emotional security, and family loyalty. The key principle in safety decision-making is that conclusions must be supported by sufficient information. A conclusion about safety must consider a timeframe in the immediate near-term or that has already occurred and consequences that are serious to a child. Serious injury is defined in North Carolina case law in the context of our child abuse statutes as a non-accidental injury resulting in the need for treatment by a medical professional. Examples include broken or fractured bones or burns that are not caused by an accident. It also includes an injury that creates a substantial risk of death, or that causes serious permanent disfigurement, coma, a permanent or protracted condition that causes pain, loss or impairment of the function of any bodily member or organ, or that results in prolonged hospitalization (G.S. 14-318.4). Actions that result in emotional abuse of the minor child may be considered a serious injury. Serious injury also includes a combination of maltreatment that may not cause actual broken or fractured bones or create a substantial risk of death but that are so egregious that no child should have to endure (e.g., choking, hitting with a fist or object, pulling out hair). Protective factors are conditions in families and communities that, when present, increase the health and well-being of children and families. They are attributes that serve as buffers, helping parents who might otherwise be at risk of abusing their children to find resources, supports, or coping strategies that allow them to parent effectively, even under stress. Protective factors may have racial, ethnic, religious, or cultural influences. All families have protective capacities. All adults in a home must be assessed for protective capacity. Guidelines for Critical Decisions Critical case decisions regarding the nature and duration of child welfare involvement with a family are based on a thorough assessment of risk, safety, and protective factors within the childs family or alternative living arrangement. These decisions must be made on a case-by-case basis and should involve consultation with Child and Family Team members and other professionals whenever possible. Child welfare social workers must follow state policy guidelines regarding two-level decision making.
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Continued child welfare involvement is indicated when: There are current, documented safety factors that result in immediate danger of serious injury. There are current, documented risk factors that are likely to result in serious injury for a young or vulnerable child in the foreseeable future and the familys protective capacities are insufficient to prevent such effects. Risk factors associated with parental substance abuse have reached such a level that they result in the failure of the parent/caregiver to maintain necessary and commonsense protective boundaries in the home environment, including selling or distributing illegal substances in the home or in the presence of the child, permitting child access to weapons in the home, admitting strangers into the home to use illegal substances, obtaining illegal substances, which becomes the primary concern to the parent or caregiver, and the child expressing fear of parents and/or home environment due to substance abuse. Continued child welfare involvement is not indicated when: There are no immediate safety factors and protective capacities are sufficient to provide protection. Risk factors can be managed with the familys commitment to a plan to assure safety through the foreseeable future. In the absence of safety factors, a non-custodial petition may be appropriate; however, a petition for DSS custody is not. Which Protective Factors Are Most Important? All parents have inner strengths or resources that can serve as a foundation for building their resilience. These may include faith, flexibility, humor, communication skills, problem-solving skills, mutually supportive caring relationships, or the ability to identify and access outside resources and services when needed. All of these strengthen the capacity to parent effectively, and they can be nurtured and developed through concrete skill-building activities or through supportive interactions with others. Research has shown that the following protective factors are linked to a lower incidence of child abuse and neglect: Nurturing and Attachment | A childs early experience of being nurtured and developing a bond with a caring adult affects all aspects of behavior and development. When parents and children have strong, warm feelings for one another, children develop trust that their parents will provide what they need to thrive, including love, acceptance, positive guidance, and protection. The parent having a motivation to protect is also critical. Knowledge of Parenting and of Child and Youth Development | Discipline is both more effective and more nurturing when parents know how to set and enforce limits and encourage appropriate behaviors based on the childs age and level of development. Parents who understand how children grow and develop can provide an environment where children can live up to their potential. Child abuse and neglect are often associated with a lack of understanding of basic child development or an inability to put that knowledge into action. Timely mentoring, coaching, advice, and practice may be more useful to parents than information alone.
