Safety, Risk And Protective Capacity

1. 1 Safety, Risk And Protective Capacity One of the Core modules designated by the State to be Standardized by July of 2005, The others include child maltreatment, overview of child welfare services, case planning, human development, andOne of the Core modules designated by the State to be Standardized by July of 2005, The others include child maltreatment, overview of child welfare services, case planning, human development, and

2. 2 Competencies Assessing safety, risk and protective capacity Gathers and evaluates relevant information about children and families Assessment and service planning informed by child welfare research and best practice, and that consider issues of personal values, fairness and equity Core competencies developed by STEC Statewide Training Education Committee formed in as part of the performance Improvement Plan Goals for 2003-2005Core competencies developed by STEC Statewide Training Education Committee formed in as part of the performance Improvement Plan Goals for 2003-2005

3. 3 Learning Objectives As found in your participant manual Knowledge Skills Values

4. 4 Agenda Challenges in assessing risk safety and protective capacity Overarching principles Decision Making Model Definitions Statewide Assessment System Application Look at the agenda Content was approved by a sub committee of STEC Many people are thanked for the contributions to this curriculumLook at the agenda Content was approved by a sub committee of STEC Many people are thanked for the contributions to this curriculum

5. 5 Rank Order Your Cases Here are ten cases Rank order them 1-highest risk 10 lowest risk 920-9-45920-9-45

6. 6 Challenges for Workers in Assessing Safety and Risk The Family�s Feelings The Worker�s Feelings Time Constraints Disagreements about assessment Use of Tools Objectivity Shared Decision Making Refresh your skills 1. This topic introduces the concept of dealing with biases and personal issues that may arise for a new worker in the child welfare field. It is recommended that participants receive additional training or extensive supervision on transference/counter-transference issues. 2. Emphasize strategies for continued professional and personal growth. The trainer can use either a handout �Hot Buttons� on page or develop strips or 3x5 cards with the issues on the handout. 1. This topic introduces the concept of dealing with biases and personal issues that may arise for a new worker in the child welfare field. It is recommended that participants receive additional training or extensive supervision on transference/counter-transference issues. 2. Emphasize strategies for continued professional and personal growth. The trainer can use either a handout �Hot Buttons� on page or develop strips or 3x5 cards with the issues on the handout.

7. 7 Rationale for Risk And Safety Assessments The law requires it Professional values and standards support the practice It defines agency parameters Consistency in decision making Focuses interventions Accountability Have participants go to the Activity Circle for Reasons on page _____ and answer the question. What are the reasons we do safety and risk assessment? Use the words LAW, GOALS, OUTCOMES, ACCOUNTABILITY, DECISION MAKING in your sentence(s), and write your answer in the circle. Have participants go to the Activity Circle for Reasons on page _____ and answer the question. What are the reasons we do safety and risk assessment? Use the words LAW, GOALS, OUTCOMES, ACCOUNTABILITY, DECISION MAKING in your sentence(s), and write your answer in the circle.

8. 8 Overarching Principles Evidenced Based Practice Fairness and Equity Strength Based Practice Engaging Community Partners

9. 9 Decision Making in Child Welfare Steps in Decision Making Information Gathering (more information on next slide) Application of Rules or Criteria that is applied Discussion Feedback Decision/Professional Judgment Reassessment

10. 10 Gathering, Documenting and Evaluation Information Who, What, When Where, Why, How Considerations in Documentation Evaluating the source of information

