SAFE RELATIONSHIPS, SAFE CHILDREN
APPENDICES FOR GUIDE TO ENHANCE PRACTICE
Revised Draft Appendices v.03 13 January 2015
Table of Contents
Appendix A: Summary Table of Health and MCFD Practitioner Roles and Responsibilities ... 3
Appendix B: Supports and Services ... 6
Appendix C: Stages of Change Tool ... 9
Appendix D: Summary of Safe Relationships, Safe Children Practice Pathway ... 11
Appendix E: Parent & Child Needs (PAC-Needs) Intake Tool ... 13
Appendix F: Speaking with a Child or Youth ... 21
Appendix G: Protective and Risk Factors for Children Identification Tables ... 23
Appendix H: Summary of Domestic Violence Risk Factors ... 27
Appendix I: Grounding Strategies ... 29
Appendix J: Current Services Exercises ... 31
Appendix K: Information Sharing Quick Reference Tool ... 32
Appendix L: Reflective Practice Checklist for Family-Centred Practice... 34
Appendix A: Summary Table of Health and MCFD Practitioner Roles and Responsibilities
Health
Entry Points to Service (illustrative examples – not intended as a comprehensive list)
Step 1 Step 2 Step 3 Step 4 Step 5 Additional Activities might include …
Identify Adults in a Parenting Role Engage Parent on Needs Inquire about Child Needs Identify Risk and Protective Factors for Children Identify Urgent/ Emergent issues Stabilize & Plan for Safety Collaborate & Connect to Required Resources Share Info to Support Safety/Wellbeing Monitor Risk/Review Goals & Progress Reflect on Progress & Practice
Service providers in some settings/organizations might have a mandate to provide other relevant
supports/services.
This column provides examples of some additional responsibilities that might be within the existing role and scope of practice for some practitioners.
General
Practice/Primary Care GPs can provide assessment, diagnosis & treatment of some adult, child & youth mental health & substance use disorders and/or initiate referrals.
Emergency
Public health
Child and Family health Those with specialized roles (e.g., psychiatrists, pediatricians, psychologists) might provide assessment, diagnosis & treatment of some adult, child & youth mental health & substance use disorders
Adult MHSU Assessment, diagnosis & treatment of adult mental health & substance use disorders
Child & Youth MHSU Assessment, diagnosis & treatment of child & youth mental health & substance use disorders
Physicians Physicians can complete a Medical Certificate if a
person meets the involuntary admission criteria of the Mental Health Act.
MCFD
Child Safety/Welfare &
Delegated Aboriginal Agency Child Safety
Child protection social workers are legally mandated to respond to reports of suspected child abuse or neglect
Children and Youth with
Special Needs
Youth Justice
Child and Youth Mental
Health Assessment, diagnosis & treatment of child & youth mental health & substance use disorders
See Appendix B “Supports and Services”
for examples of supports available through other involved programs, services, & community organizations
Initiate Contact/
Referrals as required – see
Appendix B
Initiate Contact/
Referrals as required – see
Appendix B
Additional Information about Roles and Responsibilities Regarding Specific Issues:
In addition to playing a role in the initial identification of those in a parenting role, and of potential needs related to the 3 core issues and the impacts on children, service providers in health authority and MCFD settings may, depending on their specific roles and scope of practice, be involved in delivery of specialized services required to further evaluate areas of need/concern or to provide intervention or other supports (Appendix B provides examples of other key supports and services). The following provides an overview of how to address specific issues that require additional or specialized support or service.
Assessment, diagnoses and treatment of adult mental health and/or substance use disorders:
• Although all providers can ask parents about potential concerns (i.e., initial identification), the formal assessment and diagnosis of mental health and/or substance use disorders is a specialized clinical function that is not within the role or scope of practice of all service providers. General Practitioners and other physicians in primary care settings often provide some assessment/diagnosis and intervention beyond initial identification, and/or help provide shared care for those with mental health and/or problematic substance use problems. Psychiatrists and mental health professionals in the adult mental health and substance use system will typically play a key role in arranging for and/or providing diagnostic assessments and intervention services related to mental health and/or substance use issues.
Evaluation and support regarding parental concerns about intimate partner violence:
• If parents disclose concerns regarding intimate partner violence, those in health authority and MCFD settings are to follow existing organizational policies, procedures and protocols, and the guidance in this document, that outline how to respond to support safety for the parent who discloses and for any involved children. The following general guidelines apply to all service providers:
o If a parent or their children are in immediate danger or need urgent medical attention, contact the police or ambulance services by calling 9-1-1 or the emergency number for your community.
o If it is not an emergency and there are no child protection concerns, practitioners and/or parents can contact VictimLink BC at: 1-800-563-0808 to obtain information and referrals for support.
