integrated safety-organized practice

1www.nccd-crc.org

Children’s Research CenterA nonprofit social research organization and

division of the National Council on Crime and Delinquency

www.nccdglobal.org

Integrated Safety-Organized

Practice

Module Six:Harm Statements,

Danger Statements, and Safety Goals

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Steve Edwards

Andrew Turnell

…and we hope YOU will continue to buildon these ideas and approaches.

Sonja Parker CRC StaffInsoo Kim BergSteve de Shazer

Our Thinking Draws Fromthe Legacy of Others

RobSawyer

SueLohrbach

CarverCounty

John VogelSophia Chin

Heather Meitner

NickiWeld

SusieEssex

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Safety-Organized Practice

Safety is: Actions of protection taken by the caregiver that mitigate the danger demonstrated over time.

Adapted from Boffa, J., and Podesta, H. (2004) Partnership and risk assessment in child protection practice, Protecting Children, 19(2): 36–48. Turnell, Andrew & Susie Essex Working with Denied Child Abuse, Open University Press, 2006.

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Agreements• “Try on.”• Everyone always has the right to pass. • Silence is a contribution.• We agree to share airtime and stick to time

limits.• We agree to speak personally, for ourselves as

individuals. • We agree to disagree and avoid making

assumptions or generalities. • We agree to allow others to finish speaking

before we speak and avoid interrupting and side conversations.

• We will work together to hold to these agreements and authorize the trainer to hold us to them.

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Module Subject

1 Interviewing for Safety and Danger

2 Three Questions to Organize Your Practice

3 Small Voices, Big Impact: Keeping Children at the Center of the Work

4 Solution-focused Inquiry

5 Introduction to Mapping

6 Harm Statements, Danger Statements, and Safety Goals

7 Mapping With Families

8 Safety Networks

9 Safety Planning

10 Landing Safety-Organized Practice in Everyday Work

11 Organizational Environments: Reflection, Appreciation, and Ongoing Learning

12 Summary and Looking to the Future

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Agenda

• Harm Statements• Danger Statements• Safety Goals• Use with Families• Linking SDM and Danger Statements and

Safety Goals• Let’s Practice!

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Mapping/SDM Assessments

Harm and Danger Statements

Safety Goals

Enhancing Safety Network

Safety Plan Guidelines

The Safety-Organized Practice Process

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Essential Question

What Are the

Worries?

What’s Working

Well?

What Happens

Next?

Are the children safe?

SFQ’sImpactDetailPositio

nSortSDM


nSortSDM


nSortSDM

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• What have you tried from the module last month?

• What worked well?• What were your challenges?• How did you handle those

challenges?

Checking In

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• Think of a family you or someone you know is working with now or in the recent past who has been involved with CWS between six months and ten years.

• How confident are you that you can state exactly why the family is involved with CWS?

• How confident are you that the FAMILY understands and can state exactly why the family is involved with CWS?

Let’s Get Started!

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• How confident are you that you can state EXACTLY what the family needs to do differently so you will know the children are safe?

• How confident are you that the FAMILY understands and can state what needs to happen so that everyone knows their children are safe?

Let’s Get Started #2!

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• Harm Statements: Clear and specific statements about the harm or maltreatment that has happened to the child.

• Danger Statements: Simple behavioral statements of the specific worry we have about this child now and into the future.

• Safety Goals: Clear, simple statements about what (not how) the caregiver will DO that will convince everyone the child is safe now and into the future.

These are little gems of clarity.

Definitions

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What’s It All About?

HARM STATEMENT:What already happened

DANGER STATEMENT: What we worry will happen

next

GOAL STATEMENT:What we hope happens

instead

NOW

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HARM STATEMENT:Why we GOT involved

DANGER STATEMENT: Why we need to STAY

involved

GOAL STATEMENT:What will tell us we can

STOP

NOW

What’s It All About?

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FOCUS

*Turnell, A. and Edwards S. (1999). Signs of Safety. New York: Norton

Value of Harm, Danger, and Goal Statements

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While creating harm statements, danger statements, and safety goals in the office is a great place to start, EXTRA VALUE comes when we can co-create these with families!

Moving to Best Practice

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Harm Statements

Who says (or it was

reported)

What caregiver

actions/inaction

Impact on the child

It’s essential to get agreement from the person before using his/her name in a harm statement.

