ACTION for Child Protection An Ongoing Child Protective Services Case Assessment and Case Planning Approach Based on Caregiver Protective Capacities -A Description- By Todd Holder, MSW 2006 1
Introduction If we do not define the business of Ongoing CPS then there will be plenty of people outside of us who will. Pamela Bennett National Forum on Child Welfare Workload, 2005 This paper is intended to describe for state and county child welfare directors, administrators, supervisors and worker a new, alternative intervention approach for ongoing child protective services (CPS) case practice. The primary purpose of this paper is to explain a systematic, conceptually based method for conducting ongoing CPS and achieving case outcomes employing the concept of caregiver protective capacities. Any intervention approach is specifically designed to operationalize an agency s mission in order to achieve its service objectives with an identified population. Intervention approaches are formed around specific objectives directed at desired outcomes. The approach an agency has for intervention defines case practice and decision making from case identification (i.e. receipt of a referral) to case closure in an integrated, process oriented manner. This paper describes a portion of an intervention approach by focusing on case practice and decision-making apparent during ongoing CPS. Although intake and initial assessment are not discussed in this paper, it should be understood that an effective intervention approach systematically integrates those functions with the ongoing CPS function. While intake and initial assessment will not be discussed in detail the paper does provide emphasis to the connection and interdependence between those functions and this approach to ongoing CPS. CPS has long contended with the question of what should occur with families once they are opened for ongoing services. The primary influence on defining the structure and substance of ongoing CPS has been federal law such as the Adoption Assistance and Child Welfare Act and the Adoption and Safe Families Act. As it is currently, ongoing CPS often remains imprecise; unclear; and vague because of its generality. While intake and initial assessment/investigation have received considerable definition and description, ongoing CPS remains under developed with respect to worker role, case practice and decision-making.. There often is a significant disconnect between ongoing CPS and initial assessment with respect to practice and the basis for how and why decisions are made. Rather than operating as integrated and related functions within a larger system of intervention, ongoing CPS and initial assessment frequently employ different concepts, criteria and standards for intervention. This longstanding problem of a lack of integration between initial assessment and ongoing CPS has resulted in confusion and inconsistency regarding the reason for CPS involvement with families and variation in use of concepts and criteria that guide practice and decision-making from the onset of intervention to its conclusion. Efforts to organize and structure ongoing CPS sometimes have contributed to the vagueness experienced by ongoing CPS staff regarding the purpose for ongoing CPS intervention and the role of the worker when intervening with families. This lack of definition and precision within the CPS ranks has resulted in some programs having the ongoing CPS 2
function being defined by external influences. The various perspectives existing about the purpose for ongoing CPS have served to broaden practice expectations for what ongoing CPS should entail. The apparent broadening of the scope of ongoing CPS (i.e., who CPS serves and what represents success) has increased workload management problems and reduced the clarity about the purpose and objectives for intervention. The approach to ongoing CPS intervention described in this paper promotes a system of intervention where by ongoing case practice and decision-making are well defined and built upon concepts and criteria initiated and applied during initial assessment. This approach is consistent with the developing state of the art; federal leadership and requirements; and the primary mission and mandate of CPS. In this paper the professional assumptions, principles and constructs supporting this ongoing CPS practice approach will be discussed at length as well as a thorough description of the method for completing caregiver protective capacity assessment and case planning. Basis for the Ongoing CPS Practice Approach Case practice is a method for intervening with a family using a particular mentality, knowledge and technology (i.e., interpersonal skills.) A conceptual framework for a case practice approach is formed by professional assumptions, beliefs, theories and values. This framework for intervention is based on a concept of change which provides: o The rationale for intervening with a selected population; o The purpose(s) for the ongoing CPS with the selected population; o The objectives for service delivery; and o The desired results of ongoing CPS with the selected population. The development of the service design flows out of the conceptual framework and includes structure; activities, time lines and milestones, inputs and outputs, role definitions and responsibilities; expectations regarding worker-client interaction; decision making and accountability physically represents the specified approach to case practice. Beyond the conceptual framework, what also influences the formation of this case practice approach is as follows: Federal and State Requirement for Ongoing CPS Intervention The approach for ongoing CPS is significantly shaped by federal and state regulatory requirements and the state-of-the-art for practice and decision-making. o The Adoption Assistance and Child Welfare Act (1980) provided federal requirements aimed at improving foster care services and management which 3