11. 11 Definitions Safety Risk Protective Capacity Minimum Sufficient Level of Care A safety assessment is determining the current threat of harm to the child. When making a safety assessment, there are two questions to ask: �Is the child currently safe? And if not, what needs to happen to ensure safety?� If the harm is moderate to severe, a safety plan is to be developed. Severe harm is defined as: �Danger to the child�s life or health Impairment to his or her mental well- being (including emotional abuse). Disfigurement Severe developmental impairment� �Assessing safety is grounded in (a) being well informed; (b) using prudence, reason and logic to analyze information; and (c) being conservatively guided to ensure child safety while being respectful of parents� rights.� What is the immediate threat? What is the nature and type of harm to the child? How severe are or could the consequences be to the child? What is the vulnerability of the child? How imminent is the possibility of harm? Risk Assessment is the process utilized by a county social worker to determine the likelihood that a child will be abused, neglected or exploited It does not predict when or how serious the harm may be, but rather the likelihood that harm will occur. While agencies may require risk assessment tools to be completed a various transitions in the case, the process of risk assessment is continuous. As new information is received regarding risk and protective capacities, decisions are made based on new information. Action for Child Protection defines protective capacity as �a specific quality that can be observed and understood to be part of the way a parent thinks, feels and acts that makes him or her protective.�[1] Additionally, protective capacity is inclusive of the resources that are available and can be utilized in achieving safety for the child. [1] Action for Child Protection. National Resource Center for Child Protective Services (NRCCPS) funded by the Department of Health and Human Services, Administration for Children and Families Children�s Bureau. Protective Capacities July, 2003http://www.actionchildprotection.org/archive/article0703.htm retrieved 1/20/05 Behavioral characteristics �specific action, activity and performance that is consistent with and results in parenting and protective vigilance Does the care taker have the physical capacity and energy to care for the child? If the caretaker has a disability(ies) ( i.e. blindness, deafness, paraplegia, chronic illness).how has the caretaker addressed the disability in parenting the child Cognitive characteristics- �the specific intellect, knowledge, understanding and perception that contributes to protective vigilance.� Emotional characteristics - specific feelings, attitudes and identification with the child and motivation that result in parenting and protective vigilance �The minimum sufficient level of care is a social standard, a minimum of parent behavior. The minimum sufficient level of care is the point below which a home is inadequate for the care of a child. This standard is meant as a minimum, not an ideal. The courts and public agencies do not have the right to dictate childrearing values to parents, but can require that no danger exists for the child. This standard implies that children need a certain amount of physical and emotional nurturing. Without it, the child is deprived of the care needed to reach satisfactory adulthood. When parenting falls below this standard, state intervention for the safety of children is warranted. . In other words, the same criteria used in deciding to remove a child should be used when making a decision to reunite the family.� It maintains the child�s right to safety and permanence while not ignoring the parents� right to their children. It is required by law (as a practical way to interpret the �reasonable efforts� provision of PL 96-272). It is possible for parents to reach. It provides a reference point for decision-makers. It protects (to some degree) from individual biases and value judgments. It discourages unnecessary removal from the family home. It discourages unnecessarily long placements in foster care. It keeps decision-makers focused on what is the least detrimental alternative for the child. It is sensitive across cultures.� Have participants go to the Activity Circle for Safety, etc on page _____ and answer the question. What have you learned about safety, risk and protective capacity? Fill in your thoughts in the circles below Have participants go to the Activity Circle for MSLC on page _____ and answer the question. What are the challenges to applying the MSLC in a case? Fill in your responses in the circle below. A safety assessment is determining the current threat of harm to the child. When making a safety assessment, there are two questions to ask: �Is the child currently safe? And if not, what needs to happen to ensure safety?� If the harm is moderate to severe, a safety plan is to be developed. Severe harm is defined as: �Danger to the child�s life or health Impairment to his or her mental well- being (including emotional abuse). Disfigurement Severe developmental impairment� �Assessing safety is grounded in (a) being well informed; (b) using prudence, reason and logic to analyze information; and (c) being conservatively guided to ensure child safety while being respectful of parents� rights.� What is the immediate threat? What is the nature and type of harm to the child? How severe are or could the consequences be to the child? What is the vulnerability of the child? How imminent is the possibility of harm? Risk Assessment is the process utilized by a county social worker to determine the likelihood that a child will be abused, neglected or exploited It does not predict when or how serious the harm may be, but rather the likelihood that harm will occur. While agencies may require risk assessment tools to be completed a various transitions in the case, the process of risk assessment is continuous. As new information is received regarding risk and protective capacities, decisions are made based on new information. Action for Child Protection defines protective capacity as �a specific quality that can be observed and understood to be part of the way a parent thinks, feels and acts that makes him or her protective.�[1] Additionally, protective capacity is inclusive of the resources that are available and can be utilized in achieving safety for the child.

12. 12 Safety Assessment Questions to ask yourself: What is the immediate threat? What is the nature of the harm to a child? How severe are or could the consequences be What is the vulnerability to the child? Who imminent is the possibility of harm?

13. 13 Risk Assessment is� Future orientated Likelihood of maltreatment in the future Lower threshold

14. 14 Protective Capacity is� Ability or wiliness to use internal and external resources to mitigate the safety or risk concerns. Looking for the strengths RELATED to the risk.

