Child Welfare in Ontario: Developing a Collaborative Intervention Model




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Outcomes

During the first two years of the Brant CAS project (which was not a full-time program in the first year) 342 individuals participated in a conference. There were 26 children prevented from admission to CAS care, 9 children were placed with kin after being in CAS care, 17 children were placed with kin, 8 children were placed on adoption with consent, 7 children were made crown wards on consent, custody/access disputes were resolved for 8 children, a parental support/respite plan was made for 30 children, more intrusive action was prevented for 10 children, a trial was averted for 10 cases, and 15 cases were closed following a FGC. Similar outcomes have been achieved in other programs.


Conclusion

Family group conferencing helps build strong, healthy communities and families and empowers and challenges them to actively participate in planning for their children who have been identified as needing protection. Through FGC families are provided with the opportunity to tap their own resources to rebuild and strengthen existing social support networks and forge effective partnerships with formal systems. All decisions and practices focus on ensuring the best interests, protection and well being for abused or neglected children within a broader family context. Although family group conferencing within child welfare is relatively new to Ontario it is widely practiced in the U.S. and at least 20 other countries throughout the world. Fortunately we have the opportunity to ensure that this promising and empowering approach to permanency planning and decision making for children is more widely implemented in Ontario and there appears to be the will within the child welfare sector for this to become integrated in the service delivery system.


Written by Bruce Burbank, liaison with Family Group Conferencing Initiative.


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Clinical Supervision in a Child Welfare Context


Current Pre-Transformation Situation

The parameters around ORAM have taken supervision to a confined and prescriptive approach. The standards, the recording package and the expectation for supervisory monitoring of every step of the work do not allow the time or culture for clinical supervision. Stress studies speak to the psychological process of hyper-vigilance that the current system engenders. (CAS Toronto). In addition, the liability-focused approach to the work does not allow for a good balance nor is there concrete evidence that it actually keeps children safer. In fact, some postulate that the opposite is true. A positive working relationship along with a caring that is felt by the child or family member can reduce liability more effectively (Solomon).

The present Ontario Risk Assessment Model promotes the concept of ‘power over’ with children and their families. This is also a parallel occurrence between supervisors and their workers through constant micro managing of worker actions. A more delegating role would include clarifying expected outcomes and allowing workers some flexibility on how to attain then with children and families.


The present model also promotes the process whereby workers bring forward situations and problems instead of possible solutions to cases. This is not to say that this model does not provide supervisors with some sense of predictability, calmness, and security but it is done from a limited perspective that does not allow for growth or flexibility in the supervisees or in turn with their clients. Often workers send documents by e-mail to their supervisors and then the approved documents are sent back electronically. The degree of face-to-face dialogue and discussion of alternative courses of actions is not negotiated in a traditional social work manner. The supervisor has little opportunity to help the worker look at options and to determine areas of stress and doubt that may ordinarily be discovered and resolved. As a result, the ability to move to new points of competence and confidence are somewhat delayed by the day to day process which does not maximize opportunities for growth.


Fortunately it is anticipated that Differential Response will move the field away from a narrow, risk assessment/compliance monitoring approach to a wider, possibly (strengths based) focus. Although the discussion paper on Differential Response contemplates at least a two-track model, human beings do not so easily fit into a binary system of classification. We would propose that clinical supervision should be about both safety and building on strengths. Clinical supervision needs to have both the components of focusing in and stepping back, with both factors influencing decision-making. As such, supervisors in this new system will need to have skills, which can effectively cope with change and its uncertainty; shift perspectives comfortably; and allow for risk decisions and actions without having as much written information from their workers.

There are other possible benefits and outcomes from a more clinical/collaborative approach to supervision. Children will still be as safe or safer, and parents will have a greater chance of engaging their workers in helping their children acquire safety. Workers will feel more enabled through being proactively engaged to search for what works and as a result, both supervisors and workers feel more motivated and professionally challenged and stimulated. In addition, supervisors will be able to place more focus on positive client outcomes rather than primarily on the present prescriptive procedures that the worker are required to follow under the present version of the Ontario Risk Assessment Model.