resulted in significant structuring of ongoing CPS (e.g., case plans; time lines; service provision.) o The past decade has experienced the influence of family centered thinking. Virtually all CPS programs nationally promote family centered practice which values a strengths orientation; solutions existing within families; a child centered family focused mentality; and a proper balancing of the authoritative role of CPS with family self determination. o The Adoption Safe Families Act explicitly required that cases plans address safety and that treatment services be directed at the negative family/ caregiver conditions that are associated with threats to child safety. ASFA also required that progress be evaluated with respect to the conditions associated with threats to child safety identified in the case plan. ASFA describes the objective of ongoing CPS to be the establishment of safe homes. o The Children and Family Services Review (CFSR) emphasized a process for case planning that promotes caregiver involvement. The CFSR also generally qualified the intended focus for case plans and treatment services. CFSR established for states an outcome measure indicating that the end result for ongoing CPS intervention should be that families have enhanced capacity to provide for their children. o ASFA and the CFSR introduced specific requirements for safety intervention throughout the life of a CPS case and established expectations for case planning and treatment that have implication for how ongoing CPS should proceed. In essence ASFA and the CFSR have prompted an important shift in thinking with respect to safety intervention as an integral part of CPS from beginning to case closure. But notably this is the first time that explicit federal direction has occurred with respect to ongoing CPS. Historically safety intervention has been viewed as front-end initial assessment responsibility. Safety intervention has also been associated mainly with managing and controlling safety threats from having an impact on a child. (The Child Abuse Prevention and Treatment Act probably did for the front end of CPS what ASFA and the CFSR has done for ongoing CPS.) ASFA and CFSR expanded the limited view that existed regarding how and when safety intervention applied in a case. No longer is safety intervention exclusively an initial assessment activity. Expectations are clear that safety intervention continues into case planning and remediation. Ongoing CPS Practice Approach within a Community Context All systems of society must operate effectively together to make it possible for children to develop adequately All systems of society must operate effectively if families are to establish and maintain a climate that supports the continuing growth and development of both children and adults. C.S. Chilman Public Social Policy and Families, 1973 4
The design of an ongoing CPS practice approach must take into account the scope of responsibility of the CPS agency within the community. The scope of responsibility specifically refers here to the client population that CPS either seeks to serve or is primarily responsible to serve. The question of who a CPS agency serves is based on the agency s interest; its capacity; and its priorities. A community s expectations for a CPS agency with respect to the scope of responsible has a lot to do with the extent to which an agency effectively communicate client related service interests, capacity, expertise and priorities. The answer to these determining factors for the scope of agency responsibility is formed around the following questions: Who is CPS mandated client? Who is CPS distinctively suited to serve? What is CPS primary function? How is priority given to who CPS has to serve and chooses to serve? Officially in every state, the primary mandate for CPS is child protection. This ongoing CPS case practice approach supports an intervention designed to assure that children are protected and safe within communities as the first priority. While is might be necessary for agency s to serve multiple client populations, the judgment regarding when and how CPS will occur with non safety related cases usually is discretionary. The expectation in this case practice approach is when agencies decide to serve risk of maltreatment or unmet need cases those are served subsequent to safety related cases. If an agency is closing cases based on resolved risk of maltreatment it follows that risk issues and well-being are attended to after safety issues have been acceptably addressed. This ongoing CPS approach does not include child well being as a central objective. This is not to suggest that agencies cannot or should serve risk cases. If the discretionary judgment is that an agency has the capacities to effectively intervene in risk cases as well as safety then consideration should be given how to respond to differing type of case situations and needs. Certainly child well being is a direct CPS responsibility for children who are placed out-of-the-home. Otherwise child well being is only an indirect CPS responsibility at most. Any emphasis given to child well being for children in their homes is collaborative endeavor with the community and the family, whereby CPS supports caregivers motivation and efforts at meeting child well being needs. It is important to emphasize with respect to this approach for ongoing CPS, attempts by CPS to serve child well-being cases must not come at the expense of an agency s capacity to provide sufficient services for families where children are unsafe. When intervening in cases that are discretionary, the child protection mandate dictates the strategy for how best to address those cases internally within the agency and externally within the community. Child well-being consists of several domains or needs including physical health, economic security, education and safety and protection (see diagram 1). Different government and private agencies and organizations have specific responsibilities 5