15. 15 What you are looking for Behavioral Characteristics Cognitive Characteristics Emotional Characteristics Environmental Protective Capacities

16. 16 Minimum Sufficient Level of Care Page 15Page 15

17. 17 Activity: Scenarios for Safety, Risk and Protective Factors Look at the scenarios and develop additional information that raises the safety risk, demonstrates risk, and how the protective capacity mitigates risk.

18. 18 California Approach (Statewide Safety Assessment System) Uniform series of factors to be considered at uniform decision making points Throughout the life of the case Actual tools county choice Definitions and Main Concepts

19. 19 Assessment Factors for Safety Determination Current and prior maltreatment Child vulnerability Cultural and language considerations Perpetrator access to child Violence Propensity Social Environment Caregiver Protective Capacity Home environment Ability to meet child�s needs Caregiver/child interaction Safety Intervention Pre-placement preventative services Refer to handbook � Assign three factors per table Caregiver capacity is large so may want to consider with only one other factorRefer to handbook � Assign three factors per table Caregiver capacity is large so may want to consider with only one other factor

20. 20 Referral Disposition All Safety Determination Factors Plus Current and prior CWS History Caregiver willingness to change Ability to Locate Will look at these factors in application in second vignetteWill look at these factors in application in second vignette

21. 21 Safety Determination Factors The following slides are focused safety determination factors.

22. 22 Current and prior maltreatment History of abuse, neglect Severity of abuse Type of abuse Frequency of abuse Research indicates that prior maltreatment is an indication for future maltreatment. (Peterson, M. S., and Durfee, M. 2003) There are typically low, moderate and high risk locations on the body when addressing physical abuse. (Brittain, and Hunt, 2004) Chronic neglect can lead to changes in the brain. (Perry and Pollard, 1997) Research indicates that prior maltreatment is an indication for future maltreatment. (Peterson, M. S., and Durfee, M. 2003) There are typically low, moderate and high risk locations on the body when addressing physical abuse. (Brittain, and Hunt, 2004) Chronic neglect can lead to changes in the brain. (Perry and Pollard, 1997)

23. 23 Child vulnerability Age Health, mental health, developmental delays Behaviors Use of drugs or alcohol Engages in delinquent behavior In a study of child fatalities, (Lucas, et al, 2002) found that male fatality victims were over represented in the age groups of 1-4 and 4-15. Younger victims were more likely to have been physically abused by their perpetrator. Young victims were more likely to come from single, separated or divorced homes. Infant and young children who were killed more likely were alone with the perpetrator where as the older age (4-15) where more likely to have a sibling and/or mother present during the incident. (Hanson, et al., 2004) studied the mental health needs of children in Sacramento County for those in foster care and for those who were not in foster care, but active to MediCal. The authors found that while the reason for the need for mental heath services may be one or more factors for children in foster care, the rate of foster children needing mental health services occurred at 13% while those children on Medical needing mental health services was at 1%. The authors further suggest that the rate of foster care children needing mental health services is likely an �under representation� because of the prioritization of providing mental health services to those children who are more symptomatic and more with more severe mental health issues. Additional evidence suggested that foster children�s medical needs (except for severe conditions) also may not being met, because of lack of consistent medical care and follow up.In a study of child fatalities, (Lucas, et al, 2002) found that male fatality victims were over represented in the age groups of 1-4 and 4-15. Younger victims were more likely to have been physically abused by their perpetrator. Young victims were more likely to come from single, separated or divorced homes. Infant and young children who were killed more likely were alone with the perpetrator where as the older age (4-15) where more likely to have a sibling and/or mother present during the incident. (Hanson, et al., 2004) studied the mental health needs of children in Sacramento County for those in foster care and for those who were not in foster care, but active to MediCal. The authors found that while the reason for the need for mental heath services may be one or more factors for children in foster care, the rate of foster children needing mental health services occurred at 13% while those children on Medical needing mental health services was at 1%. The authors further suggest that the rate of foster care children needing mental health services is likely an �under representation� because of the prioritization of providing mental health services to those children who are more symptomatic and more with more severe mental health issues. Additional evidence suggested that foster children�s medical needs (except for severe conditions) also may not being met, because of lack of consistent medical care and follow up.

24. 24 Cultural and language considerations Connections to cultural identity Tribal connections Primary language not English Be aware of the Indian Child Welfare Act. Use of family members to interpret during an investigation is inadvisable (check with your county�s policy). Be aware of the Indian Child Welfare Act. Use of family members to interpret during an investigation is inadvisable (check with your county�s policy).