• The formal evaluation and response to risks related to intimate partner violence is the responsibility of those in the justice sector and in MCFD Child Safety/child welfare.
• When concerns about intimate partner violence are disclosed, the role of health authority and other MCFD service providers (e.g., Child and Youth Mental Health, Children and Youth with Special Needs) is to contact, coordinate and collaborate with the justice sector and/or MCFD Child Safety if/as required, and to assist with contacting local community supports and services (e.g., victim services, transition house, safe home, counselling and other services – see http://www.pssg.gov.bc.ca/victimservices/directory/index.htm for a directory.)
• At the organizational level, Violence Against Women in Relationships (VAWIR) committees play a lead role in supporting local community coordination and collaboration amongst government and non-government agencies, and some communities have Integrated Community Assessment Teams (ICAT) teams that provide case-specific consultation and coordination in high-risk cases.
• Safety assessment and response to child protection concerns: MCFD has the lead responsibility for responding to suspected child abuse and neglect. It also delegates authority for child protection and family support to Aboriginal Child and Family Services Agencies, which provide services to their communities. See Guide to Enhance Practice (Step 3) for information regarding service provider responsibilities in relation to reports of child abuse or neglect.
• Justice and child welfare response to intimate partner violence: The justice system and MCFD Child Safety/child welfare have specific roles and
responsibilities in responding to issues of intimate partner violence. Although those in health and in other MCFD services (e.g., Child and Youth Mental
counsel, Corrections, Victim Services, Court Services, Family Justice Services and the Family Maintenance Enforcement Program (http://www.pssg.gov.bc.ca/victimservices/shareddocs/pubs/vawir.pdf)
Assessment, diagnoses and treatment of infant, child and youth mental health and/or substance use concerns:
• Although all providers can ask parents about potential concerns (i.e., initial identification), the formal assessment and diagnosis of child and youth mental health and/or substance use disorders is a specialized clinical function that is not within the role or scope of practice of all service providers.
General Practitioners, Pediatricians and other physicians in primary care settings often provide some assessment/diagnosis and intervention beyond initial screening, and/or help provide shared care for those with mental health and/or problematic substance use. Child and Adolescent psychiatrists and mental health professionals (including MCFD Child and Youth Mental Health practitioners) in the mental health and substance use system will typically have the lead responsibility for arranging for and/or providing diagnostic assessments and intervention services related to infant, child and youth mental health and/or substance use issues. There are Children with Witness Abuse Counselling Programs in communities throughout BC (http://www.pssg.gov.bc.ca/victimservices/shareddocs/children-who-witness-abuse-counselling.pdf
Lead Practitioner Role:
• Families identified with additional needs that require integrated support from more than one service provider should experience seamless care, supported by a Lead Practitioner who assumes the role of supporting coordinated and collaborative services. The Lead Practitioner acts as the primary point of contact for the family, and the role involves coordination and advocacy. The Lead Practitioner is not a specific job, and the role can potentially be fulfilled by any of a number of different service providers. This includes those outside of MCFD and health authorities, such as those working in education and in community service organizations. The Lead Practitioner does not assume a role in supervising, managing or directing the work of other service providers, and the Lead Practitioner is not responsible for the work carried out by those from other agencies and organizations.
• The primary Lead Practitioner functions include:
o Acting as the primary contact for the family
o Supporting development of a coordinated and collaborative “team around the family”
o Coordinating the planning and referrals in support of the family
o Advocating for families experiencing barriers in accessing needed supports and services
• The Lead Practitioner will typically be someone who already has a significant role with the family. The designation of someone as the Lead Practitioner should come from those already working with the family, and should be based on discussion and agreement between families and involved service providers. For MCFD service providers, the role is functionally equivalent to the Integrated Case Manager, outlined in Integrated Case Management documents and training.
• For more information about designation of a Lead Practitioner consult the UK resource:
http://www.devonchildrenstrust.org.uk/toolkit/lp/Lead%20professional%20guidance.pdf
Appendix B: Supports and Services1
Program/Service Supports and Resources List (illustrative examples, not intended as a comprehensive list)
Police Contact 911 in situations involving immediate danger/safety concerns. This includes immediate safety concerns for adults and children related to any of the three core issues (e.g., mental health crisis, drug/alcohol medical crisis, danger/safety concerns due to intimate partner violence).
Help Lines for Children and Youth
• Youth Against Violence Line – For youth wanting to talk one-on-one about their safety or the safety of others. Call or email a Youth Against Violence support worker 24 hours a day, 7 days a week, in a confidential, multilingual service. Call 1-800-680-4264 or email
• Helpline for Children (in British Columbia – available 24/7)) – For concerns regarding abuse. Call 310-1234 (no area code required).