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The Philosophical Underpinnings of Collaborative Clinical Supervision


How do we move from the current situation to the Vision for a more Collaborative approach to Clinical Supervision? Moving from a very highly prescribed, administrative and regulated mode of supervision that emanated from the Reform agenda, a move to a more collaborative mode of engaging families will require a shift in the way we provide supervision to our front-line. The sense in the field currently is there is a pent-up demand to not just supervise the ‘work’ (the production of the worker) but also to attune to and provide supervision to the ‘worker’ (their capacity to produce) so that we develop and grow both the workers and their capacity to facilitate sustainable and meaningful change with their families.


To begin with a balanced clinical supervision in Transformation requires a set of values that are tied to the child welfare organization as a whole and have been spoken to in other portions of this Position Paper. Reference too can be given to the OACAS Human Resources Group, which is currently developing a resource paper for looking at ‘Change Management’. It will assist staff in adjusting to change when they have previously been trained and oriented in a very prescriptive model. In the meantime, this paper is supporting the principles outlined below.



  • Recognition that the culture of the organization influences all relationships including that of the supervisor and the worker. This in keeping with Section 2 of this Position Paper and in literature written on the OACAS Excellent System. In this approach, various options can be evaluated on a local level to ensure a consistent culture that can bring expertise together in a consistent manner.

  • Appropriate supervision will ensure professional accountability mechanisms of service delivery to children, families and to the community

  • Agency quality assurance systems encourage clinical supervision and supervisors have a lead role in quality assurance that evaluates client outcomes.

  • Supervisors will be provided by the agency with the skills, permission, and opportunity to prioritize clinical supervision

  • The Teacher, trainer, mentor roles of the Clinical Supervisor are promoted and encouraged. They are described in greater detail in this section of the paper.

  • Supervisors feel adequately supported and safe in engaging in a balanced approach to supervision.

  • Recognition of the concepts of ‘power over’ and ‘power with’ which are parallel processes in supervision. They are described in greater detail in this section of the paper.


There are many constructs or theories on how to enhance empathy including such diverse constructs such as Maslow’s motivational theories (referred to in the ‘What Supervisors Bring’ section), learning style theories, interaction style tools (DISC, Myers-Briggs etc.), Situational Leadership of Hersey and Blanchard, Covey’s Principal Centred leadership, understanding resistance, all of which can provide some guidance. Covey’s approach, for example will allow supervisors to be more effective by not just focusing on the reactive crisis orientation to the work. It is likely not the construct or technique that is the most salient variable at work here, but the true driving force may very well be the will and efforts by staff into trying to understand the various points of view.

^
Determinants on the Roles and Competencies of a Collaborative Supervisor:

In No More Bells & Whistles, Miller, Hubble and Duncan review the latest research with respect to the impact of the key variables on therapeutic outcomes. What the research has suggested is the following:

  • 15% of outcomes are attributable to the client’s hopes and beliefs that change will happen

  • 15% of change is related to the therapeutic techniques used by the worker

  • 30% is attributable to the worker/parent relationship

  • 40% is attributable to the client’s individual characteristics and social context.


Does our supervision, training and overall direction to staff currently reflect a similar focus or attention reflective of what really works? The answer is probably not. The system under Reform actually takes us primarily to the 15% attributable to technique and even that is not related to clinical technique, rather to a forensic based approach that really is not supported by research. So what do we need to do differently? Reviewing the above percentages suggests we should be focusing on the worker/parent relationship more than on techniques. We can likely also have an influence on the client’s hopes and beliefs by influencing the hopes and beliefs of the worker. We likely should also be spending some time on the social context of the client and those other instrumental barriers that have been shown to have a role in change. If 15% of change in a therapeutic relationship is related to the technique used and if relationship accounts for 30% and if what the client brings is 40% then we have the 60% to work with in supervision.