25. 25 Perpetrator access to child No legal impediments Non- protective caregiver does not engage in safety planning Caregiver takes steps to protect child

26. 26 Violence Propensity Criminal record Domestic Violence Previous history of violent behavior Weapons Aggressive, threatening behavior Abuse of animals is also linked to child abuse (Peterson, M. S., and Durfee, M. 2003) A strong link exits between domestic violence and child maltreatment (Peterson, M. S., and Durfee, M. 2003) Research indicates that victim caregiver is at risk to also abuse the child. (Hartley, 2004) Maltreatment is more prevalent in families that experience spousal abuse (DiLauro, 2004) The severity of spousal abuse is predictive if child maltreatment (DiLauro, 2004) Approximately 77% of children from violent families have been abused at some time. (DiLauro, 2004) Child fatalities occurred more frequently �at home, on the weekends and initiated by some family disturbance.� (Lucas, et al, 2002) Abuse of animals is also linked to child abuse (Peterson, M. S., and Durfee, M. 2003) A strong link exits between domestic violence and child maltreatment (Peterson, M. S., and Durfee, M. 2003) Research indicates that victim caregiver is at risk to also abuse the child. (Hartley, 2004) Maltreatment is more prevalent in families that experience spousal abuse (DiLauro, 2004) The severity of spousal abuse is predictive if child maltreatment (DiLauro, 2004) Approximately 77% of children from violent families have been abused at some time. (DiLauro, 2004) Child fatalities occurred more frequently �at home, on the weekends and initiated by some family disturbance.� (Lucas, et al, 2002)

27. 27 Social Environment Connections with: Family Community Church Neighborhood Availability of supports (Lyons et al., 2005) researched the effects of informal supports on parenting practices for maltreating families. The authors suggest that it is important to assess the informal supports capacity to �provide constructive parenting support� in order to enhance altering inappropriate parenting practices. Ansay, Perkins, (2001) studied families that participated in visitation center activities and those that did not and its impact on reunification. In general, families that were in visitation center activities, including visits, were more likely to have visits with their children and more likely to reach a permanent place outcome. Case closure, (from adoption or reunification) occurred earlier than those families that did not have involvement with a visitation center. For those who did not participate in visitation centers, adoptions was a more likely outcome, suggesting a need for reaching out to non- participating families for supervised interaction with their children.(Lyons et al., 2005) researched the effects of informal supports on parenting practices for maltreating families. The authors suggest that it is important to assess the informal supports capacity to �provide constructive parenting support� in order to enhance altering inappropriate parenting practices. Ansay, Perkins, (2001) studied families that participated in visitation center activities and those that did not and its impact on reunification. In general, families that were in visitation center activities, including visits, were more likely to have visits with their children and more likely to reach a permanent place outcome. Case closure, (from adoption or reunification) occurred earlier than those families that did not have involvement with a visitation center. For those who did not participate in visitation centers, adoptions was a more likely outcome, suggesting a need for reaching out to non- participating families for supervised interaction with their children.