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Parental Resilience | Resilience is the ability to handle everyday stressors and recover from occasional crises. Parents who are emotionally resilient have a positive attitude, creatively solve problems, effectively address challenges, and are less likely to direct anger and frustration at their children. In addition, these parents are aware of their own challengesfor example, those arising from inappropriate parenting they received as childrenand accept help and/or counseling when needed. Social Connections | Evidence links social isolation and perceived lack of support to child maltreatment. Trusted and caring family and friends provide emotional support to parents by offering encouragement and assistance in facing the daily challenges of raising a family. Supportive adults in the family and the community can model alternative parenting styles and can serve as resources for parents when they need help. Concrete Support for Parents | Many factors beyond the parent-child relationship affect a familys ability to care for their children. Parents need basic resources such as food, clothing, housing, transportation, and access to essential services that address family-specific needs (such as child care and healthcare) to ensure the health and well-being of their children. Some families may also need support connecting to social services such as alcohol and drug treatment, domestic violence counseling, or public benefits. Providing or connecting families to the concrete support that families need is critical. These combined efforts help families cope with stress and prevent situations where maltreatment could occur.
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ComplETinG AssEssmEnT TOOLS WiTh ThE FamilY Overview Tools used for assessing safety and risk and/or written safety plans are completed by the caseworker and family together. A copy of the completed tool may be left with the family, or shared with extended family, meeting facilitator, or community partner at a family team meeting. Families will better understand the risk and safety concerns of the agency. Their input may help to explain or mitigate risk factors. Families will be better prepared to engage in safety planning when concerns are clear to them. Take your safety assessment form with you to your initial meeting with the family and complete it together. Complete a safety plan with the family; use carbon paper and leave the copy with the family to post on their refrigerator. Catawba County: Overall workers found this to be helpful in getting to know the family, engage the family, accurately answer questions, and keep everyone on the same page. Families felt listened to, heard, and they began to identify their own issues. Also, questions were immediately addressed and confusion cleared up.Working on the forms together also led to good discussions with the families that may not otherwise occur. All workers involved reported that they would try to complete assessments with families in each case. Wyoming: Families understand risk issues better and the process is much more transparent. The issues are more concrete for families. Things to Think about Make sure the language is family-friendly and free of jargon. Consider making changes to forms based on family feedback. Translate tools into other languages spoken by families in your area. Catawba County, NC Oklahoma Olmsted County, MN Wyoming
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DEfininG SafETY and risk Overview Agency staff, families, community partners, and other systems all have clear and consistent definitions of what constitutes safety and risk. Other terms, such as protective capacity, purposeful visitation, and culture may also be defined. The terms risk and safety are used often in the child welfare field, but many teams in this BSC realized that these terms were not consistently defined for staff, families, and community partners. When all parties have shared definitions and understandings of terms, they can more easily communicate concerns, challenges, potential solutions, and successes. Having a common understanding of safety and risk between the agency and the community will result in shared responsibility for supporting families and increased collaboration around minimizing risks for families while increasing child safety. Engage one community partner in a discussion about the agencys definitions of safety and risk. Post definitions on the wall during family team meetings. Pomona: Our community partners have now seriously begun to understand our internal perspective relative to safety, risk, and culture. They have helped us to establish a common language that describes what we do as an agency so that children and families also understand our involvement in their lives. Are your definitions clear and understandable to everyone? Try testing them with some parents and youth. Ask for their input into how to make the definitions more user-friendly. Initial conversations with partners may be uncomfortable and/or negative based on historical relationships. Communication issues will need to be addressed at multiple levels of agencies and community partners, not only at the leadership level. Pomona Reminder Card Pasadena posters Originally Tried Pasadena, CA Pomona, CA Stanislaus County, CA
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CSW Safety & Risk Reminder Card
