SAFE RELATIONSHIPS, SAFE CHILDREN

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DRAFT FOR REVIEW ONLY- DO NOT CIRCULATE

SAFE RELATIONSHIPS, SAFE CHILDREN

Community Implementation Toolkit

Revised Draft Document v.03 13 January 2015

Revised Draft Document v.03

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ABOUT THE TOOLKIT

Mental health, problematic substance use, and/or intimate partner violence issues (MH, SU & IPV) often go unrecognized, are misunderstood or are not addressed due to stigma, yet such issues can have a substantial cumulative impact on adults, their parenting capacity, and the needs of their children. Indeed, the presence of these three complex and sensitive issues, separately or in combination, can significantly reduce protective factors and increase risk factors for children. Invisible needs equal unmet needs, therefore it is essential that parents be supported in a safe manner to disclose their concerns and seek help for themselves and their children.

As part of the Safe Relationships, Safe Children initiative, health care and child serving agencies across British Columbia are tasked with ensuring that all staff members incorporate the steps of the Safe Relationships, Safe Children Practice Pathway into their work, shifting to a collaborative, safety-focused, family-centred practice in order to better identify, understand and support adults, children and families affected by MH, SU & IPV. The Toolkit provides guidance to help Community Leads roll out the initiative across the province during Phase 3, recognizing that each community is unique and has its own culture, processes, and capacity. The Safe Relationships, Safe Children initiative seeks to build on existing evidence - based practices and strong community partnerships (including partnerships with the anti-violence sector) already in place throughout the province. The initiative is meant to strengthen and enhance existing service mechanisms – not replace or restructure them.

Community Leads will be responsible for raising awareness about the initiative, encouraging collaboration across service lines and assisting agencies and organizations to assess strengths and gaps in supporting families with needs related to MH, SU & IPV.

In short, Community Leads are expected to:

1. Form an Advisory Committee 2. Consult with Families

3. Engage practitioners (including coordinating training)

The Toolkit is one of three main resources being developed for the initiative. Other resources include the Guide to Enhance Practice (which includes the Practice Pathway), and the Safe Relationships, Safe Children Curriculum. The guidance contained in the Toolkit represents the best information available at the time, and in large part reflects the experience, knowledge and expertise acquired during Phases 1 and 2 of the initiative.

Feedback on the Toolkit and Guide was also obtained through provincial and community-level engagement and consultation efforts with representatives from the anti-violence sector, including the Ending Violence Association of BC, the BC Society of Transition Houses and BC Women’s Hospital Woman Abuse Response Program. The use of Family Journey Mapping exercises with individuals who have accessed services in pilot communities was a valuable means of obtaining family perspectives to strengthen the approach. Ongoing engagement is expected, including plans to engage with the First Nations Health Directors Association, Métis Nation BC, the BC Association of Aboriginal Friendship Centres, and others as they are identified.

The terminology used for the three core issues that are the focus of this initiative was chosen very carefully.

The terms “mental health challenges” and/or “problematic substance use” are used as they are the most inclusive and are consistent with the language in Healthy Minds, Healthy People: A Ten-Year Plan to Address Mental Health and Substance Use in British Columbia. The term “intimate partner violence” was chosen over Revised Draft Document v.03

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the historical term “domestic violence” as the latter can also encompass child or elder abuse, or abuse by any member of a household (World Health Organization, 2012).

There is an important distinction to be made about IPV in relation to the other two core issues. Specifically – whereas MH & SU issues may or may not involve violence, IPV by definition does. IPV is best understood as a pattern of intentionally coercive and violent behaviour towards an individual with whom there is or has been an intimate relationship. It is a predominantly gendered phenomenon with women much more likely to be the victims and men the perpetrators. Untreated and unaddressed IPV is more than a health and social concern – it is a criminal matter involving the overt use of violence that calls for a justice system response.

Treatment is critical of course, but not the only issue. The involvement of the anti-violence sector to help reinforce the practice change recommended by the Safe Relationships, Safe Children initiative is key.

The nature of such diverse and complex needs related to MH, SU & IPV means that there will be multiple evidence-based intervention frameworks of relevance, depending on the nature of the main risk factors/problems.

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PRACTICE PRINCIPLES

The Safe Relationships, Safe Children initiative is guided by the following practice principles:

Safeguarding children is everyone’s responsibility.

Invisible needs equal unmet needs. Outcomes for parents and their children are improved and risk reduced when parental needs related to mental health, problematic substance use and intimate partner violence (MH, SU & IPV) are identified and supported early.

MH, SU & IPV issues are inter-related issues that affect the entire family. A comprehensive, family-centred and collaborative approach encourages practitioners to view and work with clients as individuals while also understanding them within the context of their family.

In cases of IPV, the safety and well-being of children are often dependent on the safety of the non-abusing mother. Wherever possible, supportive services should be offered to the mother in order to enhance her ability to continue to care safely for her children. In order to maximize women’s safety and the safety of their children, practitioners must have a firm understanding of the dynamics of power and control inherent in relationships where IPV is a factor.

Trauma-informed practices are essential given that MH, SU & IPV often occur in combination and that all are potentially linked to adverse experiences including past and present trauma. Witnessing or experiencing traumatic events can have a particularly devastating impact on children’s wellbeing and development. In addition, the gender imbalance in intimate partner violence places women at more frequent and greater risk of harm including trauma. The impact of women’s previous experiences of violence and the potential for re- traumatizing women seeking care must be closely considered.

A strengths-based approach looks for what parents and children do well despite problems and how they have tried to overcome their problems. It also inspires hope and encourages expectations for improvement and change. This approach is transparent and does not avoid difficult conversations about discrepancies in family member’s understandings of the issues at hand.

Collaboration and communication by professionals across child-focused and adult-focused services is vital to enable improved understanding, assessment and responses to parental and family issues. Improved outcomes for parents and their children are more likely to be met and risk reduced when information is shared effectively across agencies and when multi-agency and multidisciplinary partnerships are collaborative and coordinated.

Culturally safe and culturally appropriate services to children and families demonstrate respect for and builds on the values, preferences, beliefs, culture and identity of the child and family as well as their community. Practitioners need to be aware of and understand that parenting and family functioning are strongly influenced by culture and background, as are individual responses to MH, SU & IPV.