28. 28 Caregiver Protective Capacity Engagement with Agency Health, mental health history Drug, alcohol use Parenting, Disciplining Ability to Protect Family of origin- abuse, neglect Communication skills Problems with adult relationships Socioeconomic status  In a review of 24,900 infants� cases, �caretaker emotional disturbance, violence between caretakers and prior physical abuse were all associated with increased risk of later physical abuse.� (Palusci, et al, article in press, 2005)Documented history of mental illness, Depression remains a significant risk factor for perpetrators. Mood disorders, personality disorders and PTSD symptoms in caretakers are likely to maltreatment (DiLauro, 2004)As high as 80% of CPS caseloads have AOD as an issue. Additionally AOD is associated primarily with neglect and physical abuse cases. (DiLauro, 2004) Families in which their AOD lead to involvement of criminal activities were the most likely to have child maltreatment re-occur. The connection between service provision and reoccurrence of maltreatment also suggested that AOD-involved single African American women were most at risk for maltreatment re-occurrence. (Fuller and Wells, 2003) A strong relationship between poverty and maltreatment, but across all classes (DiLauro, 2004)Poverty and neglect are more strongly related than poverty and abuse. (DiLauro,2004)Lower educational and employment levels are more likely to lead to neglect rather than physical abuse. (DiLauro, 2004)�TANF receipt (in the absence of employment) is associated with a greater risk of CPS reports compared to those who leave TANF without work, those who work without welfare, and those who combine both work and welfare.� (Slack,et al., 2003) The authors suggest that those families who combine work and welfare, may have an enhanced ability to �manage the demands of work and parenting when cash welfare benefits continue� and thus may provide a protective capacity for the child.Berger (2004) analyzed data from the National Longitudinal Survey of Youth to explore the effects of income, family structure, and public policies on several indicators of child maltreatment. The analysis provided �some tentative evidence that higher welfare benefits and lower unemployment rates may serve as protective factors for children.� Training on substance abuse and cycle of addiction is recommended.In a review of 24,900 infants� cases, �caretaker emotional disturbance, violence between caretakers and prior physical abuse were all associated with increased risk of later physical abuse.� (Palusci, et al, article in press, 2005)Documented history of mental illness, Depression remains a significant risk factor for perpetrators. Mood disorders, personality disorders and PTSD symptoms in caretakers are likely to maltreatment (DiLauro, 2004)As high as 80% of CPS caseloads have AOD as an issue. Additionally AOD is associated primarily with neglect and physical abuse cases. (DiLauro, 2004) Families in which their AOD lead to involvement of criminal activities were the most likely to have child maltreatment re-occur. The connection between service provision and reoccurrence of maltreatment also suggested that AOD-involved single African American women were most at risk for maltreatment re-occurrence. (Fuller and Wells, 2003) A strong relationship between poverty and maltreatment, but across all classes (DiLauro, 2004)Poverty and neglect are more strongly related than poverty and abuse. (DiLauro,2004)Lower educational and employment levels are more likely to lead to neglect rather than physical abuse. (DiLauro, 2004)�TANF receipt (in the absence of employment) is associated with a greater risk of CPS reports compared to those who leave TANF without work, those who work without welfare, and those who combine both work and welfare.� (Slack,et al., 2003) The authors suggest that those families who combine work and welfare, may have an enhanced ability to �manage the demands of work and parenting when cash welfare benefits continue� and thus may provide a protective capacity for the child.Berger (2004) analyzed data from the National Longitudinal Survey of Youth to explore the effects of income, family structure, and public policies on several indicators of child maltreatment. The analysis provided �some tentative evidence that higher welfare benefits and lower unemployment rates may serve as protective factors for children.� Training on substance abuse and cycle of addiction is recommended.

29. 29 Home environment Inadequate, dangerous housing Special concerns regarding homelessness

30. 30 Ability to meet child�s needs Basic needs Stable vs transient life style (Dopke, et al., 2003) compared �high risk� individuals ( likely to abuse) and �low risk� individuals regarding differences in determining whether a child�s behavior was perceived as compliant or non- compliant. �Although high- and low-risk individuals were equally able (both with moderate accuracy) to discriminate between compliance and noncompliance, high-risk individuals appeared less �willing� to consider behaviors to be compliant. It is important then to assess parent�s perception of child�s behavior and the level of �bias� of determining whether a child is compliant or non compliant. (Rodriguez and Price, 2004) found in a study of the participant�s attitude toward their own childhood discipline, that participants who perceived themselves to deserve the discipline they received, �they were more likely to report attitudes consistent with physical abuse � and to indicate they would implement harsher, more abusive discipline with their own children.� This finding is consistent with previous research and �supports the large body of historical literature on the cycle of violence.�(Dopke, et al., 2003) compared �high risk� individuals ( likely to abuse) and �low risk� individuals regarding differences in determining whether a child�s behavior was perceived as compliant or non- compliant. �Although high- and low-risk individuals were equally able (both with moderate accuracy) to discriminate between compliance and noncompliance, high-risk individuals appeared less �willing� to consider behaviors to be compliant. It is important then to assess parent�s perception of child�s behavior and the level of �bias� of determining whether a child is compliant or non compliant. (Rodriguez and Price, 2004) found in a study of the participant�s attitude toward their own childhood discipline, that participants who perceived themselves to deserve the discipline they received, �they were more likely to report attitudes consistent with physical abuse � and to indicate they would implement harsher, more abusive discipline with their own children.� This finding is consistent with previous research and �supports the large body of historical literature on the cycle of violence.�

31. 31 Caregiver/child interaction Evidence of bonding, attachment Role Reversal Parents who have: unrealistic expectations or distorted perceptions, display less ability to solve problems, lack awareness of age appropriate behavior, display harsher discipline, inability to empathize, have regular difficulty parenting when children are non-compliant are more likely to maltreat their children. (DiLauro, 2004) Parents who have: unrealistic expectations or distorted perceptions, display less ability to solve problems, lack awareness of age appropriate behavior, display harsher discipline, inability to empathize, have regular difficulty parenting when children are non-compliant are more likely to maltreat their children. (DiLauro, 2004)

32. 32 Safety Interventions Safety plan A review of the records is one of the best indicators of future maltreatment. A review of the records is one of the best indicators of future maltreatment.

