SET Referral Review Tool

SET Referral Review Tool To be used to review referrals only

Referral Name:

Referral #:

Referral Received Date: Referral Closed Date:

Region: Program:

Social Workers assigned/ involved during referral time period:

Reviewer’s Name and Title:

Date(s) of Review:

Documents Reviewed (Check all that apply):

Delivered Services Log Investigative Narrative Safety Plan

Case Consultation Forms TDM referral/results form SDM Safety Assessment(s)

SDM Risk Assessment(s) History of Child Placements Genogram:

in CWS/CMS in Hard File

Court Reports: Imported SOP Tools:

Emergency Response Document (ERD) SDM Hotline Tool FSNA

List any additional documents:

List the family members being reviewed (ex: Jane/mother; Jack/mother’s boyfriend; Tommy/child):

Brief Summary of the Referral:

SET Referral Review Tool (6/16 v24: Referral) 1 County of San Diego/HHSA/CWS Directions: The purpose of this case review tool is to determine if case practice is consistent with the CWS Safety Enhanced Together (SET) key expectations. The referral record will be reviewed to evaluate case practice. The referral record refers to everything that is available in CWS/CMS and Structured Decision Making (SDM) reports. Reviewers may look at the hard file, but it is not required. If any concerns about safety or risk are identified while conducting this review, the reviewer is to notify their supervisor in a timely manner. The review time period (RTP) will start at the beginning of the month, for the six-month period.

 For example: If a SET Review is assigned in November 2015, the review time period will be 5/1/2015- 10/31/2015

The reviewer is to consider the work done with the entire family when completing the tool. The “target child” is the child whose name/case number was assigned to the reviewer to complete the review. For each question the reviewer answers “Yes,” “No,” or “N/A.” The reviewer will then rate the question on the Likert scale below each question. For any “No” or “N/A” answers, please put a brief reason why that answer was chosen in the comments box below the question. For questions with multiple participants/ placements being rated, the reviewer can mark “Yes” for the question even if it only applies to one participant/ placement. If the question does not apply to some family members/placement being rated, write “NO” or “N/A” next to the names of those family members/placements that do not apply. If none of the family members apply or meet criteria, mark the entire question as “No” or “N/A,” do not complete the Likert scale, and the reviewer can move on to the next question. The questions that require separate ratings will be identified by the specialized instructions included just above the rating scale.

For questions rating parents, the name and rating are to be written on the lines above the comments box for each parent. For any other key adult the social worker had contact with, you may write their name/relationship in the comments box with the rating next to their name.

 Example:

-Rating multiple family members would look like this:

Yes____ rate below

No_____

N/A____

Below the Likert scale mark:

Mother: Sara/Emerging__ Father: Paul/ No Other: Step-Father Jack/ Emerging

Comments: Father: Richard/ N/A – whereabouts unknown

Only mark one box on the Likert scale for each question. When selecting a box on the scale, choose the highest box where all criteria within the box have been met. If only some of the criteria have been met for a box, the box should not be marked. This scale is cumulative, and to meet the criteria for the higher boxes, you must also have done everything in the lower boxes.

For example:

SET Referral Review Tool (6/16 v24: Referral) 2 County of San Diego/HHSA/CWS  If all of the expectations for Novice have not been met, then mark “No” for the question and do not mark any of the boxes on the Likert scale.

 If all the criteria for Novice have been met, then determine if the criteria listed for Emerging have been met too. If all of the criteria for Emerging have not been met, then select Novice for the rating. If all the criteria for Emerging have been met, then move to Accomplished and so on.

 To achieve a score of Master, you would have to have met all the criteria in the boxes for Novice, Emerging, Accomplished, and Distinguished.

 Exceptions: There are specific circumstances where only applicable criteria need to be met in each box. One example is if the reviewer is rating a non-verbal child. Only criteria in each box that relates to non-verbal children would need to be met to move to the next box.

Comment boxes may be utilized to note positive practices or areas where practice could be improved. For any N/A answers, please note the reason why it does not apply in the comments section. The reviewer has the option to complete the box at the end of the form to capture any overall feedback.

Please only consider the target child in ratings when the target child was in a specialized program (e.g. Adoptions, Residential Services, San Pasqual Academy, or Extended Foster Care) and the siblings were in a different program on the date the referral was assigned to the reviewer. If this exception applies, only rate the target child on this tool and put the reason in the comments box.

*Do not complete this review tool if any of the following apply: Referral was evaluated out; Social Worker (SW) was unable to locate the family; Family refused to speak with SW and no interviews were conducted; or Referral was on out-of-home abuse (aka: Licensed Group Home/Foster Family Agency/Licensed Foster Home.