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The Question That the Harm Statement Answers

“What exactly has been reported that the caregivers did to hurt the children physically, developmentally, or emotionally?”

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Clear and specific statements about the harm or maltreatment that has happened to the child.

It was reported

Caregiver actions/inacti

onsImpact on the

child

Harm Statements

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Doctor Bones reported that Adam’s dad, Matt, hit Adam several times with an open hand and a closed fist last Sunday, causing several bruises on Adam’s head and back.

It was reported

Caregiver actions/inactio

nsImpact on the

child

Harm Statement Example

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Harm Statement Tips• The harm statement needs to

include specific details: who has reported the concern (when it is possible to share this), what exactly happened, and the impact on the child. • They should be written in honest,

detailed, non-judgmental “just the facts” language.• Screener narratives could include

a provisional harm statement based on the facts marked on the SDM screening tool.

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Harm Statement Practice

It was reported


nsImpact on the

child

Wendy, age 4, runs around her apartment complex during the day while her mother, Beth, sleeps. The apartment manager recently found her playing with glass from a broken window. Wendy’s right hand was cut from the glass, requiring stitches.

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Danger Statements

Who is worried

About what potential caregiver

actions/inaction

Possible impact on the child

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The Question That the Danger Statement Answers

“What is CWS most worried will happen to the children if they are in the care of their parents and nothing else happens to mitigate the danger?”

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Simple behavioral statements of the specific worry we have about this child now and into the future.

Who is worried

Potential caregiver

actions/inactions

Potential future impact

on child

Danger Statements

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Danger Statement Example

CWS, Doctor Bones, the police, and Adam’s mom, Tonya, are worried that Adams’ dad, Matt, may hit Adam again, leaving him with bruises and even more serious injuries.

Who is worried

Potential caregiver

actions/inactions


on child

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Danger Statement Uses• Danger statements clearly identify what the professionals are

worried may happen if there are not enhanced actions of protection by the family and network.

• Sharing danger statements with the family (and within the agency!) helps create a sharpened focus on the key issues that need to be addressed so the family can make changes and demonstrate actions of protection. This can also prevent “case drift.”

Who is worriedAbout what

potential caregiver

actions/inaction

Possible impact on the child

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Danger Statement Tips• Be real. If you raise the stakes,

don’t get carried away.• They should be written in honest,

detailed, non-judgmental “just the facts” language.

• If no harm already happened, the danger is about what ALMOST happened, or is LIKELY to happen, based on caregiver actions.

• SDM safety assessment items that were marked could be resources for ideas on what we are worried about.

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Internally:

• Enhanced clarity in our own thinking as we start to think about our cases.

• Greater clarity as cases get moved from one unit to another.

• Helps facilitate discussions between supervisor and worker, manager and supervisor, perhaps even legal and clinical!

• A process, not an event, and can be refined over time.

The Value of Danger Statements

“what stands out to me about these harm and danger statements are no beating around the bush, and everything is out on the table.”

- New worker just practicing H+D statements

Danger Statements & Genograms are like vital signs at shift change in the hospital.

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Crafting the Statements

• Use the formula (But don’t get stuck in it!)

• Behavioral detail

• Family language

• Impact on child

• Make sure all concerns are listed

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Danger Statement Practice

Wendy, age 4, runs around her apartment complex during the day while her mother, Beth, sleeps. The apartment manager recently found her playing with glass from a broken window. Wendy’s right hand was cut from the glass, requiring stitches.

Who is worried

Potential caregiver

actions/inactions


on child

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Safety Goals

Who is a part of the network/pla

n

What will caregiver

DO differently

For how long?

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“What does CWS need to see the parents doing differently with their children so everyone will know the children are safe?” (not services)

The Question That the Safety Goal Answers

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Danger Stateme

nt

Safety Goal

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“What is CWS most worried will happen to

the children if they are in the care of their parents

and nothing else happens to mitigate the

danger?”

What does CWS need to see the parents doing differently with their

children so everyone will know the children are safe? (not services)

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Or think of them like book ends

Danger Statement Safety Goal

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Who is a part of the network/pl

an

What will caregiver

DO differently

For how long?

Clear, simple statements about what the caregiver will DO that will convince everyone the child is safe now and into the future.