Outcome-based approaches are required – practitioners should tie the goals and strategies of services and supports to observable and measurable indicators of success, monitor progress in terms of these indicators, and revise strategies accordingly.

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ACKNOWLEDGMENTS

Currently under development.

Revised Draft Document v.03 2

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A. THE SAFE RELATIONSHIPS, SAFE CHILDREN INITIATIVE

The Safe Relationships, Safe Children initiative is one of many initiatives arising from Taking Action on Domestic Violence in British Columbia.¹ The action plan was developed in response to the 2012 Representative for Children and Youth’s (RCY) report, Honouring Kaitlynne, Max and Cordon: Make Their Voices Heard Now.² That report details the RCY’s investigation into the deaths in April 2008, of three young children, Kaitlynne, Max, and Cordon Schoenborn, at the hands of their father, Allan Schoenborn. Schoenborn had a long history of violence (including intimate partner violence), untreated mental health issues and problematic substance use problems.

The RCY’s report makes eight recommendations across five ministries. Taking Action on Domestic Violence in British Columbia provides full details of the comprehensive action plan for responding to the eight recommendations. A 2013 progress report³ on the plan is available on the Provincial Office of Domestic Violence (PODV) website. In addition, the government of BC released the Provincial Domestic Violence Plan⁴ in early 2014. The plan is the result of engagement with the community anti-violence sector, government partners, and others, and seeks to build on many areas of success and strength, and to identify and address priority areas in need of immediate attention.

Safe Relationships, Safe Children is but one component of these coordinated efforts. The initiative focuses specifically on the first recommendation of the RCY report, Honouring Kaitlynne, Max and Cordon: Make Their Voices Heard Now. Recommendation One is that the Ministry of Health (MoH) work in partnership with the Ministry of Children and Family Development (MCFD) to introduce protocols, policies and tools within health and child serving systems to ensure that all staff and professionals understand, identify and reduce risk factors for children and families affected by serious untreated parental mental illness, problematic substance use and/or domestic violence (MH, SU & IPV). The RCY report underscores the importance of approaches that are family-oriented and family-sensitive, while promoting the safety and well-being of children.

The Safe Relationships, Safe Children initiative also speaks to recommendations made in two other RCY reports released in 2014. In Lost in the Shadows: How a Lack of Help Meant a Loss of Hope for One First Nations Girl,⁵ the RCY reiterates the need to improve service coordination and collaboration for families where there is a parent with a mental illness, and highlights the significant barriers that First Nations families living in rural or isolated communities face in accessing required services. In Children at Risk: The Case for a Better Response to Parental Addiction,⁶ the RCY points to the need to fill existing service gaps for parents with substance use issues, their children, and other involved family members.

1 http://www.mcf.gov.bc.ca/podv/pdf/domestic_violence_response_booklet.pdf

2 http://www.rcybc.ca/Images/PDFs/Reports/RCY-SchoenbornReportFINAL%20Feb%2027.pdf

3 http://www.mcf.gov.bc.ca/podv/pdf/progress_report.pdf

4 http://www.mcf.gov.bc.ca/podv/publications.htm

5 https://www.rcybc.ca/sites/default/files/documents/pdf/reports_publications/rcy_lost-in-the- shadows_forweb_17feb.pdf

6 https://www.rcybc.ca/sites/default/files/documents/pdf/reports_publications/rcy_childrenatrisk-finalweb.pdf

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The success of the Safe Relationships, Safe Children initiative is also linked to and will be supported by other government commitments, including those in Taking Action on Domestic Violence in British Columbia, in Healthy Minds, Healthy People: A Ten-Year Plan to Address Mental Health and Substance Use in British Columbia,⁷ and in A Path Forward: BC First Nations and Aboriginal People’s Mental Wellness and Substance Use – Ten Year Plan.⁸

Engagement, Collaboration and Planning

The specific focus of the Safe Relationships, Safe Children initiative is clearly articulated in the RCY’s first recommendation in Honouring Kaitlynne, Max and Cordon, and the planning and collaboration actions to support it are described in Taking Action on Domestic Violence in British Columbia. The scope of Safe Relationships, Safe Children is intentionally directed towards one key area – ensuring that staff within health-care and child-serving systems understand, identify and reduce risk factors for children and families affected by untreated parental MH, SU & IPV.

The Safe Relationships, Safe Children initiative takes an evidence-informed approach to improving outcomes for families with complex needs related to one or more of the three core issues. Early work for this initiative included the development of two comprehensive best practice literature reviews – one that focused on tools and processes to identify parents challenged by MH, SU & IPV (Oliver, 2012) issues and another that focused on building resilience and reducing risks in children affected by the three core issues (Templeton, 2013).

There is recognition that success will require that those in health and child serving systems will need to work collaboratively with other government and community organizations, and in particular community anti- violence organizations, to support these children and their families. To that end, planning and development work for Safe Relationships, Safe Children was and continues to be informed by ongoing engagement and consultation with the following stakeholders:

o Provincial representatives from MoH, including the Aboriginal Health Directorate, MCFD including Provincial Office of Domestic Violence (PODV), with future engagement planned with Ministry of Education;

o Provincial representatives from the community anti-violence sector (including the Ending Violence Association of BC, the BC Society of Transition Houses and BC Women’s Hospital Woman Abuse Response Program);

o Representatives from the regional health authorities (inclusive of primary care, acute care and community MHSU services), local MCFD services, DAAs, community anti-violence sector groups, physician representatives, representatives from justice, and others;

o Representatives from the First Nations Health Authority;

o Local community representatives of the twenty (formerly twenty-one) Phase 2 implementation sites.⁹

Further consideration and processes to reflect the distinct needs and desires of First Nations, Aboriginal and Métis individuals, families and communities are planned (including, for example, consultation with Métis Nation BC, BC Association of Aboriginal Friendship Centres).

7 http://www.health.gov.bc.ca/library/publications/year/2010/healthy_minds_healthy_people.pdf

8 http://www.fnhc.ca/pdf/FNHA_MWSU.pdf

9 The communities of Hope and Agassiz have merged into one pilot site, and some other sites have expanded to other communities.