This line is available 24 hours a day, 7 days a week. Also see the Helpline for Children website.
• Kids Help Phone (available 24/7) – provides telephone counseling. Call the Kids Help Phone at 1 800 668-6868. Confidential &
anonymous.
VictimLink BC
VictimLink BC (1-800-563-0808) provides information on programs and services available for victims of crime. Service providers or individuals can contact VictimLink BC directly – their phone number is toll-free, confidential, and available 24 hours a day, 7 days a week. Victim service workers offer information and referral services to all victims of crime and immediate crisis support to victims of family and sexual violence. Also see http://www.domesticviolencebc.ca/ for the most up-to-date information about supports and services.
Government &
Police-Based (contact
VictimLink BC for additional info)
B.C. Government & Police-based Domestic Violence Programs & Services include:
• More than 90 police-based victim service programs in B.C. operating out of RCMP detachments & municipal police departments.
• The Crime Victim Assistance Program provides medical expenses, counselling services, protective measures, income support and other benefits to assist eligible victims of crime and their immediate family members.
• The Victim Safety Unit provides notification services to registered victims of crime regarding the custody status of an accused or offender including releases from custody and information about conditions that must be followed when in the community.
Community- Based Victim Service Programs (contact
VictimLink BC for
B.C. Community-based Domestic Violence Programs & Services include:
• Over 60 community-based victim service programs provide emotional support, information, referrals, justice system support and safety planning for victims of family and sexual violence.
• Over 90 Stopping the Violence Counselling Programs across provide counselling for women who have experienced violence in relationships to help them deal with the trauma of the experience. Call VictimLink BC at 1-800-563-0808.
• Transition Houses and Safe Homes and second stage housing. These safe, temporary housing measures provide access to emotional support 1See the following for additional information about roles and responsibilities for responding to intimate partner violence:
BC Ministries of Public Safety and Solicitor General, Attorney General, & Children and Family Development (2010). Violence Against Women in
Program/Service Supports and Resources List (illustrative examples, not intended as a comprehensive list) additional
information) and help in accessing housing, child care, and financial, medical, legal assistance.
• Outreach Service Programs and Multicultural Outreach Service Programs. There are more than 50 outreach services programs in B.C.
that respond to the needs of women and children who have experienced or are at risk of violence, and another dozen multicultural outreach service programs. Services include supportive counselling for women, referrals to community services, local transportation, accompaniment and advocacy.
• Children Who Witness Abuse Counselling Programs provide individual and group counselling services for children who witness abuse of a parent. To connect with a local program call VictimLink BC at 1-800-563-0808.
• The Ending Violence Association of British Columbia (EVA BC) works to coordinate and support the work of victim-serving and other anti- violence programs in British Columbia through the provision of issue-based consultation and analysis, resource development, training, research and education.
Adult Mental Health &
Substance Use
HereToHelp ( http://www.heretohelp.bc.ca/get-help ) provides a comprehensive listing of information about mental health and substance use.
24/7 Phone Lines for those in crisis:
• Call 911 in emergency situations in which someone’s life is in danger
• Local crisis lines: Call for information on local services or for someone to talk to. If a person is in distress, they can call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
• 1-800-SUICIDE: 1-800-SUICIDE (1-800-784-2433).
Information on MHSU Supports & Services
• Family Physicians can provide/and or initiate referrals for Adult MHSU services.
• HealthLink BC: Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information, including mental health and substance use information.
• The Alcohol & Drug Information and Referral Service: Call 1-800-663-1441 (toll-free in BC) or 604-660-9382 (in the Lower Mainland) to find resources and support. They can provide info on treatments and counsellors across the province.
Child and Youth Mental Health &
Substance Use
The Kelty Mental Health Resource Centre (http://keltymentalhealth.ca/node/2572 ) is a provincial resource centre that provides mental health and substance use information, resources, and peer support to children, youth and their families from across BC. The site includes information on emergency/urgent services, and on non-urgent supports and services.
Crisis/Urgent
• Call 911 in emergency situations in which someone’s life is in danger.
• 1-800-SUICIDE: 1-800-SUICIDE (1-800-784-2433).
• Local crisis lines: Call for information on local services or for someone to talk to. If a person is in distress, they can call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal.
• Child and Adolescent Mental Health Crisis Response Units – See http://keltymentalhealth.ca/mental-health/navigating-mental-health- system for details. Some communities have crisis response teams that can respond to urgent situations and help do initial stabilization, triage, and referral.
