Module 6: Family Engagement Standards – Preparation and … · • CFOP 170-9, Chapter 4, Family...

Case Management Pre-Service Curriculum | Module 6 -TG 1

Module 6:

Family Engagement Standards – Preparation and Introduction

Florida Department of Children and Families June 2016


Module 6: Family Engagement Standards –

Preparation and Introduction Display Slide 6.0.1

Time: ½ to ¾ day Module Purpose:

This module provides an overview of the family engagement standards: Preparation and Introduction.

Display Slide 6.0.2 (PG: 2)

Agenda:

Unit 6.1: Family Functioning Assessment-Ongoing Unit 6.2: Overview of Preparation Unit 6.2: Overview of Introduction

Materials: • Trainer’s Guide (TG)

• Participant’s Guide (PG)


• PowerPoint slide deck • Flip chart paper and markers • Videos: No videos • Additional Resource Materials (ARM):

o ARM: 2, Case Management Flowchart • Handouts needing printed: No handouts

References: Links:

• Florida Statute: http://centerforchildwelfare.fmhi.usf.edu/flstat/FloridaStatues.shtml

• Florida Administrative Code: http://centerforchildwelfare.fmhi.usf.edu/HorizontalTab/FloridaAdminCode.shtml#

• Operating Procedures/Practice Guidelines: http://centerforchildwelfare.fmhi.usf.edu/HorizontalTab/DeptOperatingProcedures.shtml

References: Unit 6.1 • CFOP 170-1, Chapter 2, Core Safety Constructs • CFOP 170-9, Chapter 4, Family Engagement Standards for Exploration of

Caregiver Protective Capacities

Unit 6.2 • CFOP 170-9, Chapter 1, Family Engagement Standards for Preparation

Unit 6.3 • CFOP 170-9, Chapter 2, Engagement Standards for Introduction Activities

Activities: Unit 6.1:

• Activity A: Determining the Focus of Your Family Functioning Assessment-Ongoing - TG: 13 , PG: 6

Unit 6.2: • Activity B: The Stages of Change and You - TG: 32, PG: 18

Unit 6.3: • Activity C: What Would YOU Want to Know? - TG: 37, PG: 20 • Activity D: Observation of the Introduction Stage - TG: 43, PG: 23 • Activity E: Introduction with the Sandler/Braun Family - TG: 45, PG:

25

http://centerforchildwelfare.fmhi.usf.edu/flstat/FloridaStatues.shtml

http://centerforchildwelfare.fmhi.usf.edu/HorizontalTab/FloridaAdminCode.shtml



http://centerforchildwelfare.fmhi.usf.edu/HorizontalTab/DeptOperatingProcedures.shtml

http://centerforchildwelfare.fmhi.usf.edu/HorizontalTab/DeptOperatingProcedures.shtml


Credits: Much of the material in this course was adapted from ACTION for Child Protection training materials and articles.

Module 6: Family Engagement Standards – Preparation and Introduction ................................ 1

Unit 6.1: Family Functioning Assessment-Ongoing ........................................................................ 5

Unit 6.2: Overview of Preparation ................................................................................................ 17

Unit 6.3: Overview of Introduction ............................................................................................... 35


Unit 6.1: Family Functioning Assessment-

Ongoing Display Slide 6.1.1

Unit Overview:

The purpose of this unit is to discuss the philosophy behind and the focus of the Family Functioning Assessment-Ongoing.

References: • CFOP 170-1, Chapter 2, Core Safety Constructs

• CFOP 170-9, Chapter 4, Family Engagement Standards for Exploration of Caregiver Protective Capacities


Learning Objectives:

1. Describe the philosophy of the Family Functioning Assessment-Ongoing. 2. Identify the participants who should be included in the Family Functioning

Assessment-Ongoing.



The Family Functioning Assessment-Ongoing (FFA-Ongoing) is a continuation of the family functioning assessment that was completed by the investigator. This does not mean an “add on” or “ditto” process. Through the application of the family engagement standards, Case Managers can begin the FFA-Ongoing with thorough knowledge regarding the family and the reasons for intervention. The purpose of the FFA-Ongoing is to evaluate family conditions and how these conditions are influencing danger threats, child needs, and caregiver protective capacities. This information should be used to commence development of the case plan so treatment services can begin. Since the FFA-Ongoing is a fluid process, the Case Manager needs to always be aware of information collection that informs changes to both the family functioning assessment and the safety plan.



Trainer Note: Remind participants that the FFA-Ongoing is the first formal intervention during ongoing case management. PG: 4

When does the Family Functioning Assessment-Ongoing begin?

Endorse: The FFA-Ongoing begins at the point that the CPI transfers a case to ongoing case management.

After the case transfer is completed you have thirty-days to complete the FFA-Ongoing. The diagram shows the core concepts that drive the FFA-Ongoing. The key to completing the FFA-Ongoing and developing focused case plan outcomes is the ability of the Case Manager to engage caregivers in the FFA-Ongoing process. It is important that caregivers see themselves as having a stake in what happens to them and have a say regarding how things will be addressed in the Case Plan.


A majority of the conversations during the FFA-Ongoing are concerned with raising caregiver’s awareness and having caregivers recognize and identify protective capacities associated with impending danger in addition to seeking areas of agreement regarding what must change to eliminate or reduce and sufficiently manage threats to child safety. We will discuss this more in depth in later modules and labs, in particular focusing on developing mutuality, recognizing self-determination, and developing discrepancy. Display Slides 6.1.5 (PG: 4-5)

1. Are danger threats being managed with a sufficient safety plan?

• This pertains to the active role of the Case Manager to ensure that the safety plan is being managed by ensuring that each person who has a role in the safety plan is executing his or her duties to ensure child safety.

2. How can existing protective capacities (strengths) be built upon to make

changes? • This requires the Case Manager to identify and recognize that despite

the family’s current involvement with the agency, they have strengths that need to be identified and utilized to illicit the change in families. This requires that the Case Manager has a strengths based approach to working with families.


3. What is the relationship between danger threats and diminished caregiver protective capacities — what must change? • This requires that the Case Manager understands and can conceptually

apply the concepts of danger threats and diminished caregiver protective capacities. The Case Manager has to be able to identify the specific caregiver protective capacities that are related to the family conditions associated with the identified impending danger threats.