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Implementation

Safe Relationships, Safe Children is being implemented in three stages:

Phase 1 (2013) One urban and one rural pilot community (Richmond and Vernon)

• Best practice literature reviews

• Development of resources (including the Guide to Enhance Practice, a Community Implementation Toolkit, protocols, identification tools, an online curriculum and an evaluation framework) and local community processes (as described in the Community Implementation Toolkit) to support the identification and reduction of risk factors for children and families affected by serious untreated parental MH, SU &

• Lessons learned from Phase 1 have informed subsequent materials and IPV implementation

Phase 2 (2014) Two urban and two rural pilot implementation sites in each health authority region

• Further refinement of materials

• Development and piloting of training curriculum

• Development of evaluation framework

• Additional consultation with other community stakeholders including representatives from local women-serving agencies in the anti-violence sector

• A separate or parallel process for developing resources for the initiative specifically for Aboriginal and First Nations communities

• Lessons learned from Phase 2 will inform subsequent materials and implementation Phase 3 (2015) Implementation of model province-wide

• Finalization and launch of training curriculum

• Evaluation Framework

It is important to recognize that practice will best be enhanced within an infrastructure that invites a comprehensive, collaborative approach that utilizes a family-centred lens. Training will be provided to support practitioners to manage issues that are outside of their traditional core area of expertise, but developing the trust needed to work with others will be essential. Provincial and local mechanisms (such as protocols, policies and guidelines) are being developed to support collaborative practice.

The Guide to Enhance Practice and the Community Implementation Toolkit are currently utilized as draft documents intended to guide and support the work in the implementation sites. Resources and tools for Safe Relationships, Safe Children will be available online at (exact location to be determined).

Roles and Responsibilities

MOH, in partnership with health authorities, and MCFD, in partnership with DAAs, are responsible for ensuring that practitioners in their organizations meet the requirements of government’s commitment to implement family-centred and family-sensitive approaches across systems to better identify, actively refer and support the safety needs of children in families identified as having MH, SU & IPV issues.

The Guide to Enhance Practice (a companion document to this Toolkit) describes a 5-step Practice Pathway for supporting families with needs related to MH, SU & IPV. Although it is impossible to specify all of the details regarding specific roles and responsibilities of all different providers within the various settings, Appendix A in the Guide to Enhance Practice provides an illustrative summary table outlining practitioner

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roles within some key entry points to health and child-serving services. Essentially, within the 5-step Practice Pathway there are 10 Minimum Practice Requirements expected to be met at all entry points to service within health authority and MCFD jurisdictions. Organizations are responsible for determining the best means of ensuring that practitioners and/or teams in those settings (with support from specialized services as required) meet the following minimum expectations:

1. Identify Adults in a Parenting Role

2. Engage Parent on Potential Needs Related to Three Core Issues 3. Inquire about Child Needs

4. Identify Risk and Protective Factors for Children

5. Identify Emergent/Urgent Issues that Require Immediate Action 6. Stabilize and Plan for Future Safety

7. Collaborate with Parents and Others to Actively Connect Families to Required Supports 8. Share Information to Support Safety and Wellbeing

9. Monitor Risk and Review Goals and Progress 10. Reflect on Progress and Practice

To clarify, the Minimum Practice Requirements apply to Health and MCFD. Other agencies/groups may also adopt these as best practices if/as appropriate, but are not required to do so.

See Appendix 1 Governance and Implementation Structure Phase 2 SRSC initiative

Aim of the Initiative

MH, SU & IPV are problems that can occur separately or in combination in adults, yet such issues often go unrecognized, are misunderstood or are not addressed due to stigma. When a parent experiences one of these issues it can have serious implications for the children and the entire family. The risk to children’s safety and their ongoing development are most severe when all three factors are present, with risks and harm cumulative as factors coalesce. Children’s needs are best met when parental needs related to MH, SU &

IPV are identified and supported.

Unfortunately, the fear, chaos, uncertainty, secrecy and stigma of living with any of the three core issues under discussion can be barriers to parents seeking help. For example, women who are being abused may be reluctant to share information due to fear or reprisal from a partner, previous experience of judgmental or blaming responses from health and social service providers, and other concerns about inappropriate responses such as service providers sharing information with an abusive partner or family member. For children it can be hard for them to understand and be able to articulate what they are experiencing, how they feel and what they need. Often there is collusion between family members, with children wishing to protect and be loyal to their parents and family. Service providers may also contribute to barriers through a reluctance to actively seek information about these issues due to anxiety, perceived lack of organizational support, time constraints, concerns about what to do if they identify problems, fear of offending parents, fear of impacting a trust relationship with a parent if a child protection report must be made, lack of awareness and training, and similar issues (Registered Nurses’ Association of Ontario, 2012). The Safe Relationships, Safe Children initiative is about reducing these barriers and making the invisible visible.

The overall goal of Safe Relationships, Safe Children is to promote child safety and well-being by enhancing system capacity to strengthen support to families where adults with parenting responsibilities are challenged or affected by one or more of the three core issues. For the current initiative, the term “parent” is used in a

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broad sense to encompass all adults acting in a parental or care giving role to children and youth (including, for example, an expectant parent, step-parent, grandparent, foster parent, other relative or caregiver, or a partner to a parent).

The key objectives of the initiative are to:

 Increase awareness about the three core issues and their frequent interconnectedness and increase understanding of how issues related to MH, SU & IPV – on their own or together – affect parenting responsibilities and ultimately pose risks to children and families;

 Establish processes to identify all adults in a parenting role at entry points to health and child serving systems (“parents” can include an expectant parent, step-parent, grandparent, foster parent, other relative or caregiver, or a partner to a parent);

 Shift practice such that practitioners specifically develop approaches that address the safety of children and families in relation to MH, SU & IPV;

 Ensure that professional interventions across adult and child services are sufficiently family-centred, strengths-based, trauma-informed and sensitive to the distinct needs of women impacted by violence and children exposed to violence. This might include extending the reach of existing initiatives such as Trauma Informed Practice (TIP) training and/or MCFD domestic violence training;

 Strengthen community collaboration efforts to better support parents, children, and families with needs related to parental MH, SU & IPV issues by leveraging successful community models and processes (e.g., Richmond’s Supporting Families model, Interagency Case Assessment Teams, Violence Against Women in Relationships Coordination Committees);

 Ensure that services are culturally safe, culturally competent and informed by awareness that some groups, such as First Nations and Aboriginal families, new immigrants, and others can face particular challenges that require culturally-informed approaches. This should include extending the reach of existing initiatives such as the Indigenous Cultural Competency (ICC) training;

 Ensure that practitioners are aware of how to monitor for factors associated with increased risks to families and children related to MH, SU & IPV issues, and that they can use active outreach and similar strategies to connect with at-risk families experiencing barriers to engagement.