Information on non-emergency services (from Kelty Mental Health Resource Centre):
• Family Doctor (GP) • School Teacher / Counsellor
• Child and Youth Mental Health (MCFD) • Private Counsellor / Psychologist
• Aboriginal Services • Family Support Organizations
Program/Service Supports and Resources List (illustrative examples, not intended as a comprehensive list)
• Cross-Cultural Clinician • Alcohol and Drug Information and Referral Line
Appendix C: Stages of Change Tool
Stage of Change Characteristics Techniques Pre-contemplation
Sees no need to change (not intending to take action within the next 6 months)
Not currently considering change.
Not interested in changing or interested in any help.
Projects blame and defensiveness.
May have tried to change in the past but has become demoralized about their ability to do so.
Labeled as resistant or unmotivated but in fact services may not designed or matched to their needs.
Focus on provision of information about issue (MH, SU or IPV)
Raise the client's awareness of the problem and the possibility of change. Do not give prescriptive advice.
Validate lack of readiness and clarify that decision to change is theirs.
Encourage re-evaluation of current behaviour, encourage self-exploration, not action.
Explain and personalize the risk.
Develop harm reduction strategies with client.
Contemplation Considers change but also rejects it (not considering change within the next month)
Ambivalence is the main
characteristic of this stage. "Sitting on the fence" about change.
People are more aware of the pros of changing but acutely aware of the cons.
Loose timeframe is to change within the next 6 months.
Help the client tip the balance in favour of change and to see the benefits of changing and the consequences of not changing.
Validate lack of readiness, clarify that the decision is theirs.
Discuss options to overcome barriers to changing behaviour.
Preparation
Wants to do something about the problem (planning to act within 1 month)
At this stage, the person engages in specific actions to bring about change. The goal during this stage is to produce change in a particular area or areas.
Focus on restructuring cues and social support.
Bolster self-efficacy for dealing with obstacles.
Combat feelings of loss and reiterate long-term benefits.
Help the client to take steps toward change.
Stage of Change Characteristics Techniques Action:
Practicing new behaviour for 3-6 months
At this stage, the person engages in specific actions to bring about change. The goal during this stage is to produce change in a particular area or areas.
Focus on restructuring cues and social support.
Bolster self-efficacy for dealing with obstacles.
Combat feelings of loss and reiterate long- term benefits.
Help the client to take steps toward change.
Maintenance
Continued commitment to sustaining new behaviour ( 6 months to 5 years)
Clients have engaged in and used services and resources, risks to children have been reduced.
Clients are also able to successfully avoid any temptations to return to the using.
Clients are able to maintain the new status quo with increased
confidence.
Plan for follow-up support.
Reinforce internal rewards.
Discuss coping with relapse.
Help the client to identify and use strategies to prevent relapse.
Relapse
Resumption of old behaviours
Returning to a previous stage:
increased denial, feeling as though they don’t need to continue.
Relapse on drugs and alcohol.
Evaluate triggers for relapse.
Reassess motivation and barriers.
Plan stronger coping strategies.
Help the client to renew the processes of contemplation, preparation, and action, without becoming stuck or demoralized because of relapse.
Adapted from:
• Prochaska, J. & DiClemente, C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19, 276-288
• Treatment planning based on stages of change model. Retrieved from http://familytalk.ca/wp- content/uploads/2012/09/Stages-of-Change1.pdf.
Appendix D: Summary of Safe Relationships, Safe Children Practice Pathway
“SEE OVER”
A standard, 2-page Practice Pathway Summary has been developed. Additional work is underway to develop other formats (including flow chart diagram) for use in a variety of settings.
The following questions/form can be used “as is” or required elements can be added to existing intake or other data- gathering forms. All service providers are to collect information about parental status at entry to health and child serving systems.
Appendix E: Parent & Child Needs (PAC-Needs) Intake Tool Part A
Adult/Parent Name: _________________________ Date of Birth: ____________________
Practitioner name: __________________________ Date PAC-Needs completed: ____________________
ESSENTIAL QUESTIONS ABOUT PARENTING STATUS
Are you a parent, an expectant parent, or are you one of the caregivers for children or youth under the age of 19?
(Including, for example, an expectant parent, step-parent, grandparent, foster parent, other relative or caregiver, or a partner to a parent).
Y N
If No, continue with your usual process. If Yes, continue with the following:
What is the gender and age of each child? Are you currently the child’s
full-time primary caregiver?
1. Child Name: ____________________________ Age: _________ M F Y N
2. Child Name: ____________________________ Age: _________ M F Y N
3. Child Name: ____________________________ Age: _________ M F Y N
4. Child Name: ____________________________ Age: _________ M F Y N
If no, which of the following best describes the contact you have with your child(ren)?