Please list the reason for exclusion:

SET Referral Review Tool (6/16 v24: Referral) 3 County of San Diego/HHSA/CWS Section 1

1. Did the Hotline Screener use Safety-Organized Practice (SOP) techniques when speaking to the Reporting Party?

Yes rate below

N/A (circle all that apply): Hotline report was faxed in; Hotline report was mailed in; PSW in region took

report; There was no direct contact with RP; other (specify the reason in the comments box below)

Connection to key expectations – SOP; Community Partner Collaboration; Support Systems/ Safety Networks

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to Emerging In addition to In addition to  Basic questionsPractice: Practice: Accomplished Practice:Distinguished Practice: about demographics and abuse/neglect  Information  Used  Attempted to  Provisional were asked had behavioral Solution Focused obtain information harm and danger detail Inquiry to on the family’s statements were  Identified at -e.g. what successfully support/safety written and substitute care identify strengths, network included in the least one family provider behaviors safety concerns, ERD strength are associated with resources, and any concern, when do acts of protection  Attempted to these behaviors use Solution happen, how they Focused Inquiry impact the child (SFI) -e.g. Asked a scaling question

Comments:

2. Were attempts made to engage the family by using Safety-Organized Practice (SOP) tools/ interventions during the investigation?

SET Referral Review Tool (6/16 v24: Referral) 4 County of San Diego/HHSA/CWS Yes rate below

N/A (specify in comments box below)

Connection to key expectations – SOP; Family Partnerships; Child/Youth Voice; Support Systems/Safety Networks; Open and Clear Communication

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  Asked basic Practice: Emerging Practice: Accomplished Distinguished questions Practice: Practice: required for  Used SOP  Used SOP investigations tools and/or SFI tools and/or SFI  Included  Obtained with to successfully child’s voice information on  Attempted more than one identify when discussing the family’s Solution Focused family member strengths, concerns with support/safety Inquiry (SFI) or safety, the parent(s) network use of other SOP resources and tools any acts of  Utilized  Attempted protection with information from to contact the all parents that SOP tools identified were involved in and/or SFI to support the referral discuss safety system/safety planning with the network family if a -if parent(s) give protective issue permission was identified

Comments:

SET Referral Review Tool (6/16 v24: Referral) 5 County of San Diego/HHSA/CWS 3. Was a genogram of the family created/updated, or was there information in narrative form about family connections?

Yes rate below

N/A (circle all that apply: safely surrendered baby; No information on parents or any family members and the child is non-verbal; other (specify in comment box below)

Connection to key expectations – Support Systems/Safety Networks; Comprehensive Assessments Enhanced by Agency Tools; Connection Preservation

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  Documentati Practice: Emerging Practice: Accomplished Distinguished on showed only Practice: Practice: minimal  There is  There is a information about documentation or genogram that  Genogra  Used the family a genogram includes nuclear m included genogram to connections which identifies family and family patterns, discuss family some extended extended family such as relationships family substance with the  If this was a abuse, parent(s) and removal – the domestic all verbal genogram was violence, children and completed to the marriage, their responses 5th degree divorce, and/or were mental health documented in the narratives  If there is or incorporated contact with both into the parents (or family genogram members on both sides of the family), the genogram contains information on extended family members on both sides of the family

Comments:

SET Referral Review Tool (6/16 v24: Referral) 6 County of San Diego/HHSA/CWS 4. Were questions asked regarding the cultural factors present in the family system?

-Culture is defined as: The sum total of an individual’s or family’s identity, including the learned behavior of a group passed on from generation to generation, e.g., values, beliefs, lifestyle, traditions, historical trauma, race, ethnicity, language, religion/spirituality, sexual orientation, gender expression, class, etc.

Yes rate below

N/A (circle all that apply): children non-verbal and no family members could be located; other (describe in

comment box)

Connection to key expectations – Cultural Responsiveness; Open and Clear Communication; Family Partnerships

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  Documente Practice: Emerging Practice: Accomplished Practice: Distinguished d the race / Practice: ethnicity of the  Asked  Attempted  Discussed the family additional to provide family’s culture in  Utilized questions about culturally relation to the cultural  Asked about cultural norms / appropriate allegations and/or connections preferred practices / beliefs resources / protective issues when doing language / traditions referrals to the -e.g. discussed safety planning family differences OR creating / between cultural reviewing  Asked if the  Identified practices and child safety / family has Native strengths from abuse laws if support American the family’s applicable networks with heritage (NAH) culture the family  If the family  If needed, had NAH, additional research attempted to was done to gather gather specific more information information on about cultural family members norms/practices and tribal affiliation so noticing could be done and tribal contacts could be established

SET Referral Review Tool (6/16 v24: Referral) 7 County of San Diego/HHSA/CWS Comments:

5. Was the family assisted with identifying and maintaining a support system/safety network?

Yes rate below

N/A (circle all that apply): Parent’s whereabouts have been unknown for the entire RTP; Other (specify

the reason in the comments box below)

*To answer this question, reviewers may need to look outside the RTP.