The guidance developed as part of the Safe Relationships, Safe Children initiative is intended to supplement – not replace – existing processes, and to increase capacity to support completion of any of the required practice elements that are not in place. Many health settings/services and social service agencies already have existing processes that address issues related to parental MH, SU & IPV. In a time of scarce resources, communities and organizations will be encouraged to identify and build on existing strengths.

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B. SHIFTING PRACTICE – THE SAFE RELATIONSHIPS, SAFE CHILDREN PRACTICE MODEL

The importance of shifting practice to better identify and support the parenting role of adults affected by mental health challenges, problematic substance use or intimate partner violence (MH, SU & IPV) is hard to overstate. Being a parent can be a major motivator for individual change. It can also be a major stressor.

Individually, the presence of MH, SU or IPV represents a significant risk factor for children, but in reality, such problems rarely occur in isolation. Experiencing one of the three issues can lead to problems with the other two. For example, intimate partner violence is associated with increased risk of mental health problems and substance abuse in women. In turn, people struggling with mental health problems and substance abuse are more susceptible to further violence. There are similarities across all three issues in the risks which children face but there are also unique features according to the problem which children are living with. The presence of domestic violence is believed to be a particularly significant risk factor for children (Templeton, 2013).

Family-centred practice is a process that links behaviours of practitioners with outcomes for families. Supporting families and ensuring the safety of children affected by MH, SU &

IPV issues requires professionals to have an understanding of risk and protective factors at the individual, family and environmental levels. This whole-of-family approach consists of identifying and addressing the needs of the children, adults and the family and ensuring that support provided to them is coordinated and focused on concerns affecting the family unit as a whole (Bromfield et al, 2012; Chovil, 2009).

The Safe Relationships, Safe Children practice model is offered as a straightforward application of the initiative’s Practice Principles (p. 5).¹⁰ The model, which consists of three concurrent activities and a 5-step Practice Pathway, is intended to assist practitioners and service providers to better identify and support families who require services for issues related to mental health challenges, problematic substance use and intimate partner violence (MH, SU & IPV). Most service agencies and programs already have existing client engagement, needs-identification and support processes or procedures in place. The practice model is intended to enhance existing mechanisms – not replace them – in order to ensure a more comprehensive family-centred approach to supporting families with complex needs.

Children and family are at the very centre of the model, surrounded and supported by the practitioners who make up the care team (including a lead practitioner, where possible) as well as other community resources and supports. Refer to Appendix A of the Guide to Enhance Practice for more information related to the roles

10 The Safe Relationships, Safe Children Practice Pathway is adapted in part from the Think Child, Think Parent, Think Family framework and also borrows from the concept of the three concurrent activities described by Buckley, Horwath &

Whelan (2006).

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and responsibilities expected of practitioners for this initiative. The model can be visually represented as follows:

In simplest terms, the Safe Relationships, Safe Children initiative is intended to change practice by taking a broad, integrated approach across the various agencies and partners within each community (including health, community anti-violence and child-serving systems) to identify and serve the needs of children and families who struggle with the three core issues that are the focus of this work. Conceptually, at the service provider level, it will be helpful for practitioners and staff to remain concurrently focused on three overarching, principle based activities – engaging, safeguarding, and collaborating. The focus on these three activities is borrowed from a framework for working with vulnerable children and their families developed in Ireland (Buckley, Horwath & Whelan, 2006). The three activities are intended to be kept in mind and interwoven with the five steps that make up the Safe Relationships, Safe Children Practice Pathway.

The Five Steps of the Safe Relationships, Safe Children Practice Pathway

Throughout their work with parents and families, practitioners are encouraged to maintain a focus on the three concurrent activities described above as they consider the five steps of the Practice Pathway. The Practice Pathway supports a “thoughtful” approach to working with parents and families. Practitioners are encouraged to “think” through the five principle-based steps and where applicable and possible, make related changes to their practice to ensure coverage of the 10 Minimum Practice Requirements (two per each step.) In addition to recognizing potential limits due to scope of practice and/or capacity to move through the Pathway, practitioners are reminded to consider client level of readiness to engage/act at each step, and to support accordingly.

Step 1 Think Parent: Incorporate Parenting Issues into Practice a) Identify Adults in a Parenting Role

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b) Engage Parent on Potential Needs Related to Three Core Issues Step 2 Think Child: Make Children Visible

a) Inquire about Child Needs

b) Identify Risk and Protective Factors for Children Step 3 Think Safety: Respond to Safety Risks

a) Identify Emergent/Urgent Issues that Require Immediate Action b) Stabilize and Plan for Future Safety

Step 4 Think Family: The Importance of a Joined-Up Approach

a) Collaborate with Parents and Others to Actively Connect Families to Required Supports b) Share Information to Support Safety and Wellbeing

Step 5 Think Outcomes: Stay Connected and Engaged with Families a) Monitor Risk and Review Goals and Progress b) Reflect on Progress and Practice

The five steps are not necessarily designed to be taken in the linear fashion presented. Rather, practitioners are encouraged to use professional judgment about sequencing. At the same time, practitioners need to be aware of what is within their own scope of practice and what needs to be referred.

The purpose of the Safe Relationships, Safe Children Curriculum is to support a shift in practice for health- care and child-serving staff in their collaborative efforts to better identify, understand and support families with parental needs related to mental health, substance use and/or intimate partner violence and by so doing to ensure that children are visible to the adult system of care. A set of learning modules will encourage learners to evaluate and reflect upon their current practice and strengthen their confidence and ability to support parents, children and families living in these environments.