TDM Meeting Preparation In the TDM Meeting CSWs should be able to: Explain why the family is at the TDM meeting; Describe the safety and risks issues identified through the SDM assessments; Describe the familys behaviors or conditions that must change for the children to be safe in the home; Discuss any safety plan that is in place; and Describe the protective capacities and strengths of the family. In the TDM everyone has the right To be treated with respect To be heard To express opinions To be part of the decision making To ask questions
SDM Safety Factors 1. Physical harm/threat 2. Previous maltreatment 3. Sexual abuse 4. Failure to protect 5. Questionable explanation 6. Refuses access/may flee 7. Immediate needs not met 8. Hazardous living conditions 9. Impairment by substance abuse 10. Domestic violence 11. Child is danger to self/others 12. Emotional/developmental/cognitive Impairment SDM Risk - Neglect Factors 1. 2. 3. 4. 5. 6. Current complaint is for neglect Prior investigations household has previously received CPS Number of children involved in the CA/N Incident Age of Younger child in household Primary caretaker provide physical care inconsistent with child needs 7. Primary caretaker has a past or current mental health problems 8. Primary caretaker has historic or currently alcohol or drug problems 9. Characteristics of children in the household 10. Housing SDM Risk - Abuse Factors 1. 2. 3. 4. 5. 6. 7. 8. 9. Current complaint is for abuse Number of prior abuse investigation Household has previously received CPS Prior injury to a child resulting from CA/N Primary caretakers assessment of incident Domestic Violence in the Household in the past year Primary caretaker characteristics Primary caretaker has a history of abuse or neglect as a child Secondary caretaker has historic or current alcohol or drug problem 10. Characteristics of children household
Important Definitions Safety: Deciding if a child is in danger of being hurt right now (Decision to remove). Risk: Looking at the possibility that a child may be hurt in the future (Decision to open case). Strengths: Are those positive qualities or resources present in every family. Protective Capacities: Does the parent have the ability or support system available to provide an environment that keeps children free from harm? Culture: The unique specific traditions and activities of a household or a person in a family. Cultural Sensitivity: Learning about and considering a households practices and traditions when making safety and risk assessments and developing a safety plan for the child to remain in the home.
what are protective capacities?
Inherent family capacities and resources that can be mobilized to actively contribute to the ongoing protection of children. Capabilities, motives, perceptions, beliefs, or emotions that can avoid or reduce the threat of serious harm to children.
safety
Deciding if a child is in danger of being hurt or neglected right now.
risk
Looking at the possibility that a child may be hurt or neglected in the future.
purposeful visitation
Visitation with teaching and demonstrating activities to support the reunification of parents with their child(ren).
EnGaGE OF ChildrEn in SafETY PlanninG Overview Gather information from children to create safety plans with the input of the child, include the childs perspective in court reports, and use this tool as often as needed within the case to determine the childs needs, worries, and so on. Integrating the voice of the child into the safety plan will create clearer plans that address the worries of the children and will allow the caregivers to better understand the situation from their childs perspective. Use an age-appropriate interview guide or drawing tool (see links below) to elicit a childs feelings about what makes him or her feel safe or not safe. Carver County used tools from the Signs of Safety model (link below). Children seemed more willing to engage us in the assessment process since it appears to be more like play than an interviewing process. Parents for the most part were supportive and happy that we were engaging their children instead of talking at their children. Children seemed like they felt listened to. Plans included things that made a child feel safer, which may have included a safety object that the child chose for the safety network, or people that the child felt safer with. It has also been useful when we have adversarial roles with other professionals such as a guardian or court process because social workers, with the childs permission, can share their perspective with the judge, or guardian, etc., without being called upon to testify. The power of a childs words or drawings is much stronger than anything a social worker could say. Choose the tool and interviewing technique appropriate to the age and developmental level of the child. www.signsofsafety.net Carver County, MN
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EnhancEd Risk AssEssmEnT Tool Overview A risk assessment tool was revised by adding new questions to gather information that is relevant to a specific population served by the agency. Two jurisdictions tried this change to elicit information that could be relevant to safety assessments for children in military families. Safety and risk assessment tools developed to determine issues commonly seen in the general population may not include questions that provide valuable information regarding specific groups, such as military families dealing with multiple deployments or returning soldiers with post-traumatic stress syndrome. Use the Texas Enhanced Risk Assessment Tool to elicit information specific to military families. Develop a question you think is relevant to a population in your area, and test it on your next assessment visit. We began with one worker and five questions and as a result of all the hard work and constant communication, we have expanded our Advanced Risk Assessment to all investigators within our region.all our workers have a better understanding of the military culture and can navigate both systems with ease and confidence. Know why you are asking each question. Do you believe the answer may impact the safety of children? Test each question. What do the answers tell you? Do they lead to another question? Texas Enhanced Risk Assessment Tool Texas