Regular part-time care
Some access or visits, or
Very little or no contact
Are you currently receiving services to assist you with your parenting? Y N Do you wish to have any support around your involvement with your children? Y N Introductory statement
“Is it okay if I ask you some questions about how you and other family members are doing? Our goal is to help support you and your entire family in relation to your health needs and those of your family. The questions are to assist us in better
understanding those needs, and support you to connect with resources. Your answers will help us to get a better idea of what is happening for your family, and to suggest potential supports and services that may be helpful.
Before I begin, I want to remind you that completion of any/all of these questions is voluntary. You do not have to answer any or all of these questions if you don’t want to, and you do not need to explain your decision. Privacy - Your answers will remain confidential unless they indicate a risk of harm to you, your child, or another person. You can skip any question that you do not want to answer. Is it okay if ask you the additional questions?”
AREA A1. MENTAL HEALTH/COPING SKILLS Introduction
“The first questions are about your mental health and well-being. The impact of mental health and substance use problems in British Columbia is much more common than many people realize. Each year about 1 in 5 people will experience significant mental health and/or substance use problems that cause distress and have an impact on their ability to function. Some people who experience mental health and/or substance use problems are also more likely to have experienced adverse or traumatic life events. For example, a history of childhood trauma, poverty, or significant loss can contribute to health impacts in adulthood, including physical health and mental health challenges”.
Does anyone in the family have any mental health concerns, a serious mental illness* or disability?
Y N Sometimes
Can you tell me if there is any support being received to help manage these concerns? (for example, visiting a mental health worker, GP, counsellor or caseworker)
Details___________________________________________________________________________________________
_________________________________________________________________________________________________
Do you struggle with, or have any concerns with, managing your feelings or emotions (e.g., anger, sadness, worry).
Y N Sometimes
Do you ever hear voices or have problems with your thoughts? Y N Sometimes
Details___________________________________________________________________________________________
_________________________________________________________________________________________________
Have you ever been given medication for emotional problems (e.g. “nerves, anxieties, worries” or other)
No, never
Yes, in the past but not currently
Yes, currently. Medication(s): _________________________________
If the parent answers YES to any of the above, ask
Do the symptoms (feelings or emotions) you have described contribute to any difficulties for you in any of the following areas such as:
Your health (e.g. sleep disturbance)
Finances (e.g. managing resources to buy food, pay gas and electricity bills/rent)
Parenting your kids (e.g. getting the kids to school, spending time with your kids)
Details___________________________________________________________________________________________
_________________________________________________________________________________________________
*This includes forms of psychosis, schizophrenia, bipolar or similar conditions. If a serious mental illness is present, practitioners should check to ensure that the individual is connected with professional clinical support.
AREA A2. SUBSTANCE ABUSE/USE Introduction
“I’m going to ask you a few questions about your use of alcohol and other drugs during the past 3 months. These questions are not a judgment of your use of alcohol or drugs, but rather they will help us determine the best standard of service for you”
Have you used alcohol or other drugs? (illegal drugs, inhalants, prescription/over-the-counter drugs) Y N
In the last three months, have you felt you should cut down or stop drinking or using drugs?
Y N Sometimes
In the last three months, has anyone annoyed you or gotten on your nerves by telling you to cut down or stop
drinking or using drugs? Y N
In the last three months, have you felt guilty or bad about how much you drink or use drugs? Y N In the last three months, have you woke up wanting to have an alcoholic drink or use drugs? Y N Does your (or your partner’s) use of alcohol or drugs contribute to any difficulties for you in any of the following areas such as:
Your health (e.g. sleep disturbance)
Finances (e.g. managing money to buy food, pay gas and electricity bills/rent)
Parenting your kids (e.g. getting the kids to school, spending time with your kids)
Details___________________________________________________________________________________________
_________________________________________________________________________________________________
Would you like help with managing the impact of drugs or alcohol on these areas? Y N AREA A3. FAMILY SAFETY/ FAMILY RELATIONSHIPS
Introduction
“It is quite common for parents to experience stress in their relationships, and this can be more challenging if they are
experiencing health or other stressors. This could result in some tension in their relationships and the way they talk to each other.
For this reason we now ask all parents some questions about family safety. May I ask you a few questions?”
Do you have any reason to be concerned about your own safety or the safety of your children? (physical, mental, emotional)
Y N Sometimes
Do you have any other concerns about your children’s well-being at the moment?
Y N Sometimes
Do you have reason to be concerned about the safety of anyone else in the family, pets or property?
Y N Sometimes
If the parent answers YES to any of the above, ask
Would you like help to improve your safety or the safety of your child/ren? Y N
PAC-Needs Intake Tool
Part B – Child Needs
AREA B1. PARENTING AND THE THREE CORE ISSUES Introduction
Being a parent can be a major motivator for individual change. Talking about parenting is particularly important to supporting families with multiple needs, as parents may be unaware of the services and help available to them.