See Appendix 2 Leaning Objectives of the SRSC Curriculum

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C. IMPLEMENTING THE SAFE RELATIONSHIPS, SAFE CHILDREN INITIATIVE

The purpose of the Safe Relationships, Safe Children implementation is to ensure that all practitioners incorporate the steps of the Practice Pathway into their work, shifting to a collaborative, family-centred practice in order to better identify, understand and support adults, children and families affected by MH, SU

& IPV. Although Community Leads are encouraged to pay attention to each of the core components of implementation as listed below, they are not necessarily designed to be taken in the linear fashion presented.

How implementation is achieved will vary depending upon community capacity, setting and existing structures.

Form a community advisory committee

(a new stand-alone committee or leverage an existing committee structure)

Develop a project plan and design a community engagement process to assess community strengths and gaps for supporting families impacted by MH, SU & IPV

Consult with Families Examples:

• Family Journey Mapping

• Family Advisory Committee (FAC)

• F.O.R.C.E.

Engage with Practitioners Examples:

• Presentations

• Surveys

Support Training (ensure and coordinate access to online

curriculum)

Initiate or Strengthen Collaborative Practices

Evaluate Progress

Community kick-off event

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FORM A COMMUNITY ADVISORY COMMITTEE

Community Leads are tasked with forming a community advisory committee consisting of local stakeholders who will provide oversight to the implementation of local plans. Community capacity will determine which of the following options will work best for an advisory group:

1. Creation of a new, stand-alone advisory committee;

2. Connection with an existing local committee whose priorities align with the work of the Safe Relationships, Safe Children initiative (for example, Violence Against Women in Relationships committee or another inter-agency or inter-ministerial committee with a broad-based membership and a history of working together, such as MHSU Collaborative or Child & Youth Collaborative).

Membership

The committee should be representative of the key local stakeholders in each community. For example, the committees from the two Phase 1 pilot communities (Richmond and Vernon) included various representatives from the following organizations and sectors:

 Regional Health Authority

 Local hospital(s) – inpatient psychiatry, emergency

 Regional office of the Ministry of Children and Family Development

 Regional office of the Ministry of Social Development and Social Innovation

 Regional office of the Ministry of the Attorney General

 Regional Income Assistance Office

 Community-based victim services specializing in anti-violence work

 Police based-based victim services

 Women’s Transition House

 Friendship Centre

 First Nations and Aboriginal Lead – Health Authority

 Local Band Social Services or Health Programs

 Métis Nation BC

 Relevant child-serving programs (e.g., Children Who Witness Abuse programs)

 Relevant counselling programs for abused women (Stopping the Violence Counselling)

 Regional Office of the Canadian Mental Health Association

 Child / Youth and Family Services agency

 Family Resource Centre

 RCMP or municipal police – ideally a representative from the Domestic Violence Unit

 School District

 Adult Corrections

 For future sites where there are Delegated Aboriginal Agencies (DAAs) in the pilot communities, the DAAs will be involved.

 Other community service providers such as immigrant serving agencies or workers in the settlement sector

Community Leads

The Community Leads will be identified by the Regional Leads and will usually consist of a representative of a Health Authority and a representative from MCFD. Given the scope of work expected of the Community Leads, the Regional Leads will make every attempt to ensure that the Community Leads have access to adequate supports and resources throughout the implementation process.

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Establishing the CAC will be one of the responsibilities of the Community Leads. Other primary responsibilities of the Community Lead(s):

• Takes the lead on additional community engagement (such as presentations to other stakeholder groups)

• Provides work plan and training plan information, and any requisite information for committee members.

• Schedules meeting dates, times and confirms locations of the meetings.

• Prepares agendas for committee meetings and circulates agendas to committee members in advance of meetings.

• Arranges for minutes to be taken at meetings and distributes them in timely fashion, producing documents, and generating correspondence as required.

• Liaises with the Regional Leads and Provincial Implementation Advisory Committee and others within the Provincial Implementation Structure as required or requested.

• Acts as a resource to the committee with respect to the planning and implementation of the project at the local level.

• Acts as co-chairs of the CAC.

Committee Co-Chairs

The Committee Co-Chairs play a pivotal role in the work of the CAC.

The Co-Chairs of the CAC share the following responsibilities:

• Preside over the regular and special meetings of the CAC by facilitating discussion and decision- making processes.

• Create ad-hoc committees that will facilitate implementation within the community.

• Extend invitations to other stakeholders - to attend meetings to provide the committee with data, information, and/or materials to map existing services, identify gaps, and make recommendations.

Responsibilities of the Community Advisory Committee

The role of individual members of the CAC is to collaborate, participate in and/or lead working groups, provide input to the development of the work and training plans, to encourage information-sharing within their organization and the systems they interact with; and to provide feedback on the initiative. Individual members will also act as a liaison between his/her agency and the advisory committee.

The responsibilities of the committee as a whole are to:

• Develop and oversee the implementation of a local work plan in the community and design a community engagement strategy, which will include raising awareness about the initiative, encouraging collaboration across service line and assisting agencies and organizations to assess strengths and gaps in supporting families with needs related to MH, SU & IPV.

• To identify and establish key and supporting partnerships in the community and to ensure that the local plans are aligned with the provincial strategy and action plan.

• To monitor the community implementation to ensure that the objectives of the initiative are met, provide updates to regional leads on the status of implementation of the work plan and to make recommendations that may be put forward for the current and next phases of the project.

• To proactively identify and inform the Provincial Implementation Advisory Committee and local and regional sponsors of any issues, concerns or potential impediments to implementation, and

recommend solutions to mitigate delay and promote success of the implementation.

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Including Families

Wherever possible, communities will want to make every effort to include family member representation on the CAC. Family members’ knowledge about service provision makes them essential allies and helps to improve the system of care.

Most Health Authorities have a Family Advisory Committee (FAC). The FACs may be a potential source for soliciting a member to represent families on the CAC. The FAC Coordinator may be able to present a person to sit on the CAC, or act as a conduit between families and the CAC. Alternatively, a community may have other family support organizations or committees (such as the F.O.R.C.E) who can be consulted about potential members. Including family members raises the concept of family-centred services to an even more comprehensive level, one that Chovil (2009) has termed family engagement. In the family engagement model, services are family-driven, where families have an important part to play in program design, implementation and evaluation (Chovil, p. 14).