Actions of protection taken by caregiver that mitigate the danger

Demonstrated over time

Goal Statements

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Matt will work with CWS and his safety network (family, friends, and professionals) to show everyone he will always discipline Adam in ways that do not injure him (such as using time-outs, taking away Adam’s Gameboy, and giving incentives like earning a toy). CWS will need to see this safety plan in place and working continuously for a period of six months so that everyone is confident that the safety plan will keep working once CWS withdraws.


an

What will caregiver

DO differently

For how long

Example of a Safety Goal

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How

long

Low or moderate riskStrong safety networkLong history of past protectionHistory of past successful change effortsLess vulnerable child

High or very high riskLess safety network

Less history of protection in pastMore evidence of prior change

efforts that did not lastMore vulnerable child

How Long?

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How

long

Low or moderate riskStrong safety networkLong history of past protectionHistory of past successful change effortsLess vulnerable child

High or very high riskLess safety network

Less history of protection in pastMore evidence of prior change

efforts that did not lastMore vulnerable child

SDM RISK REASSESSMENT

How Long?

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Two Kinds of Safety GoalsX will make a plan to show

everyone that Y child will be safe by doing … CWS will need to see

this plan working

continuously for nine

months …

So that we can begin to make plans for this child

to go home

So that we can close this case

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• Mistake services for safety

• Intervention drift• Lack motivation to

make hard changes• Hard to measure

progress

What happens without a well-formed safety

goal?

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Directly relate to the danger statements

Be specific and describe what we are expecting

the parents to do differently, rather than what we are expecting

to see stop

Craft them collaboratively

whenever possible

Write them in straightforward,

measurable language

Safety Goal Tips

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Dead Man’s Goals

Well-Formed Goals

Safety Goal Tip:Avoid “Dead Man’s” Goals

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Dead Man’s Goals

• Mr. Smith will not leave Billy alone again.

• Mr. Smith will not hit Billy again.

Safety Goal Tip:Avoid “Dead Man’s” Goals

Well-Formed Goals• Mr. Smith will

always make sure there is a supportive and safe adult who can look after Billy.

• Mr. Smith will always discipline Billy in ways that won’t hurt him.

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Safety Goal PracticeWendy, age 4, runs around her apartment complex during the day while her mother, Beth, sleeps. The apartment manager recently found her playing with glass from a broken window. Wendy’s right hand was cut from the glass, requiring stitches.


an

What will caregiver

DO differently

For how long

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Example Safety GoalsOngoing Safety Goal for Return Home:Beth agrees to work with her neighbor and her best friend Joy to show everyone that she can stay awake during the day and childproof her home to make it safe for Wendy when she returns home.Ongoing Safety Goal for Case Closure:Beth agrees to work with her neighbor, her landlord and her best friend Joy to show everyone that she can supervise Wendy whenever she is outside playing. This plan will be in place for at least 3 months.

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Use With Families

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With families:

• Increase family clarity and understanding about agency fears and goals

• Greater sense of family ownership and more buy-in and commitment to change

• Important even in this attempt to engage the family not to give up agency “bottom lines”

The Value of Family-Generated Danger Statements and Safety Goals

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Tips for Family Work• Explain what danger

statements and safety goals are and why they are important.

• What’s your stake in the ground, or your bottom line for safety?

• Be open to negotiating the wording—this is their family and these statements are designed to galvanize them to create more safety—but stick to your bottom lines.

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Best Practices in Creating Danger Statements and Safety Goals

1. Make sure the danger statement and safety goals have the agency’s bottom lines.

2. Try sharing them and refining them with the family (while still holding the bottom line!).

3. Best practice is using your SFQs to develop statements that have both agency bottom lines AND family buy-in.

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On a scale from 0–10, where 10 = “this really matters” or “I really agree (with the danger or goal),” and 0 = ‘You are completely off base or wrong’, where would you say this is?

0 5

10

After You Have Started, SCALE IT With the Family!

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Venues for Crafting or Sharing• At a parent’s house or in the

office

• In a TDM

• In an internal case review meeting

• Or on a case plan!

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Ideas for Using Danger Statements and Safety Goals

• Write them on the first page of the case plan.

• Write them in court reports as an opening statement.