Display Slide 6.1.6 (PG: 4-5)

4. What is the parent’s perspective or awareness of his/her caregiver

protective capacities? • This requires the core tenets associated with the family-centered

practice—family engagement in the change process. This may require that the Case Manager engage with families regarding their self-awareness and work with families to elevate their awareness if needed. This also requires an evaluation of what stage of change the caregiver is currently demonstrating.

5. What are the child’s needs and how are the parents meeting or not meeting

those needs? • The agency has a responsibility to assure that the child’s well-being is

being addressed. When parents are not meeting their child’s needs, the agency must ensure that the needs are met. This requires the Case Manager to assess the child’s needs and the parent’s ability to meet those needs.


Display Slide 6.1.7 (PG: 4-5)

6. What are the parents ready and willing to work on in the case plan?

• This requires the acknowledgement that the case plans that are developed are the family’s plan, and as such their role and agreement to the outcomes is paramount. This also requires that the Case Manager understand the concept of the stages of change to be able to recognize what stage the parent may be in and work to engage families in outcomes that are specific, measurable, attainable, reasonable, and timely.

7. What are the areas of disagreement in what needs to change?

• As the Case Manager is aware of what parents are ready and willing to work on, they too must be aware of any disagreements regarding what must change and engage the family in the change process through use of their engagement skills.

8. What strategy (case plan) will be used to assist in enhancing diminished

caregiver protective capacities? • What will the case plan look like? What will the outcomes look like?

How will we know when change has occurred? This requires the case plan to be SMART—specific, measurable, attainable, reasonable, and timely. This requires the Case Manager to be creative in their strategies and target change at the specific caregiver protective capacities that were identified to be related to the impending danger.



One of the first things you will determine when beginning the Family Engagement Standards is who to assess and include in the FFA-Ongoing. The focus of the FFA-Ongoing is on the primary caregivers and children within the household where an unsafe determination is made during a child protection investigation. A primary caregiver is anyone in the home with significant caregiver responsibilities for the children in the home. It is not always easy to determine who the primary caregivers are. You cannot depend on the FFA-Investigation to determine this for you, as the household composition or dynamics may have changed after this assessment was completed. In order to identify the primary caregivers you must have a clear understanding of who provides care, parenting, quality time, and/or discipline for the children. You will need to observe the family interacting and gather information from the children, parents, household members, extended family members, and friends who are familiar with how the family and household functions. The FFA-Ongoing includes separate information domains and caregiver protective capacities for all of the primary caregivers. Correctly identifying the primary caregivers is important as they are the ones responsible for protecting the children within the household and their ability to provide this protection needs to be thoroughly evaluated in the FFA-Ongoing. A description of all household members must be included in the FFA-Ongoing even if the person is not an identified participant in the FFA-Ongoing. These


descriptions include the person’s relationship to the parent, reason for the person’s presence in the home, impact his/her presence has on any of the domains, and an assessment of the other person’s background history information to assess for any patterns of behavior which present safety concerns. When there is a parent living in a separate household, information about their relationship with the child should be included in the child functioning domain. Depending on their ongoing involvement with the child and family, relevant information about them may also need to be included in other domains. If an investigation has found the parent living in a separate household is responsible for conditions that resulted in the child being unsafe in this household, then a separate FFA-Ongoing on the other parent’s household will be developed. Trainer Note: During this discussion it may be helpful to draw a visual of the households on a flip chart to illustrate the focus of the FFA-Ongoing. Possible scenarios you can draw include multiple families living in one home, divorced parents, and extended family members living in the home. The focus of the FFA-Ongoing is reinforced in the next activity with scenarios of different household compositions.


Activity A: Determining the Focus of Your Family Functioning Assessment-Ongoing Display Slide 6.1.9 (PG: 6)

Time: 15 minutes Purpose: The purpose of this activity is to correctly identify who to assess on the

Family Functioning Assessment-Ongoing. Materials: • PG: 6-7, Determining the Focus of your Family Functioning

Assessment-Ongoing worksheet • CFOP 170-1, Chapter 2, Core Safety Constructs • CFOP 170-9, Chapter 4, Family Engagement Standards for Exploration

of Caregiver Protective Capacities • Flip chart and markers

Trainer Instructions:

Exercise/Activity:

• It is recommended participants be split into groups of 2-4 people to help them process the activity.

• Ask participants to read the scenarios and determine how many FFA’s-Ongoing should be created and who should be on each FFA-Ongoing.

• Be sure to walk around and listen to the discussions and prompt when needed.

• Remind participants to refer back to their CFOP should they need assistance.


Exercise Debrief:

• Debrief the responses with the group. If the class becomes confused or has different responses, it is helpful to draw a visual of the different family units on a flipchart.

Activity Instructions:

1. Read the scenarios and determine how many FFA’s-Ongoing should be created and who should be on each FFA-Ongoing.

2. Refer back to your CFOP for assistance. 3. Be prepared to discuss.

Focus of Your Family Functioning Assessment

Trainer Version

1. Ten-year-old twins Ann and Gina primarily live in the home with their mother Joy, step father John, and his two year old son Mathew. Ann and Gina visit with their father, Tom, and his significant other Erica every other weekend. The FFA determined Gina and Ann to be unsafe at their father’s home due to ongoing out of control drug use in the home by Tom and Erica. The In-Home Safety Analysis and Planning was completed and an in-home safety plan has been established.

a. How many FFA’s-Ongoing should there be? o One

b. Who should be included in the FFA-Ongoing?

o Children: Gina and Ann o Caregivers: Tom and Erica

2. Shannon, her husband Sam, and their five year old child Sam Jr. all resided together until

Sam was arrested last month for burglary. He has been in the county jail since then and will be released in one month. Once released he is planning to return home with Shannon and Sam Jr. A report is received stating that there is ongoing domestic violence in the home between Shannon and Sam with multiple altercations that Sam Jr. has witnessed and gotten physically involved in. The FFA determined Sam to be unsafe and after the In-Home Safety Analysis and Planning was completed an in-home safety plan was put in place.