Develop a Project Plan and Get Project Work Underway

Community Leads are encouraged to leverage existing community resources and structures as the foundation for project planning, implementation and evaluation. Community culture and capacity will dictate the level of “formality” adopted for project management by each CAC. Once the advisory committee has been formed, committees should decide which of the following project management processes they want to adopt.

Adopt Terms of Reference for the Community Advisory Committee Adopting Terms of Reference is recommended if it fits for the committee.

See Appendix 3 Community Advisory Committee Terms of Reference Template

Develop a Project Plan and Timeline

Within the initial pilot sites of Richmond and Vernon, existing models of collaborative practice provided an important foundation from which to support the deliverables and implementation milestones. In Richmond, the mental health and substance use agencies had previously forged relationships based on a collaborative practice model, which led to enthusiasm to embrace an Interagency Case Assessment Team (ICAT)¹¹ model to bring domestic violence services into the collaboration. In Vernon, a model of collaboration existed in the Vernon ICAT committee - where the committee had fostered a model of successful collaborative practice with domestic violence risk assessment and safety planning. As well, Vernon had a community of services (including MoH and MCFD and community based anti-violence services) that had a strong history of collaborative practice and a demonstrated willingness to improve services for families. In both communities, these existing models of collaborative practice provided a solid foundation from which to build a work plan for the project.

While the work plans, timelines and experiences of the pilot sites of Richmond and Vernon provide excellent guides for planning in onboarding communities, no two communities are the same. In order to ensure that the unique characteristics and circumstances of the community are factored into planning, it is recommended that the Community Lead develop a community-specific work plan and timeline with the CAC.

11 In some BC communities, the ICAT acronym stands for Interagency Case Assessment Team

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See Appendix 4 Sample Work Plan and Timeline Template

Develop a Project Communications Plan

Communities may want to develop a strategic communications plan to ensure timely and regular communication with all stakeholders to support implementation success. It is important that the information that is shared about the Safe Relationships, Safe Children project is consistent in every community. By taking time to plan what and how information will be shared, communities take a positive step toward providing relevant, accurate, and consistent information to project stakeholders and other appropriate audiences.

A planned and thoughtful approach to communications will help facilitate the following four key communications objectives:

• Awareness and understanding will be created among impacted sectors, frontline workers, and key stakeholders

• Fears and concerns about the project and the resulting changes within practice and the method of services provided will be addressed

• Stakeholders, where relevant, will be engaged in planning, implementing and evaluating the project

• A method for stakeholders to address questions or to provide feedback can be established.

A communications plan is a framework that allows the CAC to plan, manage and coordinate the wide variety of communications (including presentations, written communications, documentation, etc.) that will take place during the project. The plan will help to organize and answer the following:

• What information will be communicated?

• Who will communicate the information?

• Who is the intended audience of the communication?

• How will the communication/information be delivered?

• How often will information be communicated?

The Regional Leads will be important resources to CACs in the development of a communications plan.

See Appendix 5 Communications Plan Example

Scheduling and Holding Meetings

The implementation cycle for the Safe Relationships, Safe Children project is approximately twelve (12) months in duration. Generally speaking, each pilot community selected to implement the project prototype model will work to an approximate twelve month timeline.

Based on the experiences of Richmond and Vernon, it is recommended that the CAC meet approximately every three or four weeks for the duration of the project. It may be advantageous to schedule meetings to facilitate the completion of specific project deliverables, tasks and project milestones.

It is important to plan a meeting schedule that respects committee members’ time and uses meetings as effectively and efficiently as possible. The following provides a suggested schedule with key deliverables,

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connecting meetings with specific project milestones. Note that work that needs to be completed in advance of each meeting is highlighted, with a suggestion about who should be designated to complete it.

Prior to the 1^stMeeting of the Community Advisory Committee

The Community Lead(s) prepares the following in consultation with key regional ministry and local community stakeholders:

 CAC committee membership list

 Selection and confirmation of the CAC Chair

 Draft Terms of Reference

 Overview of Pilot Project Deliverables and a Project Implementation Timeline

 Draft Schedule of Meetings

1^st Meeting

Committee reviews draft terms of reference and an overview of implementation deliverables and timeline.

The committee also initiates discussion regarding engagement of additional stakeholders (i.e. general practitioners and psychiatrists, school system professionals).

2^nd Meeting

Committee consults on draft of the work plan and implementation timeline and discusses Family Journey Mapping exercise (see below). The second meeting will have a lot of content, but the intent is to discuss the overall work of the project and firm up a timeline. Agenda for second meeting should include:

 Minutes of the 1st meeting

 Draft terms of reference for approval

 Draft of the work plan and implementation timeline for the project for approval

 Planning materials for Community Kick Off event and Planning Day (proposed invitation list, proposed agenda)

 Planning Materials for Family Journey Mapping exercise

 Determine and create, as necessary, any sub-committees required to accomplish the work

3^rd Meeting

Agenda for third meeting should include:

 Minutes of the previous meeting

 Reports from Sub-committees

 Formalize plans or review Family Journey Mapping and Kick Off Event/Planning day

 Next steps for work plan implementation (i.e., potential ICAT development, collaborative practice table)

 Training for the community

Subsequent CAC Meetings

Subsequent meetings should focus on implementation and sustainability of the training and work plan.

Although every community is different, in some workplaces/communities the formality of creating agendas in advance of meetings and taking minutes to record discussion and decisions made is not the norm.

However, it is recommended that CACs consider adopting a certain level or tone of formality. For example, there are many benefits of setting an agenda and taking minutes. The agenda helps committee members anticipate what will be discussed at a meeting and provides a “heads up” opportunity to prepare for the meeting. After preparing and then participating in the meeting, the minutes will help to document/record the discussion. Minutes:

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 Clarify the how, when, why, and by whom decisions were made

 Record the action items coming out of the discussion which generally translates to getting work done

 Provide useful information for individuals not at the meeting

D. DESIGN A COMMUNITY ENGAGEMENT STRATEGY

The Community Lead(s) should begin the community engagement process by presenting the project to key stakeholders while concurrently:

a) Planning a process to consult with families (see below) b) Planning a Community Kick-Off Event (see below)

As the project unfolds, ongoing presentations in the community will build awareness and inform and engage broader interest and participation in the initiative. Ideally, the Community Lead would attend as many community meetings as possible so that word about the project spreads to raise awareness within the community. An important side benefit of these meetings is that the Community Lead can use them as an opportunity to gather information on what the community needs.