If a parent has identified concerns and issues related to one or more of the three core issues, it may be appropriate to ask them the following questions to get a better sense of how MH, SU & IPV issues in the family are affecting their parenting capacity and their children.
• How concerned are you about this issue?
• How do you think this issue impacts your parenting? Do you parent differently when you are experiencing these problems?
• Do you think your children are aware of your issues? Have the issues been explained to them, do they seem to understand?
• If yes, how do you think these issues impact your children?
• Are you aware of any impacts on your children in terms of your relationship with them, other family/sibling issues, school, and peer functioning?
• What are the strengths and resources that help you manage this issue and might help you achieve what you hope for in relation to this issue?
• What do you need to support you and your family with this issue?
• When you think of yourself and your children what has kept you going? What would you describe as your strengths, each child’s strengths and your families strengths? How does your personality and your children’s personalities fit together? Is this mixture ever a challenge for you as a parent?
• What have friends, family and others in the community done that has worked well for you in the past? Would this work for you now?
• Do your children talk to you about their concerns? Is it hard to listen to their worries? Is it important to you that they can talk to you when they are worried? Is there support that would help you to listen to their concerns?
Use the following questions if relevant to the parent’s situation:
• When you are not well or the violence is escalating is there someone who knows your children and is available for your children if they are worried and needs support?
• Do you know when you are starting to not feel well or when violence is escalating? Do your kids know when you aren’t feeling well, do they know when violence may be escalating? Can you talk to them and decide how to get support? Do you have a safety plan in place?
• Parents affected by mental health, addictions and/or domestic violence sometimes worry about losing their children so may not look for support. Do you have any such worries? If so what would help you to ask for support? Can you think of any ways that asking for support could benefit you? What type of support would lessen your fear and are there others that would increase it?
AREA B2. QUESTIONS ABOUT CHILD BASIC NEEDS (Optional) Introduction
“From what you’ve told me so far, it sounds as though you and your child(ren) might be facing some challenges as a result of the difficulties that you described. If it’s okay with you I just want to check about some areas of basic child needs. These include questions about basic needs, such as health, nutrition, and housing.
May I ask you a few more questions so we can see if there are areas where you might want some support?”
Shelter/Housing
Would you describe your housing as adequate? (e.g. long-term, affordable, suitable location/amenities, safe and not
overcrowded) Y N
Would you like help with sleeping/housing arrangements for you and your children? Y N
Nutrition
Does everyone in the family have access to three meals a day, every day? (e.g. did the family have a hot meal for dinner last night, does their diet include fruit and vegetables) Y N Sometimes Would you like help with accessing food for your family? Y N
Health/Access to Health Care
Do you have any concerns about your health or about the health of your children? Y N Sometimes Do you have any concerns about your children’s’ social or emotional health? Y N Sometimes Do you have any concerns about your children’s learning, language or other skills? Y N Sometimes Do you have a regular family physician or other health
care provider that you and your children see regularly? Y N Sometimes If yes, how regularly do you see them?
Only when the kids are sick For regular checkups
If needs identified “Would you like help with finding health care services for these issues?” Y N Education
Does your child attend childcare, kindergarten or school? Y N Does your child have any attendance problems/miss much school? Y N
Do you have any concerns about how your child is doing at daycare/school? Y N Sometimes Would you like any help regarding childcare or school issues? Y N
“Thank you for answering these questions. Do you have any questions for me?”
PAC-Needs Intake Tool
Part C – Documentation Summary Form
Client
Name: ___________________________________ Date of Birth: _________________________
Source(s) of evidence used to complete this form
(check all that apply):
Historical/collateral information through pre-existing involvement Interview done today Questionnaire/intake form done today Other (describe below):
Summary of Identified Needs
Have the issues impacted on parenting? If yes, briefly describe:
Parent requests or agrees to support?
(check)
Section 1
Mental Health Issues
Psychiatric Crisis (suicidal, psychotic)?
Untreated Serious Mental Illness?
Other Mental health concern?
yes
yes
yes
no
no
no
unknown
unknown
unknown
yes no unknown
Section 2
Substance Use Substance Misuse Crisis?
Problematic substance use concern?
Receiving intervention/support?
Interested in reducing use?
Interested in support/counseling?
yes
yes
yes
yes
yes
no
no
no
no
no
unknown
unknown
unknown
unknown
unknown
yes no unknown
Section 3
Family Safety
Evidence of/self-report of intimate partner violence?
If ‘yes” – Is the person currently feeling unsafe/in danger?
Does the client live with the abuser?