Connection to key expectations - Support Systems/Safety Networks; Open and Clear Communication; Family Partnerships; Comprehensive Assessments Enhanced by Agency Tools

Novice Emerging Accomplished Distinguished Master

In addition to In addition to In addition to In addition to  At Novice Practice: Emerging Practice: Accomplished Distinguished least one Practice: Practice: family  Explaine  An member was d to the family ecomap and/or  All verbal  Checked in asked about why the Circles of Safety family members with the support their support information on and Support that the SW was in system / safety system their supports Tool was used contact with were network more was being to identify asked about their than once during obtained and support system / support system / the investigation what network safety network safety network at to assess members need members and least once during effectiveness to know their relationship the investigation to the family  If needed -  Contact  Attempted to made information for  Formal set up a FCM with adjustments by the identified and informal identified support adding or supports was supports were system / safety removing documented identified network members network during the members or  Contact investigation changing their with the responsibilities identified  Specific during the supports was Roles were investigation attempted identified by the during the support system / investigation safety network

SET Referral Review Tool (6/16 v24: Referral) 8 County of San Diego/HHSA/CWS members and documented

 Discussed methods for keeping everyone informed Comments:

6. Was the family educated about child abuse laws?

Yes rate below

N/A (circle all that apply: safely surrendered baby; parent(s) refused to speak with the SW; Other (specify

in the comments box below)

***Rate this question for each parent that is involved with the referral. The ratings are to be written on the lines above the comments box. For any other parents, the rating should be labeled with their name and written in the comment box.

Connection to key expectations – Family Partnerships; Open and Clear Communication; Support Systems/Safety Networks

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  Told the Practice: Emerging Practice: Accomplished Distinguished parent(s) about Practice: Practice: child abuse laws  Educated  Problem parent(s) about solved with the  Gave the  Attempts child abuse laws family family an made to contact opportunity to support people  Related voice their identified by the the law to the understanding of family reason why we child abuse laws were there and and the reason  If contact any concerns for the SW’s visit made, -e.g. discussed attempted to differences  Asked the educate them between cultural family about on child abuse practices and their support laws child abuse system/safety laws, if network applicable

SET Referral Review Tool (6/16 v24: Referral) 9 County of San Diego/HHSA/CWS Please write in the name/rating for each parent:

Mother: Father: Other: Other:

Comments:

7. Were attempts made to connect the family with community resources and/or services, or assess services the family was already receiving?

Yes rate below

N/A (Circle all that apply: Safely surrendered baby; Children in adoptions and parental rights are

terminated; No safety threat/concerns identified and no referrals/services assessed to be needed at this time; Other (specify in comments box below)

Connection to key expectations –Support Systems/Safety Networks; Cultural Responsiveness; Comprehensive Assessments Enhanced by Agency Tools; Community Partner Collaboration

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  Provided Practice: Emerging Practice: Accomplished Distinguished family with a Practice: Practice: general list of  Provided  Asked the resources or specific referrals family about  Attempted  Followed- verbally provided barriers to to contact up with the information on  Explained connecting to providers to family to see if general referrals nature/ type of services facilitate service they made service and how provision with contact with OR will meet  Completed family new providers family’s need an eco-map or have been -If already in services  Discussed maintaining OR OR family’s culture contact with  Asked the (including any existing family about -If already in -If already in NAH) to ensure providers services the they services services referrals/ were already services met -If already in services receiving  Asked  Asked their needs family about about any  Attempts their needs and barriers to were made to if they were continuing with conduct joint being met by services visits with existing service service providers to providers  Suggested help engage/ additional maintain the service providers family in their if needed

SET Referral Review Tool (6/16 v24: Referral) 10 County of San Diego/HHSA/CWS services  Completed an eco-map

Comments:

8. Were the family’s strengths, acts of protection, and/or protective capacities identified?

Yes rate below

N/A (Specify reason in the comments box below)

Connection to key expectations – Comprehensive Assessments Enhanced by Agency Tools; SOP; Family Partnerships; Child/Youth Voice