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Texas Enhanced Risk Assessment Is any caregiver currently deployed? q YES q NO
If yes, when did the caregiver deploy? q 1-3 Months q 9-12 Months q 4-6 Months q Over 12 Months q 7-9 Months
Has any caregiver returned from deployment recently? q YES q NO
If yes, when did the caregiver return? q 1-3 Months q 9-12 Month q 4-6 Months q Over 12 Months q 7-9 Months
Has any caregiver been diagnosed with PTSD or is any caregiver suspected of having PTSD? Diagnosed Suspected q YES q YES q NO q NO
Has any caregiver been subject to adverse action by his unit to include negative counseling statements? q YES q NO
What is the soldiers rank? q E1-E4 q E5-E6 q O3-O4 q E7-E8 q O5-O6 q E9 q O7-UP q O1-O2
How many army installations have you and your family been stationed at? q 0 q 1 q 2 q 3 q 4 and over
Do you own any weapons? q YES q NO
Where are they stored and are they registered?
150
FamilY STrEnGThs QuEsTions AT PoinT Of REfErral Overview Intake workers will ask questions to determine family strengths, resources, and support. By including information on family strengths and protective capacities, the intake specialist is able to gather as much information as possible. Identification of strengths, resources, and support available to the family will help with safety planning and creation of appropriate safety networks. Add questions to your intake protocol that elicit information about the familys strengths and resources, and have one intake worker test them. Do the questions gather useful information? Do you need more or different questions? We learned that we shouldnt just rely on the story that the reporting party gives us. Often times they have information about the child and family that they believe is not relevant and in reality it is and helps to determine the safety of a child. Reporting parties can have general concerns about the well-being of a child but when you look at the whole situation, it may not be as serious as it appears. Intake workers who are trained social workers may be better able to ask appropriate follow-up questions than hotline staff without casework experience. Larimer County form with questions Larimer County, CO
Why Try This?
How Can I Try This?
Success in the BSC
151
Larimer County, CO General questions to be asked on all referrals What: Nature of the abuse or neglectful environment. Where is the child now? Where is the alleged perpetrator now? When were the children last seen and by whom? How long has this been occurring? Have things stayed about the same, become worse, or improved? What school does the child attend and how long is he or she there? Is the child reporting how often this occurs? Are there any weapons in the home or is there drug use by family members? Who else lives in the home? Questions specific to referral type Neglect What specifically did the reporter see? Description of environment and who saw it? When did they see it? Age of children and what they have been exposed to? Regarding the appearance of the child, what did the reporter see (clothing not appropriate for season, in poor condition, etc.?) Emotional Abuse What is being said to the child or what did the child witness? When, where, and how often does this occur? DomesticViolence Where were the children? Were the police called? Who called 911 and at what time? Were any charges filed or was either parent incarcerated? Did child(ren) make any statements about how they feel regarding what occurred? Lack of Supervision How often and what time of day does it occur? Do they know where the parent goes at these times?
152
Physical Abuse Did the reporter see an injury? What did it look like? When/where did it occur and by whom? Have any siblings ever suffered similar abuse? Drug Allegation How do you know the parent is using drugs? Drug-Exposed Child Is mother still at the hospital? Who else is at the hospital? Has mecstat been ordered? Types and level of drugs present? Does mom have a place to go? Do they have a car seat and other supplies? Sexual Abuse What, when, who, and how often? Did anyone else witness the incident? If perpetrator is over age 10, has law enforcement been notified? Is child reporting that he or she has been inappropriately touched before? What is the relationship of the perpetrator to the child? Family Coping and Community Support How long has the family lived in the community? How long at current address? Does the family have a telephone, transportation, etc? Does the family call on others to help solve problems? Whom do they call upon? How would you describe the child (happy, sad, worried, tired, fun-loving?) Ability to cope: developmental delays or physical handicap? How does the child do in school and does he or she express any fear/apprehension of going home? Does the child have friends? Has he or she had any involvement with the law/courts? Any previous removals? What does the parent say about the child? how does he or she describe the child? Are the parents concerned about these problems? How did they react to you expressing concern? What would you say is good about moms/dads parenting? What would the child say about the same? Are there times when its not like this and can you pinpoint anything different about those times? Are you familiar with any of the extended family? Who are they and how is their relationship with the family? What do they say?