Are the children exposed to the abuse/violence?
yes
yes
yes
yes
no
no
no
no
unknown
unknown
unknown
unknown
yes no unknown
Section 4
Basic Child/Youth Needs Housing
Health Nutrition Education
yes
yes
yes
yes
no
no
no
no
unknown
unknown
unknown
unknown
Suggested Referrals/Actions Actions taken
Mental Health Issues
Psychiatric Crisis Response Service referral
Follow-up appointment set to clarify “unknown” items
Referral for assessment of mental health concern
Referral for mental health support/intervention
Other (describe)
List of referrals made/dates:
Use Follow-up appointment set to clarify “unknown” items
Referral for assessment of substance use issues
Referral for substance use support/intervention
Other (describe)
Family Safety
Follow-up appointment booked to clarify unknown items
Support/refer/connect client with local police
Child Protection (local Ministry of Children and Family Development or Delegated Aboriginal Agency office)
Victim Link BC
Intimate Partner Violence Community Programs (further assessment, counseling, shelter)
Other (describe)
List of referrals made/dates:
Child-related needs (including support regarding child basic needs)
Follow-up appointment set to obtain additional information
Referral for follow-up assessment of child/youth needs related to parental issues
Refer for child/youth support/intervention services (e.g., Children who witness violence program, Child and Youth Mental Health)
Contact with/referral to MSDSI (social services) regarding family basic needs
Contact with MCFD/DAA Child Safety/Protection for support service request to assist family
Contact with MCFD Special Needs for support service request
Contact with MCFD/DAA Child Safety/Protection for report of child protection concern/duty to report (abuse, neglect)
Other (describe)
List of referrals made/dates:
Staff Signature: Date
Sources
Micah. (2012). Practice guide: Child and parenting needs for Micah projects adult-focussed teams to identify and respond to the needs of vulnerable children and their families. Retrieved from http://www.micahprojects.org.au/resource_files/micah/IR_108_Embedding-Child-Awareness-Practice- Guide.pdf
Area A1. Mental Health/Coping Skills. These items adapted from the Camberwell Assessment of Need (CAN). Key reference: Howard, L., Hunt, K., Slade, M., O'Keane, V., Senevirante, T., Leese, M., et al. (2007). Assessing the needs of pregnant women and mothers with severe mental illness: The psychometric properties of the Camberwell Assessment of Need - Mothers (CAN-M). International Journal of Methods in Psychiatric Research, 16, 177-185.
Area A2. Substance Use. These items adapted from the CAGE-AID questionnaire. Key reference: Brown, R.L., & Rounds, L.A. (1995).
Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice. Wisconsin Medical Journal, 94, 135-140.
Area A3. Intimate Partner Violence/family relationships. These items adapted from the practice framework to guide screening and assessment of domestic violence. Key reference: Winkworth, G., & McArthur, M. (2009). A practice framework to guide screening and assessment in the Australian Family Relationship Centres and Advice Line, Child and Family Social Work, 410-419.
Area B1. Parenting and the Three Core Issues. List of questions developed during Phase 1 by Roz Walls, Sonja Sinclair and Michelle Blais.
Area B2. Child Basic Needs. Developed out of practice mapping between Micah Projects and PRC. The domains and items also reflect key predictors of risk and resilience in research among homeless and low-income housed children (Buckner, 2008; Buckner, Bassuk, &
Weinreb, 2001; Masten et al., 1993; Rafferty, Shinn, & Weitzman, 2004). The content was revised slightly for use in the PAC-NEEDS.
Speaking with School-age Children or Youth. The development of the questions in this section was informed by the Australian online resource Children of Parents with a Mental Illness (COPMI): Key Questions for Children, available at
http://www.copmi.net.au/professionals/professional-fields/child-family-health/child-family-health-children.html
Appendix F: Speaking with a Child or Youth
There may come a time when it is appropriate to speak with a child or children of the parent you are working with and supporting. It is important to always work within your scope of practice/role (see Appendix A, Summary Table of Health and MDFD Practitioner Roles and Responsibilities).
Review the material under Step 2 – Think Child, in the Guide to Enhance Practice prior to initiating any questioning with children.
Don’t proceed:
• If the initial conversation with the parent results in/requires contact with police and/or child safety/protection.
• Without parent and child/youth consent.
• If the questions are causing distress (maintain trauma-informed approach in work with the children as well as with the parents).
Do:
• Complete parent questions first.
• Ask for parent/caregiver permission “Is it okay for me to have a brief conversation with your children about how they are doing, so they know who I am, and what we are planning to do? Would that be alright?
• Consider age and developmental capacity of children and their awareness of the issues and adapt your language/questions accordingly.
• Tell the child your name. Explain your role.
• Ask for their permission “I just met with your mom/dad/etc. and I am someone who is going to work with them to make a plan to do some things to help with some things for your family. Your mom/dad said it was okay for me to meet you and ask you a few
questions about your family, friends, school and interests. You don’t need to answer any of my questions if you don’t want to. Is it okay for me to ask you about a few things?