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  At least one Practice: Emerging Practice: Accomplished Distinguished family strength was Practice: Practice: identified  At least one  There was act of protection documentation  Identified  Assessed  Attempted or protective on how these acts of the family’s Solution focused capacity for the acts of protection protection progress in inquiry or other family was have mitigated were used to utilizing acts of SOP tools identified some or all discuss safety protection more safety threats/ planning, if than once during concerns needed the time the referral was  Used  Included open Solution the child(ren’s) -E.g. During Focused Inquiry voice interviews, or SOP tools during with more than supervision, one family while writing member involved with the referral Investigative -e.g. both Narrative, etc. parents  Practiced Solution

SET Referral Review Tool (6/16 v24: Referral) 11 County of San Diego/HHSA/CWS Focused Questions with the family more than once during the time the referral was open

Comments:

9. During the course of the investigation were all safety threats accurately identified and documented?

Yes (All safety threats were identified) -Rate Below and Complete Section 2

No (There were safety threats that were not identified) - Explain and Do Not Complete Section 2

N/A: (circle all that apply) There are no Safety Threats to be identified; Other (specify in comments

box below)

Connection to key expectations –Comprehensive Assessments Enhanced by Agency Tools; SOP; Child/Youth Voice; Family Partnerships; Open and Clear Communication

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to Practice: Emerging Practice: Accomplished Distinguished  All safety Practice: Practice: threats were  All safety  Safety accurately threats were threats were  The family  The voice documented in identified and documented in was given an of the documented in CWS/CMS CWS/CMS using explanation of child(ren) / both CWS/CMS the impact and behaviorally youth and family and SDM extent of safety descriptive threats was used when language describing the demonstrating  The family impact of the the extent and was involved in safety threats impact of the safety planning safety threat conversations -e.g. What needs to change in order for children to be safe

Comments:

SET Referral Review Tool (6/16 v24: Referral) 12 County of San Diego/HHSA/CWS  If you answered “Yes” to Question #9 – Please Complete Section 2.

 If you answered “No” or “NA” to Question #9 – Skip Section 2 and go to the last page to provide overall feedback on this referral.

Section 2

10. Were the safety threats and Agency’s concerns described to the family?

Yes rate below

N/A (circle all that apply): Parent’s whereabouts were unknown for the entire RTP; Parents’ were

unresponsive to outreach; Other (specify in comments box below)

***Rate this question for each parent that is involved with the referral. The ratings are to be written on the lines above the comments box.

Connection to key expectations – Open and Clear Communication; SOP; Family Partnerships

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  The family was Practice: Emerging Practice: Accomplished Distinguished given an explanation Practice: Practice: about the need for  The family  Included Agency intervention was provided with behavioral  Asked the  A FCM a clear detail in the family about was held understandable harm and their explanation about danger understanding of  Safety, the need for statements safety, harm, harm, danger Agency and danger as and impact to intervention  Included it related to the child were impact to the their discussed with  Used the child investigation / the family terms of safety, family situation more than harm, and danger once  The child(ren) /  The youth and family’s voice family’s voice was obtained was included in more than the safety, once

SET Referral Review Tool (6/16 v24: Referral) 13 County of San Diego/HHSA/CWS harm, and danger statements

 Attempte d to hold a FCM Please write in the name/rating for each applicable family member:

Mother: Father: Other: Other:

Comments:

11. If a Safety Plan was implemented did it effectively address the safety threat?

Yes rate below

No (The safety plan did not address the safety threat – Explain in comments box below)

N/A: (circle all that apply) No Safety Plan was implemented; Safety Plan was not reviewed (not imported

in CWS or was not in case file); other (specify the reason in the comments box below)

Connection to key expectations – SOP; Family Partnerships; Support Systems/Safety Networks

Novice Emerging Accomplished Distinguished Master

In addition to Novice In addition to In addition to In addition to  A Safety Practice: Emerging Practice: Accomplished Distinguished Practice: Plan was Practice: developed  The Safety  A Safety At least one that Plan was Plan was  Attempts follow-up was addressed behaviorally developed which were made to conducted on the the safety specific was: include the effectiveness of threat(s) -SMART - safety network the interventions specific, in the safety measurable, plan  Changes attainable, were made if any relevant, and  Attempts issues were time-bound were made to identified include all  The involved/ parent(s) were appropriate included in the household development of members in the the plan plan

 The plan was written in the

SET Referral Review Tool (6/16 v24: Referral) 14 County of San Diego/HHSA/CWS family’s language

Comments:

12. Was the impact of trauma on the child/youth’s emotional, social, and physical development assessed if a safety threat was identified?

