Comm 166 | deewilsoncon

In-Home Safety Planning

(Originally published November 2023)

By Dee Wilson and Toni Sebastian

Introduction:

This Sounding Board is a revised updated version of a commentary disseminated in 2015. Most of this commentary remains as relevant as it was in 2015, though some safety threats have greatly increased during recent years, e.g., the danger of drug overdoses, especially of fentanyl by young children. However, the legal framework and social milieu of child welfare decision making has changed in Washington State and nationally. Far fewer children are being placed out-of-home, due in part to persistent attacks on foster care which have convinced many decision makers, including judges, that placement in foster care is often more injurious to a maltreated child than remaining in the parents’ home. One might assume that the increased resistance to foster placement would have been accompanied by a large investment in resources for in-home safety plans and an intense interest in the outcomes of these plans but, surprisingly, this is not the case.

The historical background

Interested, but uninvolved, observers of U.S. child welfare systems might assume that after 50 years of focus on protecting children from child abuse and neglect these systems have developed an impressive body of research, practice wisdom, and resources around in-home safety planning. Unfortunately, they would be surprised to learn that in-home safety planning is arguably the weakest, least developed part of child protection programs and practices in most states and large counties.

Modern CPS systems were developed in the 1960s and 70s in response to the medical “discovery” (or, more accurately, the media discovery) of battered child syndrome, i.e., severely abused babies and other young children with multiple fractures in various stages of healing and other serious injuries such as detached retinas, burns, and various internal injuries. CPS programs and policies were developed to identify severely physically abused and, subsequently, sexually abused children and to take legal action on their behalf to remove them from dangerous homes. Staffing of these cases by child protection teams and other formats revolved to an extraordinary degree around placement decisions, i.e., to place or not place an endangered child in foster care or in unlicensed kinship care. Policymakers, advocates, scholars and practitioners engaged in ongoing discussions - sometimes debates - to define a threshold of “imminent harm” beyond which children would be removed from the custody of caregivers and placed in foster care, usually the care of non–relatives. Absent risk of imminent harm, services would be offered to families on a voluntary basis.

The emphasis in child protection programs on determining whether children are “safe” or unsafe” is a more recent effort of experts and practitioners to find explicit thresholds related to child safety to inform both placement decisions and in-home safety planning. The federal government made a large investment (by child welfare standards) in family preservation programs in the 1990s, an investment that continues to this day despite a once rancorous scholarly debate regarding the effectiveness of family preservation services (FPS) in preventing out-of-home placements. Contracted FPS providers and programs such as Homebuilders (developed in Washington State) began to employ in-home safety plans. Safety planning gradually became a major concern of practitioners and program developers. Currently, both ACTION (formerly the National Resource Center for Child Protection) and Signs of Safety, developed in Australia and widely used in some states, are practice models oriented around safety assessment and safety planning, a focus that largely accounts for their widespread implementation.

Research and practice wisdom

There has been very little research in recent years regarding safety assessment, safety planning or in-home safety plans despite a growing discontent and skepticism among both scholars and practitioners regarding foster care and its effects on child development. This is in stark contrast to the large body of research on risk assessment and family preservation services, both of which generated large numbers of research studies for many years. As a result, there are no evidence-based models of in-home safety plans for child welfare agencies to utilize in developing initiatives to safely reduce entries-into-care. Nevertheless, there is a vast amount of experience in use of safety plans within public child welfare agencies and a rudimentary practice wisdom, much of which is embodied in widely utilized practice models.

There is some dated (but still relevant) research done by Berkeley Planning Associates in the 1970s, summarized by Cohn and Daro (1987), on treatment outcomes in child abuse and neglect. These 90 or so studies involving several thousand parents found rates of recurrence of serious child maltreatment during the implementation of treatment plans of 30% or higher, though recurrence of maltreatment was not necessarily a prognostic indicator of treatment outcomes. The inescapable conclusion that therapeutic interventions in child abuse and neglect are likely to be a rocky road with many ups and downs is as relevant today as 40 years ago. Any caseworker engaged in developing in-home safety plans needs to be aware of the risk of recurrence of maltreatment while parents are receiving services, or following reunification. Child welfare systems invested in safe reductions of entries-into-care should be investing heavily in improved and better resourced in-home safety plans.