• Proceed with caution – children who have experienced trauma may find some questions triggering or distressing.
• Observe for areas of strength and for potential areas of risk, vulnerability, and//or need.
Questions for School-age Children/Youth - adapt if/as needed to be developmentally/culturally appropriate:
1. Who is in your family (include family pets)? Who lives at home with you?
2. Do you have chores? What kinds of things to you do to help out at your home?
3. What do you like about school? Dislike? Do you ever miss school? If yes, how often/why?
4. What are your interests, hobbies, sports, and favorite activities? Are you part of any clubs/groups/teams at school? Outside of school? What do you do during summer vacation?
5. Are there any hobbies or things you’d like to be doing but can’t? If yes, why?
6. Do you have enough friends? A best friend? How often do you do things together?
7. What kinds of things do you do on the weekends?
8. Do you have any worries about:
a. School, friends b. Family, parents
9. Do you ever feel scared or worried about your safety? If yes – obtain details on when/what they do to stay safe.
10. Who do you tell your worries to?
11. Who helps you when you need help?
12. What makes you really happy?
13. What are you really good at?
“Thank you for answering these questions. Do you have any questions for me?”
The responses to these questions and your observations can provide information about:
• Areas of child/youth/family strength that can be used in subsequent planning.
• Areas of child/youth expressed concern that may require follow-up evaluation and support.
• Risk factors including:
o Safety
o Caring responsibilities (responsibilities that are greater than expected/age- appropriate)
o Lack of social or educational participation (barriers to attending school, being involved with friends, interests).
When the child raises a concern or discloses maltreatment:
When a child or young person discloses maltreatment or neglect, the response they receive is critical. It is essential to support and validate them for making that disclosure, and to help them to feel, and be, safe. The following suggestions can assist practitioners when dealing with disclosures by children and young people.
1. Stay calm, listen carefully to what the child says, and allow them to talk at their own pace;
2. Do not (overly) question a child who has disclosed maltreatment;
3. If possible, while validating their disclosure, discourage the child from disclosing in detail to you – it is better that this information is given to someone in authority;
4. Reassure the child that they have done the right thing in telling you;
5. Do not agree to keep secrets and explain to the child that the information will likely need to be shared with others who can help them;
6. Tell them what you will do next, e.g. talk with someone whose job it is to help children or young people who have these things happening to them. (Micah, 2012).
If you think a child is being abused or neglected, you have the legal duty to report your concern to your local child welfare worker. Contact information is available on page 57 of the B.C. Handbook for Action on Child Abuse and Neglect: For Service Providers
http://www.mcf.gov.bc.ca/child_protection/pdf/handbook_action_child_abuse.pdf
If it is after hours or you are not sure who to call, phone the toll-free Helpline for Children at 310-1234 (no area code needed) at any time, day or night. You do not need an area code and you do not have to give your name.
If the child is in immediate danger, call 9-1-1 or your local police.
Appendix G: Protective and Risk Factors for Children Identification Tables
Both sections of this Table should be used as part of the planning process when adults in the parenting role have been identified as having significant needs related to mental health challenges, problematic substance use and/or intimate partner violence (MH, SU & IPV).
Name of
Parent: Birthdate :
Date of initial completion : Date(s) of update/revision :
The protective and risk factors tables will inform a strengths-based and family-centred response to supporting identified needs. The tables can initially be completed on the basis of information known through previous contacts/collateral information and/or through interviews. The tables can then be updated over time by making revisions and initialing them/dating the revisions in the margin of the table.
The first table is to assist with identification of strengths and protective factors that can be engaged to support infants, children and youth and their families. This table should be used to identify the strengths and assets of the children, caregivers, their support networks and communities. The table provides information about key protective and risk factors that can inform decision-making and planning, but the tables are not designed as psychometrically-based checklists capable of yielding overall scores or clinical cut-offs.
Children impacted should be monitored closely for indicators of their resilience and resourcefulness.
Identification should include items listed on the table of protective factors, but also extend to a search for other unique, creative and resourceful ways that impacted individuals have developed that can be utilized and strengthened in support planning.
The second table is to assist with identification of risk factors/indictors for infants, children and youth.
Note that the information in this table should be considered alongside the BC Summary of Domestic Violence Risk Factors (available in Appendix H) in situations where such violence is identified.
When identifying risks:
• Maintain trauma-informed lens. Central to this is focus on “what has happened to this person?”
versus “what is wrong with this person?” as an aide to developing understanding.
• Maintain family-centred, strength-based principles when working with family members.
• Link risks to needs – what actions/referrals/services/supports are required to address the need?