Yes rate below

N/A (specify the reason in the comments box below)

***Rate this question for each child in the family. The ratings are to be written on the lines above the comments box.

Connection to Key Expectations – Comprehensive Assessments Enhanced by Agency Tools; Child/Youth Voice; Behaviorally Descriptive Case Plans; Support Systems/Safety Networks; Community Partner Collaboration

Novice Emerging Accomplished Distinguished Master

SET Referral Review Tool (6/16 v24: Referral) 15 County of San Diego/HHSA/CWS In addition to Novice In addition to Emerging In addition to In addition to  Informati Practice: Practice: Accomplished Distinguished on on practice: practice: emotional,  Child /  Had a trauma- social, and youth’s informed discussion  Followe  Made any physical interactions with with verbal child(ren) / d-up with changes to development parent(s) were youth about how they service services, was gathered observed at are doing providers on goals, or from the least once any referrals service parent(s), during the RTP  Asked the that were providers as teachers, or child(ren) / youth what made needed other people  Followed- changes they would in the support up on like to see  Attempt  Followed system who information ed to get up on any may have provided by  If child non- support needs contact with child / youth’s system identified by the child/ youth verbal, asked support system parent(s) if current together to family or and referrals services being assess support system  Attempts were made to provided were helpful progress and were made to service address any  Followed obtain records providers as issues up on any or reports needed -e.g. Child action items about child / -e.g. For and Family from the FCM, youth’s services such Team if one was held emotional, as developmental Meeting, social, and services, treatment physical DSEP, team functioning, if counseling, meeting, applicable social skills wrap team group, meeting, or Pathways other FCM Screening, etc.

Please write in the name/rating for each child:

Child: Child: Child: Child:

Comments:

13. Was the family educated on how the abuse and/or neglect impacts the child(ren)/youth?

Yes rate below

N/A (Circle all that apply: Parents refused to speak with the SW; Other – Explain in comments box below)

SET Referral Review Tool (6/16 v24: Referral) 16 County of San Diego/HHSA/CWS ***Rate this question for each parent that is involved with the referral. The ratings are to be written on the lines above the comments box.

Connection to key expectations – Open and Clear Communication; Family Partnerships; Child/Youth Voice; Comprehensive Assessments Enhanced by Agency Tools

Novice Emerging Accomplished Distinguished Master

In addition to In addition to In addition to In addition to  Discussed Novice Practice: Emerging Practice: Accomplished Accomplished impact of the Practice: Practice: trauma on the  Explanatio  The child(ren)/ youth n of the impact parent(s) jointly  Included  Assessme with the parent(s) (or future identified ways the voice of the nt was done of impact) of the in which the child(ren) / youth the family’s specific trauma abuse/ neglect in the understanding of on the child(ren) has impacted explanation the impact and / youth was their child their the actions they clearly and child(ren) / need to take to specifically youth help their child documented (ren) / youth more than one  Behavioral time during the detail was given referral

Please write in the name/rating for each applicable parent:

Mother: Father: Other: Other:

Comments:

14. Was a Family Centered Meeting (FCM) held with the family to address the Safety Threat?

Yes rate below

N/A: (Specify in the comments box below)

SET Referral Review Tool (6/16 v24: Referral) 17 County of San Diego/HHSA/CWS - Attempts were made to schedule a FCM, but one was not held

Connection to key expectations – Comprehensive Assessments Enhanced by Agency Tools; Community Partner Collaboration; Family Partnerships; Child/Youth Voice; Open and Clear Communication; Support Systems/Safety Networks; Aftercare Plans

Novice Emerging Accomplished Distinguished Master

In addition to In addition to In addition to In addition to  A FCM was Novice Practice: Emerging Practice: Accomplished Distinguished held, Practice: Practice: -e.g. TDM, mapping,  The FCM  The FCM Family Group only included included or  Followed-  Followed- Conferencing, etc. or attempted to attempted to up with family up with all include include formal on action plan parties on informal and informal agreed upon in agreed upon supports supports for the the meeting actions family   The Information child(ren)’s / obtained from youth’s voice parties was was used to make incorporated in adjustments in the meeting the plan and/or (child(ren) to be provide present if feedback to possible) parties on progress on goals

Comments:

*Complete box below if there is any overall feedback from the review

What’s Working Well? :

SET Referral Review Tool (6/16 v24: Referral) 18 County of San Diego/HHSA/CWS What are You Worried About? :

What Needs to Happen Next? :

SET Referral Review Tool (6/16 v24: Referral) 19 County of San Diego/HHSA/CWS