pertaining to a child s well-being. CPS holds primary responsibility for one domain. CPS participates with law enforcement and the courts to assure children s protective needs are met. Even in comparison to law enforcement and the courts, child protection is most central to the CPS mission. No single entity in a community has the capacity to effectively meet and effectively address all of child well being. If one community organization or agency was expected to address the total of child well being, inevitably the mission and service objectives of that organization would become blurred; the quality of service would be compromised; and workload demand would be considerable. Diagram 1 CPS Mission and the Case Practice Approach The CPS mission and goal for ongoing CPS intervention determines the case practice approach. The case practice approach is conceptualized and design based on the defined outcomes and objectives for ongoing CPS intervention. The outcomes and objectives of a case practice approach is predicated on who CPS primarily seeks to serve, what reasonably constitutes success for ongoing CPS and therefore what is the intended focus of case plans and treatments services. The ongoing CPS practice approach should provide a proper balance between the functional responsibilities for CPS, the capacity of a CPS agency to assure that it is able to provide sufficient services to those families that are most vulnerable and the rights of caregivers who are involved with CPS. 6
The case practice approach: o Identifies the circumstance in which a CPS agency has the right to be involved with families: Statutory and Priority o Reserves internal capacity of a CPS agency to provide sufficient services to families that are identified as needing CPS intervention: To manage threats to safety and address safety concerns in case plans and service delivery o Prioritizes who must be served by CPS based on a non discretionary judgment: Families in which children are identified during initial assessment as being unsafe. o Employs the definition for unsafe as the essential basis for decision-making: Regarding case opening and the need to keep families opened for ongoing CPS intervention. o Respects a family in which a child is unsafe as having the right for receiving a reasonable standard for service from CPS that is not subject to competition for agency resources and capacity o Respects a family s right to clearly know the reason for CPS involvement and the purpose for ongoing CPS intervention: Threat to child safety (impending danger) and the need to enhance diminished caregiver protective capacities. o Assures that the basis for when ongoing CPS intervention is completed is communicated to and understood by a family being served: The establishment of a safe home. This ongoing CPS practice approach promotes the following operational service framework derived from a specific concept for change: o CPS Mission: o CPS Intervention Goal: Assure that children are safe and are protected from maltreatment. Caregivers are able to assure the protection of their children on their own. 7
o CPS Intervention Outcome: Absence of threats to child safety and/or caregivers possess sufficient protective capacities to assure that their children are safe. o CPS Intervention Objectives: Enhance diminished caregiver protective capacities associated with threats to child safety. Assumptions Supporting the Ongoing CPS Case Practice Approach A theory has to fit the facts. If it doesn t, you have to examine the facts. If the facts are correct, and the theory doesn t work, then you have to alter the theory. -Nelson DeMille Plum Island, 1997 This ongoing CPS case practice approach is established in accordance with the following assumptions: o The most compelling reason for CPS involvement with a family should be safety and protection. o Ongoing CPS should be designed in such a way that it is integrated with and flows from initial assessment practice and decision-making in a systematic manner. o Ongoing CPS should be thought of as operating as part of the larger system of safety intervention. o The CPS system for intervention should be based on acceptable, logical, understandable concepts for human change. o Ongoing CPS intervention must take into account within its design, service related activities and interpersonal interactions that CPS tends to serve an involuntary client population. o Ongoing CPS intervention at large and worker role and responsibilities in particular should be designed according to the process by which people change. o Ongoing CPS intervention should be family centered, strengths based and outcome oriented. o Caregiver protective capacity assessment and case planning should be reasonably doable, practical and a logical part of the ongoing case practice approach. Ongoing CPS Practice Approach: Concept for Change A concept for change is central to the ongoing CPS practice approach. A concept for change provides the direction and the operational framework for ongoing CPS intervention. A concept of change sets out an overarching goal for ongoing CPS which gives rise to expected results at case closure. The structural parts of ongoing CPS (i.e., activities, decision making instruments, roles and responsibilities and record keeping) are determined and formed by a concept of change. 8
The concept for change related to this ongoing CPS approach is illustrated in diagram 2. This represents a logical if-then progression beginning with the identification of families that CPS primarily seeks to serve and ending with goals for ongoing CPS intervention. The concept for change and subsequently the intervention approach is influenced or shaped by specific dynamic factors. These factors include characteristics of the cases being served, the involvement of children, the value of caregiver involvement, the stages and process for change, the defined role of the worker, supervisory oversight and consultation, the focus of intervention, the understanding and application of practice concepts and criteria, the philosophy of practice, the practice requirements and expectations, the design of the specific remedial strategies and the interpersonal skills and techniques used to promote change. The concept for change is used to qualify the purpose for the caregiver protective capacity assessment and case plan and, therefore, informs the structure of the assessment and case planning process. The objectives for the caregiver protective capacity assessment interviews; the role of the worker; the focus of discussions with caregiver during the case planning process; the treatment outcomes for case plans; the intent of treatment services are all based on the concept for change.. The concept for change applied in this ongoing CPS approach specific to the caregiver protective capacity assessment and case planning process is as follows: o The caregiver protective capacity assessment approach is designed to result in workers having a clear understanding of threats to child safety and the relationship between threats to child safety and absent or diminished caregiver protective capacities. o The caregiver protective capacity assessment determines what must change related to diminished caregiver protective capacities. o The caregiver protective capacity assessment process encourages caregiver involvement; engagement in a process for change; acceptance of what must change; and motivation to begin change. o The caregiver protective capacity assessment is expected to progress to a case plan containing individualized goals and services directed at enhancing the diminished caregiver protective capacities. 9