The Community Lead might also be prepared for and open to invitations to present on the project as the awareness in the community builds. A PowerPoint presentation detailing the Safe Relationships, Safe Children initiative is available and can be used to build awareness.

See Appendix 6 SRSC PowerPoint Presentation Template

Consult with Families

To ensure the inclusion of the voices and experiences of those with lived experience of mental illness, problematic substance use and/or IPV to inform the direction of the project, each CAC will want to carry out a consultation exercise with families.

Although each community is encouraged to adopt a consultation method that fits best with its capacity, wherever possible a Family Journey Mapping exercise (FJM) is recommended as an important early step.

FJM is a vehicle to engage families and their expertise as service and systems enhancements are considered, it is also a way for the families receiving services to tell the story of their journey through the service delivery system. It is a simple and informative way to develop a better understanding of the service delivery system’s response and to learn about services from a family’s perspective. Importantly, it provides an opportunity to identify ways to improve or enhance services/systems, and to document best practices.

The FJM exercise was used in each of the initial pilot sites (Richmond and Vernon) to engage families who had received services in mental health, substance use and/or domestic violence over the previous two years.

In the exercise, the person telling the story is the family member who has received service(s), although they are encouraged to invite other family members (and service providers) to attend the presentation. The aim of the FJM is for the adult “presenter” to start at the point they first sought service(s) and to describe:

1. The steps they took in their service journey;

2. The role of each service provider and how each responded and facilitated the journey;

3. The time each step took and the time in between steps;

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4. What took place between steps (and services);

5. What worked for them when they accessed services;

6. What was not helpful, or what was challenging for them in accessing service;

7. What would have been helpful for them;

8. What they would have liked to see more of;

9. How their children were impacted; and

10. What supports were provided to their children.

Mapping family journeys should be an early step as the themes presented will be unique to each pilot site and will help to: identify risk factors; illuminate areas where stronger collaborative practice is needed;

highlight cracks in the service delivery system; and clarify areas of where additional training is required.

Richmond and Vernon hired a graphic recorder for their FJM exercises. This would be an additional cost to the community and not all communities have access to graphic recorders. There are other less resource intensive methods for completing the FJM exercise. Other options (i.e. using your Health Authority’s LEAN team, or conducting interviews or focus groups) can be explored with the Project Mentors.

Choosing Families

The following criteria will assist in identifying ideal “candidates” for the FJM presentations. Ideal candidates will:

 Be parents who have moved through the mental health, substance use and/or intimate partner violence response / service system(s)

 Be in a current stable and safe situation

 Have a support system in place and be comfortable with bringing a member of that support system to the FJM presentation

 Have the capacity to understand the potential impact that telling their story may have on their wellbeing

 Understand that the exercise is to illustrate their journey in negotiating systems and services rather than a detailed recount of their personal experiences.

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See Appendix 7a for more guidance relative to Planning the Family Journey Mapping Exercise and Appendix 7b Lessons Learned from Family Journey Mapping

Engage with Practitioners

The primary recommended methods for engagement with practitioners in the community are presentations to key stakeholder groups (discussed above) and by holding a Community Kick-Off event (discussed directly below).

The Safe Relationships, Safe Children Current Practice Survey is a useful engagement tool and a necessary component of the overall evaluation framework for the initiative. It is recommended that the survey (which is available in hard copy or in a digital file for use in Fluid Surveys) be filled out by participants prior to (if using Fluid Surveys) or at the beginning of the Kick-Off Day event.

The survey poses key questions about family-centred practice, practitioner confidence asking parents about parental status, MH, SU, & IPV, as well as questions about collaborative practice including information sharing.

See Appendix 8 Current Practice Survey

Organize a Community Kick-Off Event

The Community Kick-Off and Planning Day event is an important opportunity to introduce the Safe Relationships, Safe Children project to the key community stakeholders. In Richmond the Kick-Off and Planning Day were held together as an all-day event. The morning portion provided background information to the project to a wide stakeholder audience and in the afternoon portion stakeholders were asked to participate in exercises to plan the work for the community going forward. In Vernon, the Kick-Off and Planning Day were each half days and held on separate days about one month apart. Depending on the community and the availability of schedules it may make more sense to do both in one day or to split them up. Based on the experiences in Richmond and Vernon, the following “helpful hints” are provided to assist with planning understanding what needs to be accomplished through a Community Kick Off and Planning Day Event.

 Pick a date for the Community Kick-Off Event and Planning Day. Avoid dates for which regular meetings take place within the community and avoid Fridays and Mondays where it may be difficult to get full attendance for all day meetings. Consider holding the event on a Tuesday, Wednesday or Thursday. Plan for a full day with a mix of presentations and small group discussions.

 Select a central and suitable location. Think about agencies or organizations that have a large boardroom or suitable space to accommodate twenty to fifty people depending on the community.

Ideally, this space would have access to natural lighting and fresh air. Ensure that the location selected is fully accessible for those participants with disabilities or mobility concerns. A location that is on a bus/transit route will ensure that those without personal transportation can readily attend.

Look for space that is available at no, or nominal, cost.

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 Decide who to invite. To get the most benefit from the Kick-Off event and planning day, it is important to carefully consider who to invite. Getting the right mix of individuals representing a diverse group of regional and local offices, community agencies and key stakeholders is important.

Invitation lists from the Community Kick-Off and planning day events in Richmond and Vernon are available in Appendix 9a to get an idea of the range of possible stakeholders.

When planning the invitation list, list the agencies and organizations necessary to engage with, give close consideration to those individuals and groups who are in a position to:

• Effect change administratively;

• Influence attitudinal changes;

• Make a difference with the knowledge they will gain from the event;

• Provide perspective or give voice to those who most need to be heard; and

• Inform, influence or make decisions on policy and resources.

It may not be immediately apparent which person(s) within an organization or community agency should be invited. As a general guideline, begin with the most senior or responsible position in an agency and then seek that individual’s guidance to determine representation. In some instances, it may be advantageous to invite more than one employee and include the participation of several levels of staff from one organization. A wider audience may be more appropriate for the Community Kick-Off event to raise awareness of the project, with a more front-line audience involved in the planning day.

