DEE WILSON CONSULTING
In-Home Safety Planning: The Achilles Heel of Child Protection
(Originally published March 2015)
An interested but uninvolved observer of U.S. child welfare systems might assume that after 50 years of intense 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, she/he would be surprised to learn that in-home safety planning is possibly the weakest, least developed area 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 the medical evidence) 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 and severely neglected children (e.g., failure to thrive) and take legal action on their behalf to remove them from dangerous homes. In my experience, staffing of these cases involving severe maltreatment in child protection teams and other formats revolved to an extraordinary degree around placement decisions. 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, and below which services would be offered to families on a voluntary basis.
For more than 15 years in Washington State, I offered a one day or two day “Decision to Place” training oriented toward a clear articulation of this threshold. This training included a 45 minute segment on in-home safety planning, almost an afterthought to the central question of when to ask law enforcement agencies or courts to remove children from parents’ homes.
CPS systems in the late 1980s, 1990s and the early years of this century were intensely focused on developing risk assessment, and later safety assessment, tools and guidelines; and the insistence in some state and county systems on determining whether children are “Safe” or Unsafe” is a more recent chapter in the efforts of experts and practitioners to find explicit thresholds related to child safety to inform both placement decisions and in-home safety planning. At the same time, 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, or lack of effectiveness, of family preservation programs (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, and safety planning gradually became a major concern of practitioners and program developers. Currently, both ACTION (until recently the National Resource Center for Child Protection) and Signs of Safety, developed in Australia and widely used in some states, include practice models oriented around safety planning, including in-home safety planning, an area of focus that in part 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 scholarly controversies for many years. As a result, there are no evidence based models of safety planning, or in-home safety plans for child welfare agencies to reference in developing initiatives to safely reduce
entries-into-care. There is, of course, 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 ACTION’s safety model and in Signs of Safety.
However, there is some old but still relevant research done by Berkeley Planning Associates in the 1970s, and later 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 treatment 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 seems as relevant today as 40 years ago before chronically relapsing conditions such as substance abuse and mood disorders became as prevalent as they are today. Any caseworker engaged in developing in-home safety plans needs to be aware of the risk of recurrence of maltreatment during “treatment”, or following reunification. Furthermore, child welfare systems invested in safe reductions of entries-into-care should be investing heavily in improved and better resourced in-home safety plans.
In my view, the single most important element of practice wisdom learned in the past two decades regarding in-home safety planning is that effective safety plans require an active and fully engaged parental partner. There was a time before this practice wisdom developed when CPS and CWS caseworkers would attempt to “monitor” the safety of children with uncooperative parents who often found a variety of ways to resist this unwanted interference in their family’s life. ACTION’s safety model, Signs of Safety, and Solution Based casework (SBC) are parent engagement models in which social work skills are used to develop partnerships with parents. These partnerships between and among caseworkers, parents, other helping professionals and friends and extended family members are currently viewed as the foundation of effective in-home safety planning. If there is not a parent actively engaged with a caseworker, other community professionals or informal social network in ensuring the safety of her/ his children, there cannot be a dependable (“take it to the bank”) in-home safety plan.
Unfortunately, some of the other practice guidelines promulgated by experts has proven
to be far more questionable. Based on expert advice, 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, DV, etc. 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), if they are not patently ridiculous, and then follow up conscientiously to ascertain whether these agreements are being followed.
There are other practice guidelines that are 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 making 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. I once heard a CPS caseworker in another state comment that such plans “are not worth the paper they’re printed on,” which might be an understatement of the danger involved in engaging in phony safety plans.
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.
Complex plans that involved the coordinated actions of several persons are difficult to implement and hard to keep track of; for this reason, simpler plans which involve a single safety monitor, or small social network, tend to be more sustainable than more complex plans.
Safety plans and treatment plans are different; nevertheless, there are some safety oriented services such as respite care, child care, network facilitators, 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 work for caseworkers and other professionals. If caseworkers are being assigned an unreasonable number of new investigations with strict expectations regarding response times, it is highly 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 a few in-home safety plans at any one time.
Promising Practices and Next Steps
A major challenge confronting child welfare agencies in the U.S. is that such a large percentage of children at highest risk of serious harm due to child maltreatment are babies and toddlers and other pre-school children. The parents of these children are usually poor, or even destitute, and often have one or more chronically relapsing conditions (e.g., substance abuse, mood disorders) as well. In-home safety plans for very young vulnerable children need to be highly reliable to the point of fool-proof, but how can this seemingly unrealistic goal be achieved?
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 and mentoring and advocacy services. Oregon’s OnTrack, 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. These programs need to be evaluated in randomized controlled trials or in quasi-experimental research designs.
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 families and their children such as respite care on demand (as in Project Safe Families), crisis nurseries, or creative use of foster families to support birth families. U.S. child welfare systems have never seemed 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 resource families. Nevertheless, some programs of this type should be funded and evaluated by the federal Children’s Bureau. On the other hand, some states, including Washington, have made modest investments in residential substance abuse treatment programs which allow mothers to retain custody of young children. These investments should be substantially increased.
Prior to about 2001-02, Washington State had a large number of therapeutic child care programs similar to Seattle’s Childhaven, but these much needed 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-schoolchildren in chronically referring families who remain in their parent’s homes.
Screening for depression should become standard practice in all programs that serve low income persons; and evidenced based depression treatments should be widely available and easily accessible. Screening for depression continues to be low hanging fruit for prevention programs, given the availability of brief, easy to use screening instruments.
Creative Use of Family Preservation Programs
The federal government continues to allow states to support some of the costs of family preservation programs. These programs have a history of developing and implementing in- home safety plans; and both federal and state laws 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 entities involved in child protection with a strong focus on developing and implementing in-home safety plans. FPS providers are a good candidate for this role.
Finding Expertise in the Community
In most communities, there are agencies involved in substance abuse or mental health treatment or case management, or crisis intervention following DV, whose staff have had extensive practical experience with safety planning. Child welfare agencies should be utilizing the expertise of these community experts 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 family violence. There is no need for child welfare agencies to begin from scratch or to depend on general abstract guidelines that do not take account of the vulnerability of young children or the challenges posed by addiction, mental illness or family 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 governments want to see safe reductions in foster care, then they must fund the kind of research that will provide an evidence base for in-home safety planning that is useful to child welfare managers and practitioners.
Cohn, A. & Daro, D. (1987) “Is treatment too late: What ten years of evaluative research tells us.” Child Abuse and Neglect, 11, 433-442.