Diagram 2 Constructs of the CPS Ongoing Case Practice Approach There are several concepts, theories and principles that form this ongoing CPS case practice approach; the caregiver protective capacity assessment; and case planning. It is through the use of these intervention constructs that the concept for change is applied during case practice and decision making during ongoing CPS. The outcome for ongoing CPS intervention a safe home - is achieved through the use of these concepts, theories and principles. Caregiver Protective Capacities The concept of caregiver protective capacities is the most important, influential concept in determining the characteristics and approach to CPS intervention generally and ongoing CPS specifically. This concept is so essential within this case practice approach that if a name or label were given to the ongoing CPS case practice approach it would include reference to caregiver protective capacities. Diminished caregiver protective capacities are the reason a case is served during ongoing CPS; enhanced caregiver protective capacities is the reason a case is closed at the conclusion of ongoing CPS. During ongoing CPS intervention caregiver protective capacities are the main topic for conversation with caregivers during assessment, case planning, service provision and 10
evaluation activities. The caregiver protective capacity assessment process is focused on caregiver protective capacities. Case plans are developed and implemented based on what must change related to diminished caregiver protective capacities. Case closure is based on caregivers protective capacity to assure child safety. Caregiver protective capacities refers to personal and parenting behavior, cognitive and emotional characteristics that specifically and directly can be associated with a person being protective of his or her child. A caregiver protective capacity is a specific quality or personal characteristic that can be observed, understood and demonstrated as a part of the way a parent thinks, feels or acts that makes him or her protective. Caregiver protective capacity is a defining concept in this ongoing CPS case practice approach because it is fundamental to the concept of safety which is defined as the absence of threats to a child s safety or the presence of sufficient caregiver protective capacities to assure a child is protected. Impending Danger Like caregiver protective capacities, impending danger is an essential concept within the ongoing CPS practice approach. Impending danger and caregiver protective capacities are the concepts used for determining child safety at the conclusion of the initial assessment and throughout ongoing CPS intervention. Impending danger refers to threats to child safety that are not obvious or occurring at the onset of CPS intervention or in a present context but which are identified and understood upon more fully evaluating and understanding individual and family conditions and functioning. Impending danger refers to a family situation in which a child is not in immediate (present) danger but exists in a general state of danger because of family conditions or situations or family member behavior, emotion, temperament, motive, perception or function that is out-of control (unpredictable, chaotic, immobilizing, etc.) and occurs in the presence of a vulnerable child. Safe Home The mission of CPS at large and the outcome of ongoing CPS is that children are protected from maltreatment by enabling caregivers to provide a safe home. A safe home refers to the absence of perceived and/or actual threats to child safety. A safe home provides a child with a place of refuge and a perceived and felt sense of security and consistency. The caregiver protective capacity assessment involves a process for establishing a safe home for children. Case plans continue the process as individualized; family owned ; focused strategies are directed at reducing or eliminating impending danger and enhancing diminished caregiver protective capacities. 11
Family Centered Practice and Caregiver Self Determination This ongoing CPS practice approach reinforces a practice principle that caregivers are the authority, executive figures in their families and as such they are at the center and are the focus of intervention. The approach to caregiver protective capacity assessment and case planning emphasizes caregiver engagement and encourages caregivers to understand and accept the need to address what must change. Family centered practice in the context of this ongoing CPS practice approach means that caregivers are involved as full partners in every aspect of intervention. The caregivers right to self determination is a central practice tenet and key to the concept of change. Family centered practice supports a caregiver s right to choose to participate and have a say in the caregiver protective capacity assessment and case planning process. They have the right to agree or disagree with what must change concerning threats to child safety and diminished caregiver protective capacities. While the development and implementation of a case plan is not negotiable, caregivers have the right to decide about whether on not they want to participate in treatment and change. Acknowledging and supporting a caregiver s right to choose is perhaps the single most important factor for