One of the most important elements of practice wisdom developed during past decades regarding in-home safety planning is that effective safety plans require an active and fully engaged parental partner or partners. There was a time when CPS and CWS caseworkers attempted to monitor the safety of children with uncooperative parents who often found ways to resist this unwanted interference in their family’s life. The ACTION safety model and Signs of Safety are parent engagement models, one goal of which is to develop partnerships with parents. Family team meetings are utilized for this same purpose. These partnerships between and among caseworkers, parents, other helping professionals, friends, and extended family members are currently viewed as the foundation of effective in-home safety planning. If there is not a parent or caregiver actively engaged with a caseworker, other community professional or an informal social network in ensuring the safety of an at-risk child, there cannot be an effective in-home safety plan.

Unfortunately, some of the other practice guidelines promulgated by experts have proven to be more questionable. Some state child welfare systems have adopted policies which prohibit caseworkers from including parents’ promises in written safety plans. It is sensible to prohibit in-home safety plans solely dependent on a parent’s promise to refrain from physical abuse, drug abuse, domestic violence, etc. However, it is not reasonable to rule out all parental promises in safety plans. In fact, it is important for caseworkers to elicit parental agreements of various sorts (especially regarding parenting practices) and then follow up conscientiously to ascertain whether these agreements are being followed.

There are other practice guidelines widely ignored in U.S. child welfare practice:

When caseworkers develop an in-home safety plan for a child deemed to be “unsafe”, i.e., in danger, then someone responsible for child protection needs to make several home visits per week, not one visit per month, or no visits at all. I occasionally have heard Quality Assurance program managers assert that in their state system written plans in case files don’t reflect CPS actions, i.e., they are mere “window dressing” in a virtual world of child welfare documentation. One of the authors once heard a CPS caseworker in another state comment that such plans “are not worth the paper they’re printed on,” a likely understatement of the danger involved in developing phony safety plans to impress auditors.
In-home safety plans have a “half-life” of a few days or few weeks; these plans must be renewed in writing every couple of weeks (at the least) to remain viable. It is common for one or more parties to “opt out” of an agreed safety plan without informing the caseworker.
Safety plans and treatment plans are different; nevertheless, there are some safety-oriented services such as respite care, child care, network facilitators and mental health crisis intervention that can greatly strengthen in-home safety planning.

Child welfare managers and supervisors must understand that implementation of in-home safety plans, when done correctly, is time consuming for caseworkers. When caseworkers are being assigned an unreasonable number of new investigations with strict expectations regarding response times, it is unlikely that in-home safety plans will receive the attention they require. Depending on in-home safety plans in these circumstances may endanger the lives of “unsafe” children. Even when the assignment of new investigations does not exceed a reasonable standard (8-10 new investigations per month), caseworkers will usually be unable to conscientiously implement more than two or three in-home safety plans at any one time.

In-home safety plans must be developmentally appropriate

Current practice wisdom and policy guidelines that guide in-home safety planning are not sufficiently attuned to the developmental needs of infants and toddlers. Regarding safety planning, one size does not fit all ages of children and youth. In-home safety practice guidelines that ignore both differences in age and developmental needs among endangered children with open CPS cases or following reunification are poorly informed, and indicate a lack of careful thinking regarding how to protect children in troubled families.

High risk infants and other preschool children often have one or more disabilities and/or chronic illnesses, often from birth. Their parents usually have one or more chronically relapsing conditions such as substance abuse and/or chronic mental illness, sometimes combined with domestic violence. The mismatch between the needs of young children and parents’ functional impairments resulting from drug/alcohol abuse and/or mental illness increases the risk that these children will not receive reliable care of their physical and emotional needs. Infants and toddlers in these families are at highly elevated risk of serious injury or death due to unsafe sleep practices, drug overdoses, driving while intoxicated and accidents related to inadequate supervision.

Any indication of minor sentinel injuries of infants or toddlers should be viewed as an indicator of highly elevated risk of serious physical abuse. Currently, child welfare programs lack adequate safety protocols to protect children in these circumstances. Giving parents with lengthy histories of substance abuse information regarding safe sleep guidelines and observing their infant’s sleep arrangements has not been an effective safety practice. Betting a young child’s life on a drug abuser’s reliable use of a lockbox for storage of dangerous drugs is both ludicrous and reckless.