b. Who should be included in your FFA-Ongoing?

o Children: Sam Jr. o Caregivers: Shannon and Sam

3. Angie and Berta are sisters; both have two children under the age of five. They recently

moved in together to share living costs and to assist each other with child rearing. A report is received stating that both Angie and Berta are regularly high on cocaine and allow the


children to run the streets unsupervised. All of the children have been found to be unsafe though the Family Functioning Assessment.

a. How many FFA’s-Ongoing should there be? Two

b. Who would be included in the FFA-Ongoing? First FFA: Angie, Berta and Angie’s children Second FFA: Angie, Berta and Berta’s children

4. Mary resides in the home with her current husband Steve and her four minor children,

Shannon, Mike, Coraline, and Justice. Steve is the father to Shannon and Mike and Mary’s ex-husband Justin is the father to Coraline and Justice. A report was received alleging that Mary was severely physically abusing all of the children. The FFA determined that all four children, Shannon, Mike, Coraline, and Justice are unsafe. Mary refused to cooperate with a safety plan and after the In-Home Safety Analysis and Planning was completed an out-of-home safety plan was established. Coraline and Justice have been released into Steve’s care and Shannon and Mike have been placed with Ann, their Great Grandmother.


b. Who should be included in the FFA-Ongoing?

o Children: Shannon, Mike, Coraline, Justice o Caregivers: Steve and Mary

c. Are any other assessments needed?

o Other Parent Home Assessment on Steve and his household o Home study on Ann and her household

Activity STOP Family Engagement Standards Before moving further we are going to review the flow chart detailing the Family Engagement Standards. This process is used for all families who are receiving case management services as it informs the development of the case plan outcomes while maintaining safety for children.


Trainer Note: Recall this flowchart from Module 1. Provide a moment for participants to review the chart and if necessary provide a high-level review of each section. To help participants visualize what will be discussed provide participants a moment to also review the Case Management Flowchart Word template on CM ARM: 2. Display Slide 6.1.10 (PG: 8)

During the coming modules we will explore the four Family Engagement Standards. We will begin in this module with Preparation and then we will proceed with Introduction.


Unit 6.2: Overview of Preparation


Unit Overview: The purpose of this unit is to discuss the initial step in the Family

Engagement Standard for Preparation. References: • CFOP 170-9, Chapter 1, Standards for Preparing for Family

Engagement Trainer Note: The focus of this unit is how to prepare for engagement with the family. It may appear to be repetitious but it is a helpful review. Display Slide 6.2.2 (PG: 9)


1. Identify the tasks that must be accomplished during the Family Engagement Standard for Preparation.

2. Review the stages of change and identify the indicators for each stage.



The act of preparation is exactly like it sounds. It is the process of preparing for information collection and contact with the family. The purpose of the Preparation family engagement standard is to ensure that you are as informed as possible about information already known about the family, are able to identify gaps and discrepancies that must be reconciled, and are able to identify strategies for family engagement. To the extent possible, Preparation activities will begin prior to case transfer and will be completed prior to the initial meeting with the family. Lets begin by discussing the first purpose of Preparation, learning what is already known about the family. Many of the Preparation activities related to learning about the family are completed by the Case Manager prior to the Case Transfer Conference. PG: 9 What information should you review and analyze prior to attending the Case Transfer Conference?

Endorse: • The Family Functioning Assessment ensures you understand how danger

threats are manifesting in the family, the CPI’s assessment of caregiver protective capaciities, the In-Home Safety Analysis and Planning and the Conditions of Return (if applicable).

• The Safety Plan including the safety actions and the role of the safety service providers.

• All available historical information on the family including prior abuse


and neglect history, criminal history, prior service cases, and Case Management history.

While completing the case transfer process you should be using the information you learn to prepare to meet the family and begin the FFA-Ongoing. If you did not participate in the case transfer process it is important that you still complete all of the Preparation activities before moving on to Introduction. An adequate understanding of the family’s involvement with, and response to, prior intervention efforts is needed to assess and scale caregiver protective capacities and child needs in the FFA-Ongoing. Learning about the family’s history will also prepare you for conversations with parents about past interventions so you can prepare to learn from the parent’s perspective what worked, or did not work. While learning about the family you should begin to identify the current household composition and dynamics, who the caregivers are within the home, and which household members should be included in the FFA-Ongoing. Display Slide 6.2.4 (PG: 10)

When learning about the family it is important to idenfiy special circumstances and family conditions that are impacting the family. These circumstances include:

• Domestic Violence • Parents childhood history of abuse or neglect • Substance abuse • Mental illness


• Condition or circumstance of parent that will require assistance with verbal or written communication

• Criminal behaviors • Developmental delays and special needs of children in the home (includes

mental, learning disabilities, deaf and hard of hearing). When special circumstances are present you need to determine whether any specialists or subject matter experts are needed to better assess the family. This may include reaching out to counselors, psychologists, psychiatrists, teachers, early steps, other child development experts, doctors, domestic violence advocates and other specialists. When a family has already received or is currently receiving professional services the Case Manager should reach out to that professional to learn what is known and what additional information needs to be learned about:

• Past treatment for mental health or substance abuse. • Any diagnosis for the child or parent and the symptoms of their condition. • Possible impacts on daily functioning including how this may impact the

care and protection of the child. • Treatments that have been successful and unsuccessful.