ongoing CPS to be success. Achieving and sustaining change is more likely to occur when the caregiver is actively involved, invested and able to maintain self-determination and personal choice. In all aspects of ongoing CPS the worker s responsibility includes nurturing a collaborative partnership with caregivers whereby individual self determination is respected and maintained. Mutuality Mutuality is a key objective for this ongoing CPS practice approach that can only occur as a result of there being a partnership between caregivers and ongoing CPS workers. Mutuality is achieved when convergence occurs between a caregiver and a worker about the effects of diminished caregiver protective capacities. Mutuality is characterized by likeminded thinking, feelings, perceptions and intentions shared by caregivers and workers about what needs to change in order for a child to be safe. Mutuality contributes to and is associated with caregiver motivational readiness to change. Ongoing CPS intervention must always be concerned with facilitating caregiver motivation and readiness to work toward the desired outcome. The caregiver protective capacity assessment is intended to raise self awareness and create mutuality regarding what must change. The caregiver protective capacity assessment results in case plans that include mutually agreed treatment strategies. After the case plan is implemented a worker continues to encourage mutuality with caregivers regarding the need to change. In this sense the caregiver protective capacity assessment is less of a traditional evaluation and study intended to enlightened the ongoing worker and more of a process for creating self awareness among caregivers regarding what must change and supporting caregiver willingness and readiness to change, Solution Based Intervention Solution based intervention is a methodology rooted in family based services. The principal philosophy of this approach is that the best way to help people is through strengthening and empowering the family (Berg, 1994). The source or answer to 12
problems is viewed as being present within the family. The task of the case manager in collaboration with the family is to spring loose the solutions that are embedded within the family. This intervention provides a practice mentality and specific techniques that are useful in facilitating people through the stages of change. The CPS-family relationship serves as the catalyst for change which also is an essential objective during caregiver protective capacity assessment. The Trans-Theoretical Model (TTM) The Trans-Theoretical Model (TTM) provides a way to understand and intervene in human change. The premise of (TTM) is that human change occurs as a matter of choice and intention and that intervention can facilitate the process. In this ongoing CPS case practice approach the caregiver protective capacity assessment and case planning process is the first structured intervention with families once a case has been transferred to ongoing CPS. The caregiver protective capacity assessment provides ongoing case managers with the initial opportunity to begin engaging caregivers in a process whereby the facilitation of client change can occur. Stages of Change is the TTM concept that gives direction to the caregiver protective capacity assessment process and that generally governs ongoing CPS intervention. Stages of Change The stages of change represent the dynamic and motivational aspects of the process of change. They are a way of dividing up the process of change into discrete segments that can be associated with how people proceed through change. There are five sequential steps that people move through during change and also move back and forth during change. In other words, people may progress through one stage after another until change is complete or they may revert back to previous stages as they move forward some, back some, forward some and so on. The stages of change are: Pre-Contemplation Not Ready To Change! The person is yet to consider the possibility of change. The person does not actively pursue help. Problems are often identified by others. Concerning their situation and change, people are reluctant, resigned, rationalizing or rebelling. Denial and blaming are common. Contemplation Thinking About Change The person is ambivalent and both considers change and rejects it. The person might bring up the issue or ask for consultation on his or her own. The person considers concerns and thoughts but no commitment to change. Preparation Getting Ready to Make a Change This stage represents a period of time when a window of opportunity to move into change opens. The person may be modifying current behavior in preparation for further change. A near term plan to change begins to form. Action Ready to Make a Change 13
The person engages in particular actions intended to bring about change. There is continued commitment and effort. Maintenance Continuing to Support the Behavior Change The person has successfully changed behavior for at least 6 months. He or she may still be using active steps to sustain behavior change and may require different skills and strategies from those initially needed to change behavior. The person may begin resolving associated problems. (The material on the stages of change is paraphrased from the work of Carlo Di Clemente and J. Prochaska.) The stages of change provide a structure and a mentality for interacting and engaging a caregiver during the caregiver protective capacity assessment and case planning process.. The stages of change also serve as a resource for evaluating progress and change. In this ongoing CPS case practice approach the stages of change are considered and applied in practice in conjunction with two other cardinal concepts previously discussed: self determination and mutuality. The Involuntary Client A profound reality in ongoing CPS is that caregivers are involved with CPS involuntarily. This fact should never be underestimated. Any acceptable approach to ongoing CPS should fully factor in the challenge of serving an involuntary population. This ongoing CPS practice approach (specifically the caregiver protective capacity assessment and case planning process) is designed to