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Questions for Families That Help Form Danger Statements

• What do you think I’m worried about?

• What do you think your child is worried about?

• What do you think my supervisor (or the judge) is worried about?

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Questions for Families That Help Form Safety Goals

• It’s a year from now, and the danger in your family is no longer there. How would you describe your family? What would you be DOING differently?

• In your children’s wildest dreams—where your family is thriving and happy—how would they describe your family? What would you all be doing differently?

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Eliciting the Child’s Voice for Danger Statements and Safety Goals• Three Houses• Safety House

• What happened?

• What was the impact?

• What needs to happen for the child to feel safe?

• In the child’s own words!

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Interim Goals/Baby StepsOn a scale from 0–10, with 0 being the danger statementoccurring and 10 being the safety goal occurring, where

are you? What actions would the parents/network need to take for this to move up one? What might we be able to do then?

Danger Statement

Safety Goal

100

Supervised visits?

Unsupervised visits?

Overnightvisits?

Parent and network actions of protection?

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Linking the SDM® System With Danger Statements and Safety Goals

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What is the core issue?

• The SDM system can help you to very quickly identify the core safety threat, or danger, to the child.

• Finding the core means sorting through the complicating factors to get to the most critical safety threats facing the child.

• Once this is done, identifying the danger statement and safety goal is much easier.

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The SDM® System Can Be a Shortcut to Constructing a Danger Statement

Facts

• What facts are present that led you to consider marking an item on the SDM safety assessment?

Definition

• Check the definition – does it meet the criteria?

DS+ SG

• Use the facts that led you to the item and its definition as a starting point for constructing your danger statement and safety goal.

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The SDM® System Can Help Construct the Danger

Statement

Facts

• Father, Jim, gets drunk to the point of passing out three nights in a row when he is the sole caregiver of 4-year-old Sam.

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Statement

Facts• Father, Jim, gets drunk to the point of passing out three nights in a row when he is the sole caregiver of 4-year-old Sam.

Definition

• The caregiver has abused legal or illegal substances or alcoholic beverages to the extent that control of his/her actions is significantly impaired. As a result, the caregiver is unable, or will likely be unable, to care for the child; has harmed the child; or is likely to harm the child.

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Statement

Facts• Father, Jim, gets drunk to the point of passing out three nights in a row when he is the sole caregiver of 4-year-old Sam.

Definition


Danger statement

• CWS is worried that Jim might get drunk again when he is the only one watching Sam, that Jim might black out; and that Sam could get scared or seriously hurt.

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Statement

Facts

• Father, Jim, gets drunk to the point of passing out three nights in a row when he is the sole caregiver of 4-year-old Sam.

Definition


Danger statement

• CWS is worried that Jim might get drunk again when he is the only one watching Sam, that Jim “might black out,” and that Sam could get scared or seriously hurt.

Safety Goal

• Jim will work with a network of family, friends, and professionals to make a plan that will show everyone there will always be a sober adult watching Sam. CWS will need to see this plan in place and working continuously for six months to know the plan will continue once CWS withdraws.

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Linking Danger and Risk

• What exactly are we worried about? (The danger statement)Dang

er

• How worried should we be? (Risk level)

Risk

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Let’s Practice!

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Kim32

?

Allegation of substance abuse: Kim passed out while shooting heroin and cooking dinner. Paul was home. Paul goes to live with his aunt Donna and her wife, Ann.

10

Donna39

Ann40

Paul

Kim and Paul Genogram

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• Kim overdosed on heroin and became unconscious while cooking dinner. Paul, age 10, was home at the time and was scared when he couldn’t wake his mom. Her landlady heard the fire alarm and had to call the police and open the door.

• Kim has an extensive history of heroin use and reports she has been struggling with addiction “for more than 15 years.” This led to one referral four years ago when Paul came to school multiple times smelling of urine and feces.

• Kim attributes this incident to a growing depression after losing her job as a saleswoman at a department store. She has been looking for work for more than 14 weeks without finding anything. Both Donna and Ann confirm this.

• Kim stopped attending NA over two years ago (“They get kind of preachy, and the meetings were not good times”).

• Kim has been diagnosed with Borderline Personality Disorder and ADD.

What Are We Worried About?