Another purpose for completing Preparation activities is to identify gaps and discrepancies in the information known about the family. The Child Protective Investigator provides a baseline level of information on the family through the FFA, but additional information will need to be gathered by the Case Manager to scale Caregiver Protective Capacities, assess child needs and fully complete the


FFA-Ongoing. By identifying the relevant information already known, then identifying the gaps and discrepencies in that information you will be able to identify what information you still need to gather and what information needs to be reconciled. During this process you must have the ability to critically evaluate information and decisions that have been made related to safety and to translate this into your preparation for work with caregivers. As discussed in the last module preparation also includes an evaluation of the sufficiency and effectivness of the safety plan. Display Slide 6.2.6 (PG: 11)

The case transfer process and the information you have learned about the family should be used to fulfill the third purpose of Preparation: identifying strategies for family engagement. This includes using the information you have learned to plan the timing, location, and circumstances where contact should be made with both the caregivers and children. In terms of location, based on the information you have gathered, you can decide to meet the family at home, the office, or in a neutral setting. When domestic violence is occuring within the home ensure a separate meeting is set up with the survivor so the interview is not compromised. Timing is also important, as you want a day and time that would best allow the parents and children to focus on the meeting. Multiple meetings may be needed, depending on the family, to provide you with opportunities to both interview the parents at a time with few distractions and also observe family dynamics and the


interactions between the parents and children. Some family conditions or dynamics may pose a personal safety threat. When threats are identified ensure you identify strategies for managing personal safety with your Supervisor before making arrangements to meet with the family. Display Slide 6.2.7 (PG: 11)

Have participants reflect back on the Sandler/Braun activities completed in Module 2 “Preparation for Case Transfer” and ask the following questions:

• What do you remember about the Sandler/Braun family? What are the danger threats? What was the safety plan?

• What were some of the discrepancies that were found, what were the gaps of information needed?

• What information do you want to try to gather from the family when you

meet them? Accept answers from participants and refer back to Module 2 to help guide the discussion.


Stages of Change Display Slide 6.2.8 (PG: 12)

The process that all people go through when experiencing change has been conceptualized as a normal, predictable sequence of different stages. The change process tends to be cyclical, with intermittent pauses or even times of relapse or sliding backwards. As you prepare to meet with caregivers it is important to understand the concept of change and have the ability to recognize a caregivers motivation for change. A caregiver changes because he/she decides to change and wants to change. Comprehensive safety intervention systems approach change as something caregivers take ownership of and decide about. Compliance is contrary to self-determination and proves to be an oversized speed bump to effective implementation of safety intervention as a system. The stages of change represent the dynamic and motivational aspects experienced during the process of change. The Trans-Theoretical Model (TMM) is the basis for the first five stages of change. The sixth stage of change is unique to Relapse and is relevant for persons in recovery from any type of addiction. The stages of change provide Case Managers with a realistic model for understanding the difficulties that caregivers face in making choices regarding change and the challenges that are evident when intervening with caregivers to help facilitate that change. Understanding the stages that a caregiver goes through to make choices regarding change is crucial for providing ongoing Case Managers with a rationale for how to interact with caregivers during FFA-Ongoing process including being non-judgmental; supporting self-determination; creating


discrepancy for change; exploring intentions for change; considering what caregivers are ready, willing and able to do; encouraging and instilling hope for change; and providing options. Trainer Note: Use PG: 12-16, “The Trans-Theoretical Model (TTM) for the First Five Stages” and PG: 17, “Stages of Change and Motivation Tasks for CPI/CM” as guides for discussion about the stages of change. Discussion should include an overview of each stage including ways that the participants, as Case Managers, can behave in a way that help, or hinder, a parents progress through the change process. After completing the review of the handouts participants will complete an activity where they will apply the knowledge they have on the Stages of Change.

The Trans-Theoretical Model (TTM) for the First Five Stages Trans-Theoretical Model (TTM) (Prochaska & DiClemente, 1982; Prochaska, DiClemente, & Norcross, 1992) provides a way to understand the cognitive process for human change. The knowledge regarding how and why change occurs among individuals is important for understanding the rationale for the design of the ongoing family functioning assessment and has direct implications for how ongoing Case Managers should behave when intervening with caregivers. The premise of TTM is that human change is a progressive cyclical mental and behavioral process that occurs as a matter of personal caregiver choice and intention. Working from this perspective, the ongoing Case Manager seeks to engage caregivers in conversations that are intended to promote problem recognition, if not acceptance, and reinforce a caregiver’s internal desire for change. Adopting the principle assertion of TTM that change can be facilitated by influencing internal motivation, the conversations that occur with caregivers during the ongoing family functioning assessment attempt to raise self-awareness regarding the need for change, to instill hope for change and to elicit caregiver input regarding what must change related to caregiver protective capacities.

Stages of Change The stages of change embody the dynamic and motivational aspects of the process of change described in TTM. There are five sequential stages that people move through when considering the impact of personal problems, thinking about the need for change and eventually making choices about doing something to change. Rarely do individuals move through the stages of change in a prescriptive


linear way. More often, when individuals are struggling to make choices regarding the need for change, there is a tendency to vacillate between problem recognition and problem denial; between wanting to do something to change and insecurity about the ability to change; between taking steps to change and relapsing back into problem behavior.


Pre-Contemplation: Not Ready To Change! The caregiver is communicating during Family Functioning Assessment-Ongoing conversations that they do not acknowledge that there are problems and they do not consider the need to change. The caregiver who is in the pre-contemplation stage of change tends to demonstrate some level of resistance. They are reluctant to participate in conversations during the Family Functioning Assessment-Ongoing. They may express “fake cooperation” as a form of resistance and may even acknowledge that they are willing to complete services, but in reality they do not have intentions to change or they do not believe that change is possible. They may be rationalizing problems or blaming others; make excuses; or accusing the Case Manager of interfering in their lives. They could be actively rebelling against intervention by being overtly argumentative during conversations. The majority of caregivers who begin the ongoing case management process do so as involuntary clients. These caregivers tend to be in pre-contemplation about all or some of the problems that were identified during the investigation. They likely feel forced or coerced to be involved with case management and, as a result, they feel a sense of powerlessness.



Contemplation: Thinking About Change Caregivers may begin the FFA-Ongoing process thinking about problems and considering the need to change but they have likely not made a decision that change is necessary. The conversations that occur during the FFA-Ongoing are intended to facilitate caregivers to begin weighing the pros and cons for change. Caregivers who are in the contemplation stage for change are ambivalent. They consider the need for change, but they are hesitant to fully acknowledge problems, and they are not sure they want to give up negative patterns of behavior. When caregivers begin the assessment as highly resistant, efforts to facilitate change should concentrate on moving caregivers from pre-contemplation to a mindset of contemplating the need for change. Simply getting caregivers to minimally acknowledge problems and start thinking about the need for change is a realistic objective for intervention in the short-term when caregivers are very resistant to participating in the FFA-Ongoing, much less open to thinking about change.