153
It sounds like this has happened before. What have you seen the family do to sort this out? You mentioned that it is not always like this. Can you tell me what is happening when the situation is okay? What is different about those times? Are there times when the mother is attentive rather than neglectful? Can you tell me more about those times? What did the parent and child do instead? What do you think contributed to the parents responding differently? How do family members usually solve this problem? What have you seen them doing? Are there aspects of your relationship with the family that, in conjunction with our intervention, might help to influence them for the better? I hear you saying that things are not right with this family. To give me a different view of the situation, can you tell me how you will know when the problem is solved? Intervention Have you taken any other action in addressing this problem, other than make this call? Have you talked about these concerns with anyone else who knows the family? Did you tell the parents youd be calling? How did they react? If this has happened before, how has the family addressed the situation? According to what you know, how did the normal treating parent react to what occurred? Based on what you know, who is in charge of the family? Solutions What do you think is the cause of the problem? What convinced you to make this call? What would it take to make the child safer? How will you know when this problem has been solved? What else happened? Is there anything else you can think of that you would like to add to this report?
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ImmEdiaTE And WriTTEn SafETY Plan Overview Develop a safety plan with the family at the initial contact; provide written copies to the family, the supervisor, and the case file. Immediate and written safety plans developed with families ensure that everyone involved has the same expectations for child safety. When supervisors maintain a copy, workers are more likely to complete the written plan on every case. When a copy resides in the case file, assessment and ongoing workers have a clear picture of the original concerns. Developing an immediate safety plan with families may also decrease out-of-home placements. Create a safety plan with the family; write the plan out in language everyone understands and agrees on; leave a copy of the plan with the family. Carver County: Judges love the safety plans and have asked us to complete them on many of their cases that are court-involved for other issues that may not even be [child protection] related. Social workers have reported that they can leave a familys home not stressed about the risk to a child after a thorough safety plan has been made. In addition, they report and the data show that adequate safety planning reduces the chances of a child needing to be placed out of their home. Schools, guardian ad litems, and families report that children talk about their safety plans openly and confidently. Law enforcement has been in support of safety planning and has participated in our meetings. They report that it decreases their likelihood of placing a child out of the home on a 72-hour hold. Is your safety plan easy for the family to understand? Do you need to revise the form or the language to make it more accessible? Carver County, MN Wyoming
Why Try This?
How Can I Try This?
Success in the BSC
Originally Tried
155
INTERVIEWING CollaTEral ConTacTs Overview Access information regarding family history, safety, and risk of harm from collateral contacts that have direct information regarding the reported concern. Caseworkers will be able to make safety decisions more effectively by accessing the right information from collateral contacts. Ask the family what medical, educational, and other individuals/ systems they have had contact with over the past year. Contact those parties and ask a short list of screening questions to determine whether they might have significant information regarding the childs safety or risk of harm. Caseworker contacted medical staff who examined the child, teachers and family members who have had significant exposure to the family and children. The information that was gathered was detailed and helped the caseworker understand the history of the family and a collective picture of the family, outside of the specific incident that was reported. The level of safety concerns became more evident the more contacts were utilized as well as making sure they address the right questions. Who besides the family might have knowledge of important collateral contacts? This might include the child, extended family, and the reporter. Utah
Why Try This?
How Can I Try This?
Success in the BSC
Originally Tried
156
recognition
About the Report Casey Family Programs engaged the American Humane Association to facilitate the Breakthrough Series Collaborative and chronicle lessons learned from the BSC. Casey Family Programs wishes to thank the American Humane Association, and their staff who generously shared their time and reflections for this report. Our deepest thanks to the 21 participating teams without whom this BSC would not have taken place.
206.282.7300 www.casey.org
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breakthrough series collaborative