The idea that a safety monitor whom a parent trusts can assure the safety of an endangered infant or toddler is mistaken, a lesson which child welfare agencies should have learned from years of child fatality reviews. Socially isolated parents engaged in substance misuse or who are severely depressed have frequently alienated extended family members and may be exhausted by the demands of caring for a special needs child (or more than one child) without support. These parents need to be living with a responsible clean and sober adult. Safety plans which depend on safety monitors who are not in the home during evening hours or on weekends are not adequate protection in these families, even when a child and parent are in a day treatment program. When children are four years of age or older, safety plans can depend on regular attendance at therapeutic child care programs or safety monitors, rather than a live-in dependable caregiver.

This is not to say that the children of all parents with a history of substance misuse or mental illness need a safety plan; some clearly do not for various reasons. However, when a child, 0-3, is assessed as

“unsafe” due to child maltreatment that has already occurred, or because a parent appears incapable of consistent harm reduction parenting practices, in-home safety plans should always include a responsible caregiver living with the parent and child and respite care on demand.

Currently, the most promising practices for substance abusing parents of young children are found in programs that combine substance abuse treatment, housing for parents and their children, emotional support and mentoring and advocacy services. Kentucky’s START and Washington State’s Parent Child Assistance Program (PCAP) have some or all of these elements. Furthermore, these programs are staffed by professionals and paraprofessionals who are thoroughly familiar with the stages of recovery and indicators of relapse.

In the absence of these types of programs - or in addition to them - state and county child welfare systems should be developing an array of supports for at risk low-income parents and their children such as respite care, crisis nurseries, or creative use of foster families to support birth families. U.S. child welfare systems have never appeared much interested in (or even aware of) shared family care widely used in some Northern European countries in which whole families with a substance abusing or mentally ill parent are placed with a resource family. Nevertheless, programs of this type should be funded and evaluated by the federal Children’s Bureau.

States should be making large investments in residential substance abuse treatment programs which allow mothers to retain custody of young children. Currently, to our knowledge there are only two of these programs operating in Washington State, one in Spokane and another program in Everett.

Prior to about 2001-02, Washington State had a large number of therapeutic child care programs similar to Seattle’s Childhaven, but these programs for pre-school children were eliminated due to federal staffing guidelines that made them financially untenable, and by policymakers at the state level who did not understand their value. These programs should be made available to pre-school children in chronically referring families who remain in their parent’s homes and should be routinely utilized in safety plans for pre-school children.

Creative Use of Family Preservation Programs

The federal government continues to fund some of the cost of family preservation programs. These programs have a history of developing and implementing in-home safety plans; and both federal and state policies which regulate the expenditure of FPS dollars could be revised to give FPS providers an enhanced role in the implementation of safety plans for all children assessed to be “unsafe”. There is a need for private agencies which have a strong focus on developing and implementing in-home safety plans. FPS providers are a good candidate for this role, though in our experience evaluating these programs based on rates of placement prevention creates an incentive to leave children in dangerous homes when they need to be in foster care.

Finding Expertise in the Community

In most communities, there are agencies involved in substance abuse or mental health treatment, case management, or crisis intervention following DV, with staff who have extensive practical experience with safety planning. PCAP is one of these programs. Child welfare agencies should be utilizing the expertise of these programs to develop policies and programs around safety planning and safety plans. In-home safety planning needs a specialized focus for parents with substance abuse or mental health disorders, and for families with a pattern of interpersonal violence.

Finally, the lack of research in this critical area of child welfare practice needs to be filled by universities and other research entities through funding from the federal government and state governments. If policymakers want to achieve safe reductions in foster care, they must invest in research that will provide an evidence base for in-home safety planning. Practice wisdom is not sufficient. ©

References

Cohn, A. & Daro, D. (1987) “Is treatment too late: What ten years of evaluative research tells us.” Child Abuse and Neglect, 11, 433-442.

See past Sounding Board commentaries

©Dee Wilson

deewilson13@aol.com