Preparation: Getting Ready to Make a Change As a result of the self-awareness raising that occurs during the FFA-Ongoing, many caregivers will move toward taking increasing ownership for their problems (or at least some of their problems) and they will start talking about not only the need for change, but what specific behavioral change would look like. When conversations are productive with respect to eliciting caregiver feedback regarding what must change, there emerges a period of time when a window of opportunity opens for engaging caregivers to commit to taking steps to change. Display Slide 6.2.12 (PG: 14)

Action: Ready to Make a Change Caregivers who are in the action stage are not only taking steps to change, including participating in a change process with the Case Manager and other changed focused services, but they also express a belief and attitude that the actions taken to address problems will result in things being different. In effect,


when a caregiver completes the FFA-Ongoing process and commits themselves to participating in services and working toward achieving case plan outcomes, they are moving into the action stage. If at the conclusion of the FFA-Ongoing or in the months following the implementation of the case plan, a caregiver communicates that they are ready, willing and able to make change and then proceeds to take the steps to do so, they are in the action stage. Display Slide 6.2.13 (PG: 15)

Maintenance: Continuing to Support the Behavior Change A caregiver does not reach the maintenance stage of change until they demonstrate sustained behavioral change for at least 6 months. Caregivers may still be actively involved in completing their case plans and participating in services, but significant progress has been made toward the achievement of outcomes related to caregiver protective capacities and child well-being. It is important to note that a caregiver is not likely to be in the maintenance stage for all outcomes in the case plan at the same time. In most cases, it will be more likely that caregivers could be in the maintenance stage for one outcome related to caregiver protective capacities while still remaining in the action stage or even contemplation stage related to other outcomes. In ongoing case management, the change process is evaluated at least every 90 days, or at critical juncture, during the ongoing case management and services to determine when sufficient change has occurred such that no intervention is required and the case can be closed.


Stage of Change Specific to Substance Use: SAMSHA and NCSAW Display Slide 6.2.14 (PG: 16)

Relapse The assessment of stages of change has been incorporated into most substance abuse treatment programs, and treatment interventions should be thoughtfully matched to the stage of change an individual is in. Addiction programs may use stages of change models that have been customized around addiction. The first five stages of change in this curriculum are appropriate for a range of challenges. The sixth stage of “relapse” has been added and is specific to addictions. Addictions Substance abuse is a complex and chronic disease that has biological and behavioral components. A comprehensive treatment program, tailored to the individual, is necessary for the treatment success. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. Most people working to overcome an addiction experience relapse. It is much more common to have at least one relapse than not. Relapse is not the same as treatment failure. Recurrence of substance use can happen at any point during recovery. When a parent relapses, it is important to help the parent recognize the difference between lapses (a period of substance use) and relapse (the return to problem behaviors associated with substance use) and to work with the parent to re-engage him or her in treatment as soon as possible. It is also important to note that a urine toxicology screen will not tell you whether the individual has had a lapse versus a relapse. Part of effecting long-term change includes working with parents to identify the specific factors that preceded their substance use— What were the emotional, cognitive,


environmental, situational, and behavioral precedents to the relapse? Case Managers can help a parent plan for the potential of relapse and for ensuring safety of the child. Parents who learn triggers can become empowered to plan proactively for the safety of their children and to seek healthy ways to neutralize or mitigate the trigger. One element in the process of recovery is to develop a relapse prevention plan. (Excerpt from relapse from “Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers” National Center for Substance Abuse and Child Welfare (NCSACW)). PG: 17

Stages of Change and Motivation Tasks for CPI/CM

PARENT’S STAGES OF CHANGE MOTIVATIONAL TASKS FOR CPI/CM

Pre-contemplation

No perception of having a problem or need to change.

Increase parent’s perception of the problems with their current behavior; raise parent’s doubts about behavior.

Contemplation Initial recognition that behavior may be a problem and ambivalence about change.

Foster and evoke reasons to change and the risks of not changing; help tip the balance toward change.

Action Makes a conscious decision to change. Some motivation for change identified. Takes steps to change.

Help parent identify best actions to take for change; support motivations for change. Help parent implement strategy and take steps.

Maintenance Actively works on sustaining change strategies and maintaining long-term change.

Help parent to identify triggers and use strategies to prevent relapse.

Lapse or Relapse Slips (lapses) from change strategy or returns to previous problem behavior patterns (relapse).

Help parent re-engage in the contemplation, decision, and action stages.


Adapted from: Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Child Welfare Professionals. Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD, 2004. When working with families, why do Case Managers need to have an understanding of the process of change and the typical responses associated with making changes?

Endorse: • Families may have strong, but typical responses and behaviors

associated with changing, especially when put in a position where they must change whether or not they want to.

• When Case Managers are aware of typical responses/behaviors associated with change they can better identify which family behaviors and attitudes are natural/typical reactions to change and which are occurring for other reasons.

• The change process follows a cycle. When workers are aware of this cycle, they will be able to monitor where families are in that cycle, which is valuable in assessment and in developing plans which families can realistically attempt to fulfill.

You may have families where all the participants are in different stages of change and participants can vacillate between the stages, moving forward and backward along the continuum. Our understanding of where parents are, and being thoughtful as to how we help parents move forward, is essential. We all may show signs of stress during times of change, both in our feelings and behavior. The next activity wil help us explore the natural reactions we all have when faced with change.


Activity B: The Stages of Change and You Display Slide 6.2.15 (PG: 18)

Time: 30 minutes Purpose: The purpose of this exercise is to help participants apply what they have

learned about the stages of change. It will also help them develop an appreciation for how hard making changes can be for a family.

Materials: • PG: 18, The Stages of Change and You worksheet Trainer Instructions:

Exercise/Activity: • For the first part of this activity participants should work

individually. For the second part, split participants into groups of two (at most three).

• Instruct participants to identify something in their life that they are currently in the process of changing or thinking about changing. Tell participants to ensure they identify a change they are willing to share with another participant in the room.

• Part 1: Instruct participants to answer the questions under Part 1 of their “The Stages of Change and You” worksheet based on the change they identified.