Safety and Risk Assessments

series number: 006

breakthrough series collaborative

Safety and Risk Assessments

Appendix J Appendix K Appendix L Appendix M

BSC Project Background

Methodology Concept and Structure

Core Issues Impacting This BSC

Report Information Sources

Practices AND Strategies

Safety and Risk Decisions and Tools

Defining Safety and Risk Supervisor Safety and Risk Training

Pasadena, CA Pomona, CA Stanislaus County, CA Buncombe County, NC

Communicating Safety vs. Risk

Enhanced Risk Assessment Tool Hard Copy of Assessment Tool

Texas Wyoming Larimer County, CO Indiana Utah

Interviewing Collateral Contacts

Immediate and Written Safety Plan Danger Statements in Safety Planning

Carver County, MN Wyoming Carver County, MN

Some specific practice improvements in this area included:

Catawba County, NC Wyoming Indiana Oklahoma Carver County, MN

Communicating Safety vs. Risk Supervisor Safety and Risk Training

Buncombe County, NC Stanislaus County, CA

Race, Ethnicity, and Culture

Discuss Race, Ethnicity, and Culture with Families

Incorporating Traditional Tribal Values Papoose Bag Education

Cultural Brokers/Advocates Parent Mentors for Hispanic/Latino Families

Family and Youth Engagement

Some specific practice improvements in this area included:

Call Before You Knock

Early Family Meetings

Early Transparencies with Families

Stanislaus County, CA Pomona, CA Larimer County, CO

Utah Pomona, CA Pasadena, CA Philadelphia, PA Pomona, CA Texas

Pomona, CA Stanislaus County, CA Chippewa Cree Tribe Fresno County, CA

APPLYING THE METHODOLOGY

Successful Application of the Methodology

Call families before initial visits

Include parents in safety planning meetings

Develop peer mentor programs for parents

Challenges in Applying the Methodology

S (youth), J (worker), and a family

PDSA Title (cont)

Youth Input during Assessment (cont)

Success and Challenges in the Tribal Context

Using the Methodology beyond This BSC

ORGANIZATIONAL CULTURE CHANGE

The Culture of Child Welfare Organizations

Schein, E. H. (1990). Organizational culture. American Psychologist, 45(2), 109-119.

Supporting Organizational Culture Change through the BSC

Comments and Questions

Community partners in the TDM collaborative process

Sample Monthly Measures Guide for Extranet Data Entry

African American Children Re-Referrals

Re-Referrals on Open Cases

This number should be the same as Cells K and X.

White Children Re-Referrals on Open Cases

This number should be the same as Cells V and BB.

This number should be the same as Cells K and Comments X.

This number should be the same as Cells V and BB.

This number should be the same as Cells K and X.