take into account the challenges of working with involuntary clients. The following definition of the involuntary client is consistent with the vast majority of those served by CPS: one who feels forced to remain in the (CPS) relationship; coerced or constrained choices are made because the costs of leaving the (CPS) relationship are too high; a person who feels disadvantaged in the current (CPS) relationship (Rooney, 1992). Caregivers usually transfer from initial assessment to ongoing CPS and begin the caregiver protective capacity assessment and case planning process as involuntary clients. These caregivers can be divided between those that are mandated clients because of a court order or some legal restraint and non-voluntary clients who feel pressured by the agency or others to stay in the relationship. Intervention related to the involuntary client points out, particularly in reference to CPS, how crucial power, control and choice are in facilitating change. The CPS intervention, in and of itself, establishes and can perpetuate a sense of loss of autonomy and power. Working with the involuntary client requires a re-establishment of a person s sense of personal power; self-determination and reclaiming of personal choice. This really is the essence of facilitating change and reasonably includes the interpretation of consequences related to personal choice. 14
The caregiver protective capacity assessment and case planning process acknowledges the reality of where caregivers are at the point they are transferred to ongoing CPS by attempting to increase motivation and readiness to change; by focusing and clarifying intervention; by encouraging self-determination, personal choices and sense of control; by empowering caregivers with information; by educating and socializing people to necessary roles, expectations and tasks; and by involving caregivers in goal and activity/service selection. (Adapted from the work of Ron Rooney, The Involuntary Client) Motivation and Readiness Motivation and readiness are related concepts associated with the stages of change and the involuntary client. Motivation and readiness are fundamental to this ongoing CPS practice approach in the sense that the perspective that case managers have regarding client motivation and readiness will influence their approach to intervention. Often it is merely how the ongoing worker intervenes that will result in a more or less effective assessment with a family and appropriate or inappropriate case plan. Motivation refers to the causes, considerations, reasons and intentions that influence individuals to behave in a certain way (Di Clemente, 1999). This definition reframes motivation in such a way that the notion that someone is unmotivated is not necessarily accurate. In other words, all individuals are motivated to do something or to behave a certain way; it just may not be a behavior that everyone agrees is acceptable or adaptive. This means that all individuals proceeding into ongoing CPS are motivated. When conducting a caregiver protective capacity assessment to determine what must change, it is necessary to be prepared for understanding what caregivers are motivated toward and what they are motivated against. Motivational readiness refers to where a person is in relationship to the stages of change and the ability or readiness to move through a particular stage of change. Individuals who engage in the caregiver protective capacity assessment and case planning process and who begin to acknowledge the need to address what must change related to diminished caregiver protective capacities are demonstrating increased readiness. Readiness to change refers to the current state of mind of a caregiver who has resolved denial, resistance and ambivalence and is inclined to change. Ongoing CPS workers routinely experience caregivers who are not ready to change and are in fact resistant or highly motivated against the idea of change. When attempting to engage seemingly resistant caregivers during the caregiver protective capacity assessment and case planning process, it is necessary to consider why someone would present themselves as not wanting to change. Miller and Rollnick (1991) indicate that there are four reasons: reluctance, rebellion, resignation and rationalization. Reluctance When assessing for the presence of reluctance as an explanation for remaining in pre-contemplation, the ongoing CPS worker should look for those with a lack of knowledge or inertia. These people are uncertain about their problems because 15
information has not been available to them or they haven t fully processed the information about problems or the impact of problems has not become fully conscious. These clients are not resistant but indecisive, hesitant or disinclined. Rebellion These clients have a heavy investment in the problem behavior. Additionally, they are highly motivated toward independence and making their own decisions. They are resistant to being told what to do. They may be afraid and therefore defensive. They are argumentative. Resigned Resigned pre-contemplators lack energy and investment. They are emotionally tired. This may also include depressed people and those who hold a fatalistic world view. They may feel overwhelmed by the problem. Rationalizing This person has all the answers about why problems are not problems and why there is no need for change. They know the odds for personal risk and loss related to change leading to a conclusion not to even get started. Yes-But discussions, debates and intellectualization are examples of styles of communication among individuals who rationalize behavior. Active Efforts The caregiver protective capacity assessment and case planning process provides an organized method for ongoing CPS intervention that promotes active and intentional efforts when working with caregivers. The caregiver protective capacity assessment and case planning process is the first essential step in assuring that caregivers are provided with individualized, culturally responsive and appropriately matched remediation services intended to enhance caregiver protective capacities. While the law does not specify the delineation of active efforts, the caregiver protective capacity assessment and case planning process uses practice methods consistent with the spirit of active efforts. These include: Utilizing family input and perspective when identifying needs, concerns and strengths; Timely response and facilitation of case movement through the CPS intervention process; Consistent, structured and focused assessment and case planning; 16