• Part 2: Instruct participants to review their responses with a partner, looking for any commonalities or differences in their path through the change process.

Debrief with class focusing on the following topics: • How did the change being choice vs. forced make a difference?


• Before beginning, ask participants to get into the spirit of the situation in terms of what their state of mind might be and how they might be feeling as a parent going into ongoing case management with a child in placement.

• Allow participants 5 minutes to write down as many things as

possible that they would want to know; encourage them to be spontaneous and not think too much about each item, and not to amplify by writing too much—just the essence—enough to understand what it is they’d want to know.

Exercise Debrief: • Ask the participants to share what they have written down in

regards to what they would want to know.

• Inquire as to the significance of what they want to know…why was that critical to them?

• Proceed to engage a large number of the participants in the discussion.

• Look for themes and correlations between participants, highlight themes as they arise. Conclude the exercise after 15 minutes with a summation of the key themes that were identified through the group.

• Inform the group that the introduction stage is the point where families will have questions, and the ability to recognize and address those questions in a professional and diplomatic manner will assist the Case Manager in engaging the family and establishing rapport.

Following completion of this activity, ask participants to speculate what they think Melanie Braun would want to know when the Case Manager introduces themselves to her.


Part 1: • Working alone, identify something in your life you are currently in the

process of changing or thinking about changing. • Next, answer the questions on the “Stages of Change and You”

worksheet based on the change you have identified.

Part 2: • Review your responses with a partner. Look for any commonalities or

differences in their path through the change process.


Activity STOP Now that you understand the Stages of Change and have prepared to meet the family, we will discuss how you will introduce yourself to the family.


Unit 6.3: Overview of Introduction


Unit Overview:

The purpose of this unit is to discuss the next step in the Family Engagement Standard: Introduction.

References: • CFOP 170-9, Chapter 2, Family Engagement Standards for Introduction

Activities Display Slide 6.3.2 (PG: 19)


1. Identify the tasks that must be accomplished during initial contact with the family.

2. Demonstrate using rapport building skills learned in CORE.



Introduction is the act of introducing you as the change agent and the agency representative, the agency’s role, what case management is and is not, and providing clarification as to the role of the ongoing Case Manager. Display Slide 6.3.4 (PG: 19)

Introduction goes beyond a simple self-introduction and an explanation of the FFA-Ongoing. It is the beginning of your working relationship with the family and requires you to apply the essential practice skills of teaming and engagement. Informing parents is critical to this stage of intervention. This allows parents to decide how they would like to engage with the agency. It also sets the foundation for rapport building. Trainer Note: If you are in an area where Case Managers have contact with the family through the role of a safety service provider prior to the Case Transfer Conference let participants know that the Introduction Family Engagement Standard is still necessary as the family needs to understand how the Case Managers role is changing.


Activity C: What Would YOU Want to Know? Display Slide 6.3.5 (PG: 20)

Time: 15-20 minutes Purpose: The purpose of this opening exercise is to help participants begin developing

an appreciation for how encompassing the introduction can be; help them gain some respect for the position clients are in when beginning a FFA-Ongoing; and, to help them identify some specific information that perhaps ought to be included when introducing the FFA-Ongoing.

Materials: • PG: 20, What Would YOU Want to Know worksheet Trainer Instructions:

Exercise/Activity: • This is an individual exercise in which participants will document their

responses in their PG worksheet.

• Instruct participants to read the “What Would You Want to Know” scenario. Explain that they need to get into the spirit of the situation in terms of what their state of mind might be and how they might be feeling as a parent going into ongoing case management with a child in placement.

Scenario:

You are a parent who has been transferred to ongoing case management. You have had a child removed from your care. You have been investigated and told “you have been referred for ongoing services”. You are meeting your new Case Manager today. As your new Case Manager introduces herself and explains how she will work with your family, identify something that you would like to know from her.


• Next, instruct participants to generate a list of specific things that they can think of that they would like to know from a Case Manager if he or she was a client beginning an FFA-Ongoing. Participants should write only a few words or a phrase. For instance, a participant can say to herself, “I would want to know.” and then write down how long is this going to take?

• Refer participants to the instructions on the slide and in the PG in terms of the situation they should consider himself /herself in.

• Give participants 5 minutes to write as many things they’d want to know as possible; encourage them to be spontaneous and not think too much about each item, and not to amplify by writing too much—just the essence—enough to understand what it is they’d want to know.

Exercise Debrief: • Debrief as a large group.

• Ask the participants to share what they have written down in regards to

what they would want to know. Inquire as to the significance of what they want to know…why was that critical to them?

• Look for themes and correlations between participants, highlight themes as they arise. Conclude the exercise with a summation of the key themes that were identified through the group.

• Inform the class that the Introduction stage is the point where families will

have questions, and the ability to recognize and address those questions in a professional and diplomatic manner will assist the Case Manager in engaging the family and establishing rapport.

• Following completion of this activity, ask participants to speculate what

they think Melanie Braun would want to know when the Case Manager introduces themselves to her.


Instructions: 1. As you listen to the scenario being read, place yourself into the role of the

parent. Think about what you as the parent would be feeling as a parent going into ongoing case management with a child in placement.

2. Make a list of the specific things that you (as the parent) would want to know from the Case Manager. Be spontaneous and write down the essence of what you would want to know.

3. Be prepared to discuss with the class.


Scenario: You are a parent who has been transferred to ongoing case management. You have had a child removed from your care. You have been investigated and told “you have been referred for ongoing services”. You are meeting your new Case Manager today. As your new Case manager introduces herself and explains how she will work with your family, identify something that you would like to know from her.

Activity STOP Introduction Standard Display Slide 6.3.6 (PG: 21)

Introductory case management activities with parents should focus on building rapport; learning about the family; providing information to the family and beginning to develop a trust-based working relationship. For families with a history of involvement or multiple challenges, several meetings might be required. The first conversation with the family should help transition the parents from the investigation to ongoing services. This provides families with an opportunity to discuss their concerns, ask questions, and express their feelings about the circumstances surrounding their involvement with the child welfare system. This conversation also provides you with an opportunity to introduce the parents to the FFA-Ongoing including what information you will be gathering from them and others to complete this assessment.