 Using Event Brite will help spread the word about the event. The online platform is free and very easy to use – several pilot communities report using it with good results. See https://www.eventbrite.ca/

 If relevant, plan to invite an Elder from within the local First Nations and Aboriginal Community to provide a “welcoming” and “blessing” for the day. Remember to provide a gift and honorarium to the Elder for his or her participation.

 If possible, try to complete the Family Journey Mapping exercise prior to the Kick-Off Event. This will allow the results of the exercise to be presented at the Kick-Off Day Event to help foster discussion.

 Send invitations as early as possible, ideally about a month or more in advance of the event. This should give enough notice to potential participants, and will allow adequate time for response. A copy of the Richmond invitation is provided as Appendix 9b.

Wherever possible, direct contact by telephone or in-person is recommended prior to sending an invitation. This direct contact will provide an opportunity to give the recipient a “heads up” about the invitation that they will be receiving and the purpose of the community event. Contacting the invitee directly also provides an opportunity to confirm the names and contact information for participants.

Include a map or directions to the location with the invitation for participants who may not be familiar with the location. Asking recipients to RSVP to a consistent person will enable easier tracking of who has and has not responded. In the invitation email, ask potential participants to complete the Current Practice Survey (Appendix 8, discussed above) and available in online FluidSurveys format.

 Develop an agenda for the event: The Kick-Off Day and Planning Day should consist of a balance of speakers, presentations, education/ training and opportunities for small group work and discussion.

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Pre-plan and arrange small group discussion exercises to be composed of individuals across ministry, agency and departments. For the Planning Day small group discussions should center around ethical dilemmas or areas that might get in the way of implementation and practice change. These were identified as very valuable for the Richmond participants. See Appendix 9c for a copy of Richmond’s Kick-Off Day agenda.

 Identify potential presenters, key note speakers and small group leaders from within the community.

 Identify in advance a facilitator and recorder for each of the small group discussions to be held at the event. Members of the LPAC may be helpful in these roles.

 Present the Templeton Literature Review (2013) at the event to introduce material on risk and protective factors for children living with a parent with mental health challenges, problematic substance use and/or intimate partner violence.

 Present the Safe Relationships, Safe Children Practice Guide at a high level at the event, so that individuals will have a sense of the scope of practice change.

 Organize materials and supplies in advance. Ensure that the requisite supplies and materials are available onsite. Items might include:

• Nametags

• Copies of the agenda

• Tent-cards with participants’ names and organizations (placed at tables to coincide with the groups you have organized)

• Flip charts, paper and unscented markers

• Laptop and projector (if using PowerPoint to present)

• Refreshments

• PowerPoint handouts can be provided as a follow up, via email

 Send a reminder one week before the event. Circulate a reminder to everyone on the invitation list.

Include an electronic copy of the agenda with the reminder, asking that those who have not yet RSVP’d to do so, and remind participants who have already responded to provide notice about any changes to their availability.

 On the day before the event – confirm arrangements with the venue and caterer (or those who are arranging refreshments). Send another reminder by email, along with an electronic copy of the agenda and, if possible, include the name and cell phone number of a contact person who will be onsite that day. Include another copy of the map or directions. In the event that a participant is having difficulty finding the site or is detained, they will have a point of contact on the day. These details make it easier for participants and are always appreciated.

See Appendix 9a Kick-Off Day Invitation List Ideas, Appendix 9b

Kick-Off Day Invitation Example, and Appendix 9c Kick-Off Agenda Example

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E. TRAINING

In the initial pilot communities of Richmond and Vernon, the need for more training around the issues of mental health and addictions, intimate partner violence, trauma-informed care, Motivational Interviewing and information sharing was clearly identified. With regard to the latter, a protocol is currently being developed between the Ministries of Health and Children and Family Development that will outline roles and responsibilities regarding information-sharing. Training relative to the protocol will be available in due course.

The following workforce competencies were identified as essential in one of the comprehensive literature reviews completed for the Safe Relationships, Safe Children initiative:

Staff and practitioners need to be able to:

• Understand the experiences of those who are caught up with parental mental health challenges, parental problematic substance use and intimate partner violence.

• Understand the experiences of those who are caught up with parental problematic substance use, parental mental health challenges and intimate partner violence.

• Understand the particular ways in which children, parents and other family members can be affected and understand the risks when issues co-exist and the cumulative impact of such problems.

• Understand the risk and protective factors which can influence parents, children and families, and understand how these can guide talking to families, assessment and intervention.

• Learn how to ask questions and have conversations with families (and separately with parents and children) about the issues they are facing. Understand how hard it can be to seek help and to talk about the problems; understand resistance and how it can be approached.

• Understand the relationship between problematic substance use (alcohol in particular) and intimate partner violence (including understanding the power and control dynamics associated with intimate partner violence).

• Understand the risk factors for IPV, know about safety plans and where to refer clients (most often women) for specialist IPV support.

• Understand the principles of working safely with children and families, and also of working safely with other agencies.

• Understand the importance and principles of identification and assessment. Assessments should be holistic, historic & current, capture the views of all the key parties involved (and should include talking directly to children), and minimize duplication with the work of partner agencies.

• Develop inter-professional and inter-agency partnerships (e.g. reciprocal and collaborative training partnerships and programs).

• Understand the roles and responsibilities of the range of professionals involved with a family, having pathways and procedures in place to guide and support joint working between professionals and agencies. (Templeton, 2013).

The Safe Relationships, Safe Children Curriculum will provide instruction related to the above competencies (refer to Appendix 2, Learning Objectives). Communities will also want to assess their current inventories of training resources to determine how best to supplement the training need. For example, Health Authorities may wish to open up their Core Addiction Practice Training to community and other partners. MCFD might consider inviting community and health staff to various training events that could have relevance. The topic of potential training opportunities should be undertaken by each community’s CAC.

Staff can also be encouraged to access online e-learning courses and resources which are available at no cost other than the time required to complete. For example, Richmond and Vernon found Ontario’s Women’s

SAFE RELATIONSHIPS, SAFE CHILDREN