Collaborative development of case plans that are relevant to family/family member needs; Approaching intervention from a family centered/family system orientation; and Facilitating the access and use of effective and culturally responsive case plan services and service providers. Ongoing CPS Case Practice Approach within an Integrated CPS System of Intervention CPS operates most effectively when case practice and decision-making occurs along a systematic continuum of intervention that applies consistent concepts, criteria and standards. A CPS intervention system is integrated when there is a clear and logical concept for change that drives practice and decision-making from the point that a referral is received by the agency and concludes when a case closes and children are safe and in a permanent safe home. As a system of intervention the CPS functions (i.e. access, initial assessment and ongoing CPS) and associated intervention activities and tasks (i.e. information collection, safety assessment and planning, caregiver protective capacity assessment and case planning) must fit together in a cohesive manner; working toward the achievement of specific intervention outcomes. In this ongoing practice approach child safety and protection are what influences and drives the objectives for practice and decision-making at each step throughout the CPS intervention system (process). As caregivers proceed through the steps in the case process, concepts and criteria for safety are applied and inform the primary basis for the approach to intervention. There are six purposes for CPS intervention. The objectives for each of these CPS interventions are connected based on an outcome for child safety. The six purposes for CPS intervention and the specific relationship to safety are: Intervention Purpose Safety Issues CPS Function Problem Identification Impending Danger and Diminished Caregiver Protective Capacities Initial Assessment Provisional Protection Determining what must change Planning and Developing a Strategy for change Implementing and management change strategies Measuring progress toward change Control and Management Impending Danger Diminished caregiver protective capacities associated with impending danger Enhancing diminished caregiver protective capacities Facilitating caregiver change and directing treatment services at enhancing diminished caregiver protective capacities Increase in caregiver protective capacities and status of safety threats 17 Initial Assessment and Ongoing CPS Ongoing CPS Ongoing CPS Ongoing CPS Ongoing CPS
The CPS functions (initial assessment and ongoing CPS) and the practice objectives and decisions fit together to form a system of safety intervention. The illustration provides an overview for how the definition for unsafe : threats to child safety (impending danger) and diminished caregiver protective capacities drive all of CPS intervention. Initial assessment is concerned foremost with identifying families where children are unsafe. Initial assessment responds immediately to assure that threats to child safety are sufficiently controlled and managed. Ongoing CPS picks up the responsible for assuring the management of child safety while proceeding to determine what must change associated with threats to child safety and diminished caregiver protective capacities. Ongoing CPS collaborates with caregivers to develop case plans that will result in children being safe. Ongoing CPS measures progress toward enhancing caregiver protective capacities and thus creating a safe home. Due to the constant concern for child safety, it is essential that CPS case practice approaches be designed in such a way to reflect how child safety is specifically addressed at various points in the CPS case process. The initial assessment process is designed (i.e. information collection standard, safety assessment criteria and practice and decision-making standards) to effectively determine if children are unsafe. The caregiver protective capacity assessment and case planning process are designed to build upon information collected and decision(s) reached during initial assessment by applying the same concepts and criteria associated with intervention standards. The caregiver protective capacity assessment uses information from initial assessment and begins conversations with caregivers regarding why their family was opened for ongoing CPS (unsafe child) and to determine what must change in order for the case to be closed (safe child). Diagram 3 provides a more detailed description of how the initial assessment and the caregiver protective capacity assessment and case planning process, and the case progress evaluation are integrated. 18
CPS Function CPS Integrated Intervention Time Frames Access 1. Screen Referral. 2. Determine Response Time: Indications of Present Danger. Determine Response Time Initial Assessment Caregiver Protective Capacity Assessment and Case Planning Process Case Progress Evaluation 3. Initial Contact with Family: 3a. Indications of Present Danger 3b. Control Present Danger as needed. 4. Initial assessment Information Gathering: Problem Identification and Existing Caregiver Protective Capacities 5. Conclusion of Initial assessment: 5a. Determine if children are unsafe due to impending danger and Diminished Protective Capacities. 5b. Implement Safety Plan to control Impending danger. 5c. Confirm the need to serve. 6. Transfer case to ongoing Case Management. 7. Receive case from initial assessment. 7a. Ongoing Safety Management 8. Preparation for the caregiver protective capacity assessment: 8a. Consider approach for conducting the caregiver protective capacity assessment. 9. Conduct caregiver protective capacity assessment interviews: 9a. Impending danger as the focus for treatment and change 9b. Identify what must change related to diminished caregiver protective capacity associated with impending danger.. 10. Develop Case Plan: 10a. Create change strategy to enhance caregiver protective capacities 10b. Implement Case Plan. 11. Ongoing Safety Management: 11a. Sufficiency of the safety plan 12. Measure and evaluate progress: 12a. Enhancement of diminished caregiver protective capacities. 12b. Status of threats to child safety 12c. Caregiver motivational readiness 30 days to complete the Initial Assessment 60 Days to complete the caregiver protective capacity assessment and case plan Completed every 90 days Diagram 3 19