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• Kim reports that she was clean and sober for four years before this incident—a report supported by her sister Donna—during which time Paul went to school clean, on time, and with his work done.

• In her past work with the department, Kim worked with her worker and a home-based outreach team, went into drug treatment, and ensured that Paul went to school and was appropriately clothed and bathed.

• Paul was able to go into a kinship foster placement with his aunt Donna and her wife, Ann. He was able to stay in the same school system, and it is reported by the aunt and school guidance counselor that he continues to “thrive” despite these changes.

• Kim made a plan with Donna in the past that if anything were to happen to her, Paul should go to stay with Donna.

What’s Going Well?

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Make a harm statement, danger statement, and safety goal for Kim and Paul’s family

Practice!

Don’t forget to capture trauma, if present, and list it in the “impact”portion of the statement.

Kim and PaulHarm Statement Example

It was reported that Kim overdosed on heroin and became unconscious while cooking dinner. Paul, age 10, was home at the time and became scared when he couldn’t wake his mom. A landlady heard the fire alarm and had to call the police and open the door.

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Professionally generated statement:• CWS, Donna, Ann, and the treatment team at the

hospital are worried that Kim might use heroin again while she is caring for Paul, that she might not be able to watch him or take care of him, and that he could get seriously hurt without her supervision.

Family- and network-generated statement:• Kim, Donna, Ann, CWS and the people at the hospital

are worried Kim might ‘lose it,’ pick up heroin again and that Paul might get seriously hurt or even lose his mom.

Kim and Paul Danger Statement Example

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Paul is worried that mom might use drugs again and will get sick and have to go to the hospital.

Eliciting the CHILD’s Voice: Example

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Kim will work with CWS, Donna, Ann, and treatment providers to show everyone that she will always be drug-free when caring for Paul, and that if she is going to use, she will ask for help from her network to ensure a safe and sober adult is watching Paul. CWS will need to see this safety plan in place and working continuously for a period of six months to begin making plans for Paul’s return home.

Who is a part of the

network/plan

What will be done

differently

For how long does the plan need to be in

place

Kim and Paul Safety Goal Example

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In groups of three:

• One person describes a family he/she is currently working with, knows a lot about, and has at least one safety threat.

• Brief genogram, reported information, which SDM safety threats exist now, brief facts behind those threats.

• Try writing a harm statement, danger statement, and safety goal.

Practice

Who saysCaregiver

actions/inactions

Impact on the child

Who is worried


nsImpact on the

child

HARM

DANGER

Who is a part of the network/plan

What will be done differently

For how long does the plan need to be in

place

SAFETY GOAL

• What’s one thing you heard today that you value or makes sense to you?

• What are you already doing to put that into action in your work?

• What else would you like to do to “land it” even more in your work between now and next time?

In pairs:

One Last Thing: Thinking Ahead

Opportunities to Practice

ReferencesChildren’s Research Center. (2008). Structured Decision Making®: An Evidence-Based

Approach to Human Services. Retrieved from http://www.nccd-crc.org/crc/pdf/2008_sdm_book.pdf

Department of Child Protection. (2011). The Signs of Safety Child Protection Practice Framework. Department of Child Protection, Perth. Retrieved from http://www.signsofsafety.net/westernaustralia

Johnson, W. (2011). The validity and utility of the California Family Risk Assessment under practice conditions in the field: A prospective study. Child abuse & neglect, 35, 1, 18–28.

Turnell, A. & Parker, S. (2009). Introduction to the Signs of Safety. DVD and workbook. Perth, Resolutions Consultancy. Available at Signs of Safety.net

Lee, M. L., Sebold, J., & Uken, A. (2003). Solution-Focused Treatment of Domestic Violence Offenders: Accountability for Change. NY: Oxford University Press.

Child Protection Messages from Research (1995). Studies in Child Protection HMSO: London. http://www.nctsn.org/resources/topics/creating-trauma-informed-systems

Heath, Chip and Dan (2007). Made to Stick, Random House.

http://www.nccd-crc.org/crc/pdf/2008_sdm_book.pdf

http://www.signsofsafety.net/westernaustralia



http://www.nctsn.org/resources/topics/creating-trauma-informed-systems

integrated safety-organized practice

Documents

definition of safety

safety networks

safety house

safety planning

danger statements

clear safety goals

book signs of safety

harm statements