The first conversation with a family should also include a discussion around the safety plan and how it is working. During Introduction what specific information will you provide to the family and gather from the family regarding the safety plan?

Endorse: • Gather information on whether or not the safety plan is working. • Provide information on the safety plan. Includes ensuring the parents

understand what is on the safety plan and that all of the safety actions listed on the safety plan are occurring.

• Provide information on the Case Managers safety management role and the activities the Case Manager will be performing to ensure that the safety plan is working.

• Provide and gather information around Conditions for Return (if applicable), including the parents input on what assistance they will need to achieve the conditions.

During the Introduction, establishing rapport and building a working agreement with families are essential as you begin to gather and assess information for the FFA-Ongoing. A working agreement is a mutual understanding between the Case Manager and the parents which includes how the family and Case Manager will effectively work together on the FFA-Ongoing, case plan and evaluating progress over time. It includes discussions as to when and where contacts will occur, how to contact the Case Manager and Case Manager’s supervisor, how to contact the parent(s), and what to do if a meeting needs to be cancelled. Other information that needs to be discussed and gathered during the introduction includes:

• Any past involvement with the child welfare system and what the family believes worked well or did not work well during their past experiences.

• General information about the parents, children, and any other persons living in the household.

• The danger threats including the family’s understanding of the danger threats and their perception of why case management services are involved with their family.


Introducing yourself, the case management process, and the FFA-Ongoing is much more than names, activities, and schedules. It involves a concerted effort to immediately initiate a “people process.” You are providing a picture of how you view the client, how you view your interaction, and what you hope the arrangement includes. Key interpersonal skills to remember during the Introduction include: respect, genuineness, beginning where the client is, building rapport, engaging the person in the process and in thinking about change, self-determination and empowerment. The Introduction is really about recognizing and behaving in a way that shows you believe the effort is about and belongs to the client. (PG: 21) If parents are unwilling to commit to the assessment process what next steps can you take? Endorse:

• Find out the reasons why they are unwilling to participate and try to find some areas of mutual agreement between you and the parents that can be built upon.

• Acknowledge and normalize any negative feelings the parents may have towards the assessment process.

• Stay nonjudgmental and continue to attempt to gain rapport and build trust.

Introduction isn’t always easy, shouldn’t be rushed, and does demand a fair amount of preparation and clarity in your own mind about what you will share with a caregiver and how you will do that. This gives support to the importance of preparing for the FFA-Ongoing. Remember that the reason for involvement as related to the FFA-Ongoing is safety: threats exist and the caregiver is unable to protect the child from the threats (a protective capacity issue). Trainer Note: Direct participants to PG: 22, “Introduction Stage: Working with Families to Begin to Build Trust and Gather Information”. Explain that this chart goes through what activities and information should be discussed and gathered during Introduction. Many of the things on this chart have already been discussed. Have participants read over the chart and then answer any questions. After reviewing the chart “Activity B: Observations of the Introduction Stage” will provide an opportunity for participants to observe an interview that demonstrates the Family Engagement Standard of Introduction.



Introduction Standard: Working with Families to Begin to Build Trust and Gather Information

To introduce and clarify the ongoing family functioning assessment process with caregivers and to make sure that all roles, responsibilities (expectations), agency-family issues and concerns are discussed and understood.

Introduction to Ongoing Case Management

□ Engage caregivers in

assessment process. □ Introduce ongoing

Case Manager. □ Describe purpose of

ongoing case management.

□ Clarify relationship between CPI and Ongoing case management.

□ Elicit caregiver perspective.

□ Elicit concerns or worries about involvement.

Reason for Involvement □ Discuss impending danger

threats. □ Information identified

during the investigation.

□ Perception of caregiver regarding impending danger and intervention.

□ Address safety management issues (as indicated) including Conditions for Return if applicable.

Description of Ongoing Family Functioning Assessment Process

□ Engage caregivers and

seek partnership for completing the ongoing family functioning assessment.

□ Discuss purpose for the ongoing family functioning assessment and Case Planning process.

□ Describe the process for intervention.

□ Seek commitment to participate in the assessment process.


Activity D: Observation of the Introduction Display Slide 6.3.8 (PG: 23)

Time: 40 minutes Purpose: The purpose of this opening exercise is to observe interviews that

demonstrate the Introduction family engagement standard and to begin identifying some specific information that should be included when introducing the FFA-Ongoing.

Materials: • PG: 22, Introduction Stage: Working with Families to Begin to Build Trust

and Gather Information Chart • PG: 23-24, Russell Case scenario and Discussion Questions (Chapters 1

and 2) • Russell video- Scenes 1 and 2 (Center’s site)


• Throughout this curriculum we will use video exerpts from the Russell Case to observe the Family Engagement Standards.

• Exercise/Activity:

o This is an individual exercise. o Participants will document their responses in their PG. o First participants will read the Russell Case scenario. o The Trainer will then show Scenes one and two of the Russell

case. o Participants will answer the discussion questions regarding the

case. • Exercise Debrief:

o Go through the discussions questions having participants give their responses. Use the trainer guide answers to help guide the discussions.



1. Working alone, read the Russell Case Scenario. 2. Watch the video clips on the Russell Case. 3. Answer the questions on the worksheet regarding the Russell Case. 4. Be prepared to discuss.

Russell Case Summary for Video Observation:

Angela Russell was recently transferred to case management after it was determined that Angel (7 yrs.) was not safe in the home with Angela without safety services. An in-home safety plan was attempted with the family, but due to the degree that Angela was not functioning, an out-of-home safety plan was put in place that has Angela residing with her paternal grandmother. Angela and her ex-boyfriend, Brian, have been separated for the past six months. Angela and Brian’s separation was hard on Angela and Angel, and since that time things in Angela’s life have slowly started to decline, both at home and in her work life. Angela began “partying” more frequently, often leaving Angel to care for herself, or at times bringing her with her to the “parties.” The last incident brought the family to the attention of the agency. Angela did not come home the next morning, and when Angel woke up she was scared and called her grandmother, who subsequently calls the agency for assistance and out of concern for Angel.