Ongoing CPS Practice Approach: Caregiver Protective Capacity Assessment and Case Planning The caregiver protective capacity assessment begins soon after a case is transferred to Ongoing CPS. As part of an integrated system of intervention, the caregiver protective capacity assessment should be view by the family and approach by the ongoing worker as a relatively seamless continuation of the initial assessment. As previously mentioned the caregiver protective capacity assessment is designed to use information gathered during the initial assessment related to impending danger and protective capacities as the basis for conversations with caregivers. In this respect workers are not required during the caregiver protective capacity assessment to begin delving into broad areas of family functioning that are not associated with reason the case was opened by initial assessment. The caregiver protective capacity assessment represents a second tier of a larger comprehensive assessment process that begins with the initial assessment. Upon the completion of the initial assessment an extensive amount of information has been gathered about child, caregiver(s) and family functioning that can readily be used to determine what must change. The caregiver protective capacity assessment narrows the focus of intervention on specific aspects of caregiver and family functioning which enables ongoing CPS worker to gain a comprehensive understanding regarding what must change related to impending danger and diminished caregiver protective capacities. The caregiver protective capacity assessment is a structured interactive process that is intended to build partnerships with caregivers in order to identify and seek agreement regarding what needs to change related to child safety and to develop case plans that will effectively address caregiver protective capacities and child needs. The caregiver protective capacity assessment and case planning process has the following four purpose(s): 1. Engage caregivers in a collaborative partnership for change. 2. Facilitate caregivers in identifying their own needs and the needs of their children. 3. Facilitate awareness and agreement regarding what must to change in order to create a safe home. 4. Involve caregivers and children, as appropriate, in the development and implementation of changed based strategies (case plans) that are individualized and most likely to address what needs to change to assure that children are not maltreated and are safe. The caregiver protective capacity assessment and case planning process are designed to be an interactive method for achieving the four purposes outlined above. There are specific decisions and objectives for the caregiver protective capacity assessment that are associated with the designated purposes. The decisions and objectives represent the end results or outcomes of the caregiver protective capacity assessment and, therefore, they inform the framework for the assessment approach. 20
The caregiver protective capacity assessment objectives are as follows: Verify safety plan sufficiency. Elicit caregiver perception(s) regarding identified safety threats. Focus on impending danger as the highest priority for change. Identify existing caregiver protective capacities. Identify diminished caregiver protective capacities associated with impending danger. Seek mutuality with caregiver regarding what must change related to diminished caregiver protective capacities. Evaluate caregiver stage of change related to impending danger and diminished protective capacities and facilitate caregiver willingness and readiness to change. Create a change strategy with the caregivers that includes both caregiver and child needs. Establish and document case plans related to what must change to address diminished protective capacities and impending danger. The caregiver protective capacity assessment decisions are as follows: Are safety threats being adequately managed and controlled? How can existing enhanced caregiver protective capacities be used to help facilitate change? How is impending danger to the child manifested in the family? What caregiver protective capacities are diminished and, therefore, resulting failure to protect a child from impending danger? How ready, willing and able are caregivers to address impending danger and diminished protective capacities, and what are the implications for continued case manager engagement and facilitation with the family? What change strategy (case plan) will most likely enhance caregiver protective capacities and decrease impending danger? Caregiver Protective Capacity Assessment and Case Planning Structure The caregiver protective capacity assessment is structured around four stages of intervention: Preparation, Introduction, Discovery, and Change Strategy and Planning (see diagram 4). The four intervention stages identify the actions and level of effort of the ongoing CPS worker, the facilitation objectives for assessment interviews and specific assessment content that must be considered during each intervention stage. The four sequential stages of the caregiver protective capacity assessment provide direction for facilitating caregiver involvement and collaboration toward mutual problem identification, solution thinking and planning. Progression through the four stages of the caregiver protective capacity assessment and the case planning process encourages families to share their perspective regarding identified safety threats, strengths and enhanced caregiver protective capacities that exist, caregiver protective capacities needing to be developed and/or enhanced and possible strategies that will address what must change. 21