33. 33 Pre-placement preventative services History of services utilization Does situation warrant not offering PPS?

34. 34 Referral Disposition All Safety Determination Factors Plus Caregiver�s willingness to change Ability to locate Current and prior CWS History Process the last two questions on the worksheet. (What are your feelings about this child, mother and/or father? Given your feelings, do you think you have concerns about being effective with this family? If so, what are some potential resources to help you address your feelings in order to be effective with this family?) Encourage the exploration of formal and informal resources for the worker to work in this field. Suggest that for some, therapy may be indicated and that is a common resource for workers who stay in the field. Background for trainer � Bill has not moved in his position about what are the concerns for his family and child. Lindsey has been placed out of the home with the foster parents, Mr. and Mrs. Brown, and is doing well in placement. Bill is avoiding meeting with the worker at this time. Play the video for the participants. Ask participants to re- assess the mother regarding safety, risk and protective capacity. Review additional persons to obtain information.Process the last two questions on the worksheet. (What are your feelings about this child, mother and/or father? Given your feelings, do you think you have concerns about being effective with this family? If so, what are some potential resources to help you address your feelings in order to be effective with this family?) Encourage the exploration of formal and informal resources for the worker to work in this field. Suggest that for some, therapy may be indicated and that is a common resource for workers who stay in the field. Background for trainer � Bill has not moved in his position about what are the concerns for his family and child. Lindsey has been placed out of the home with the foster parents, Mr. and Mrs. Brown, and is doing well in placement. Bill is avoiding meeting with the worker at this time. Play the video for the participants. Ask participants to re- assess the mother regarding safety, risk and protective capacity. Review additional persons to obtain information.

35. 35 Current and Prior CWS History Previous Referrals, Investigations Founded, inconclusive, unfounded Previous responses to interventions

36. 36 Ability to locate Availability of caregivers Caregivers make child available

37. 37 Caregiver willingness to change Actions are congruent with statements States there are problems Invests in and cooperates with case plan

38. 38 Case Application Smith Family Carley calls her grandmother because she is afraid when she is left alone The mother, Crystal is addicted to drugs The mother�s boyfriend has been involved with the mother for two years

39. 39 Post test� Day 2, Segment 4Day 2, Segment 4

40. 40 Case Application Dutton McAdams Family Three year old Lindsey has been injured while the father was fighting with the mother Lindsey has injuries to her face and neck

41. 41 Safety Planning Rationale Safety threshold definition Four facts Specific observable condition Family condition is out of control Condition reasonably could have a SEVERE effect on the child Effect is imminent The trainer should direct the participants to the Dutton- McAdams case vignette and a Safety, Risk and Protective Capacity Worksheet on pages Have the participants read the referral and interview with Lindsey Dutton. In small groups, have the participants discuss and document on the worksheet what is known about the family, what additional information is needed. Play the video of the mother�s interview. Have participants convene back in small groups and continue the assessment process. Review the written material on the interview with Bill Dutton. Continue the assessment process. Have groups report out what the safety issues are, what are the risk factors, and any identified protective capacity factors. In small groups, have each group process one of the questions on the second page of the worksheet (flip chart paper could be used) (reserve last two questions to be addressed as Activity X.) Have each group report out answers, with the larger group adding additional information. Check with the group for any fairness and equity issues.The trainer should direct the participants to the Dutton- McAdams case vignette and a Safety, Risk and Protective Capacity Worksheet on pages Have the participants read the referral and interview with Lindsey Dutton. In small groups, have the participants discuss and document on the worksheet what is known about the family, what additional information is needed. Play the video of the mother�s interview. Have participants convene back in small groups and continue the assessment process. Review the written material on the interview with Bill Dutton. Continue the assessment process. Have groups report out what the safety issues are, what are the risk factors, and any identified protective capacity factors. In small groups, have each group process one of the questions on the second page of the worksheet (flip chart paper could be used) (reserve last two questions to be addressed as Activity X.) Have each group report out answers, with the larger group adding additional information. Check with the group for any fairness and equity issues.