Russell Family Introduction- Discussion Questions Trainer Versions

After watching Scene 1 and Scene 2 of the Russell Case please answer the following questions.

1. What essential skills did the Case Manager use during the interviews? (To assist in remembering essential skills you can utilize “The Essential Knowledge and Skills” located on page 1 of your Safety Methodology Reference Guide).

• Engagement: Showed empathy and caring • Encouraged the mother • Active listening • Difussed resistance • Clearly conveyed safety concerns • Offered next steps.

2. How did the Case Manger explain her role in working with the family? • She explained that her role was different than the role of the investigator in

that her role was to help the mother address the problems that led to the child being unsafe.


3. How did the Case Manager address the mother’s concerns? • She redirected the mother when the mother claimed that the fight with her ex-

paramour was the reason for agency involvement and when the mother just wanted to do services. The Case Manger advised that there was a process and that there needed to be a better understanding of the family situation so that appropriate services could be provided.

4. Using the “Introduction Stage: Working with Families to Begin to Build Trust and Gather

Information” chart as a reference is there any other information the Case Manager still needs to address during introduction?

• The Safety plan, including whether the current safety plan is working and what the Case Managers safety management role will be in the safety plan.

• Conditions for Return.

Is there anything you would have done differently or would have asked or explained differently?

Activity STOP Now that you have observed an introduction the next activity will provide you with the opportunity to practice completing an Introduction using the Sandler/Braun family. Activity E: Introduction with the Sandler/Braun Family Display Slide 6.3.9 (PG: 25)

Time: 1 hour 15 minutes Purpose: This exercise provides participants an opportunity to practice engaging a

caregiver and explaining the Family Functioning Assessment-Ongoing process.


Materials: • PG: 22, Introduction Standard: Working with Families to Begin to Build

Trust and Gather Information Chart • PG: 25, Introduction worksheet


Inform participants that the following series of activities will require groups to exercise their creative liberties as we progress through our work with the Sandler/Braun Family. We will proceed through the activity to where group members will role-play Introduction for the Sandler/Braun Family. Introduction Assignments: 1. Set Up and Order

• Role assignments are selected: Case Manager, Observer, and Bruce Braun – 2 minutes.

• The introduction assignment is reviewed so expectations are clear to all team members and Case Manager and Caregiver– 5 minutes.

• Case Manager conducts his or her Exploration with parent – up to 15 minutes.

• Observers and group conduct debriefing – 5 minutes. • New Role assignments are selected: Case Manager, Observer and

Melanie Braun – 2 minutes. • Case Manager and Caregiver take a few moments to prepare using

Introduction Chart as Reference– 5 minutes. • Case Manager conducts his or her Exploration with parent – up to 15

minutes. • Observers and group conduct debriefing – 5 minutes. • Remind participants to remember the items they have identified

during Preparation for the Sandler/Braun family and to make sure to reference information from the Preparation exercise prior to Introduction.

Activity/Exercise: 1. Split the class into groups of three. If the class is small or does not break

down into even groups of three this exercise can be modified by having the participants who are playing Melanie and/or Bruce also be the observer.

2. Inform participants to reflect on the engagement skills they observed in the Russell case videos.

3. Participants will need to decide within their groups who will assume the following roles for their introductions—provide overview of role as they are identified to the group:


a. Case Manager: This is your first contact with Melanie Braun/Bruce Braun and you are responsible for introducing the family to ongoing case management services, explaining the reason for involvement, and describing the FFA-Ongoing process.

b. Role of Melanie Braun/Bruce Braun: This is your first formal contact with the CPI worker. Your role as Melanie/Bruce is liberal and you are free to use ad-lib as you feel appropriate.

c. Observer: You are a non-active observer during this interaction and are there to observe the interview and take notes. Pay careful consideration to the interviewer, their approach, their use of interviewing techniques. Use the Introduction Standard Chart as a reference when providing feedback.

Review roles and orders with class from instructions above.

4. Explain that within their small groups that they will be practicing introduction for both Melanie and Bruce separately and should conduct two interviews total. Roles should be switched between role plays (for example the same participant should not play the Case Manager twice).

5. Inform groups that they will have 60 minutes to complete interviews and small group debrief.

6. Interviews between Case Manager and Caregiver should be around 15 minutes long, with 5 minutes debrief post interview.

7. Remind groups of the items they identified during preparation for the

Sandler/Braun family. Encourage groups to reference information from their preparation exercise prior to introduction.

8. Clarify any questions or comments before proceeding to explaining the exercise.


1. Group members will role-play for the Sandler/Braun family. Decide within the group who will assume the following roles for your introductions:

• Case Manager: This is your first contact with Melanie Braun/Bruce Braun and you are responsible for introducing the family to ongoing case management services, explaining the reason for involvement, and describing the FFA-Ongoing process.

• Caregiver Role of Melanie Braun/Bruce Braun: This is your first formal contact with the CPI worker. Your role as Melanie/Bruce is liberal and you are free to use ad-lib as you feel appropriate.

• Observer: You are a non-active observer during this interaction and are there to observe the interview and take notes. Pay careful consideration to the interviewer, their approach, their use of


interviewing techniques. Use Introduction Standard Chart as a reference when providing feedback.

2. Groups will practice Introduction for Melanie and Bruce separately, therefore conduct two interviews total.

Trainer Note: 1. Trainers will observe and facilitate discussion with small groups as they conduct

interviews. 2. Ensure that time is up at all groups, encouraging the groups to provide clarification as

needed to facilitate the exercise. Display Slide 6.3.10

Reconvene the large group following their introduction exercise. Solicit feedback, comments, and points of clarification from the exercise. The below questions can assist in the discussion.

A. How did participants feel during introduction? B. Were there groups that had resistant families, how did you address resistance? C. Did the groups see the application of skills, and if so what skills in particular? D. What did you see that the Case Managers did well? E. What else do they want to know about Mr. and Mrs. Braun? Do they have questions

that they have from introduction that they have formulated already?

Explain to the group that this role-play is a good exercise in formulating introduction skills for Case Managers in the field. It allows for a controlled environment for Case Managers to process the concept of introduction. Activity STOP In the next module we will further explore the intervention standards by looking more in-depth at the Exploration stage.

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