^
Supervisor Attributes Required for Clinical Supervision in a Child Welfare Context

Supervisors should acquire the following attributes in order to perform clinical supervision with their staff.


  • Incrementalism: the ability to make small decisions, get feedback, and then adjust course

  • Living with less than complete knowledge: the ability to find the right balance between thinking a problem through too long and taking action to quickly.

  • Open to new learning: the ability to move outside the comfort zone of what a supervisor knows already in order to discover new information, even if it results in redefining some of the present reality.

  • Organization: the ability to set priorities, to manage process, and to show a degree of self discipline in doing so

  • Approachability: the ability to be approached for discussion by spending extra effort to put others at ease. As such the supervisor presents as warm, pleasant and gracious; sensitive to and patient with the interpersonal anxieties of others; builds rapport well; and is a good listener

  • Compassion: as such the supervisor genuinely cares about other people; is concerned about their work and non work problems; is available and ready to help; is sympathetic; and demonstrates real empathy with the joys and pains of others

  • Composure: as such the supervisor personifies grace under pressure; does not become defensive or irritated when times are tough; is considered mature; can be counted on to hold things together during tough times; can handle stress; is not knocked off balance by the unexpected; doesn’t show frustration when resisted or blocked; is a settling influence in a crisis. The supervisor is attuned to building resilience in herself and others.

  • Conflict Management: the ability to step up to conflicts; seeing them as opportunities; reading situations quickly; good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and can negotiate cooperation with a minimum degree of disruption required

  • Confronting Issues: the ability to deal with issues in a firm and timely manner; never allowing problems to fester; regularly reviews performance and holds timely discussions; and can make negative decisions when all other efforts fail

  • Creativity: the ability to produce new and unique ideas; and the ability to make connections among previously unrelated notions



^

Supervisor Roles Required for Clinical Supervision in a Child Welfare Context


Supervisors should assume competence in the following roles in order to perform clinical supervision with their staff.

The Supervisors Role as a leader

In a true learning culture, everyone (leader and front-line staff) can play key leadership roles in different areas and at different times. An organization or leader that can answer the following questions of staff, whether they are actually ever articulated or not, sets the groundwork for a motivated worker.

What is my job?

Why is it important/how does it fit in?

How am I doing?

How can I do better?

What is in it for me?

^
The Supervisor’s Role as a Coach in Clinical Supervision

Methodologies in clinical supervision to front line staff should support and reinforce the desired orientation of services to clients. The “parallel process” of clinical supervision not only creates the conditions for the development of staff knowledge and skills, but also models learning within an experiential context that can be replicated in client services.


Supervisor’s, as coaches need to be aware of the impact that their orientation in supervision has, not only on their staff, but also ultimately, in the way in which service is delivered to our client families. Training should promote increased supervisor self-awareness along with knowledge/skills/techniques to be used in coaching front line staff.


Effective coaching requires an understanding of the individuals learning needs and learning style. While coaching training has a general orientation, it should not be thought of as a “one size fits all” methodology. The art of effective coaching is as much about “finding the fit” as it is about the content.


^ The Supervisor’s Role as a Teacher

Effective teaching technique encourages staff to stretch their skills and grow on the job. In doing so, the clinical supervisor allows staff to make mistakes of honest effort and subsequently, learn and improve their skills. Through the process of providing positive feedback, the supervisor is able to recognize the good pieces of work worthy of reward, give feedback for areas requiring improvement as well as identify, confront and challenge the perceptions of the worker when the need is identified. The importance of the role of the supervisor as a teacher (educator, trainer) for staff is highlighted in Trotter’s article that examines the positive correlation between client outcomes and the clinical skills of the front-line worker. As the worker’s main connection to training and clinical supervision, the supervisor has a direct impact on the development of the skills of their staff and hence, an indirect impact on the potential client outcomes. (Trotter, 2002)

^
The Supervisor’s Role as a Mentor

This role models what we expect of workers in their behaviour with clients in a collaborative approach. As such the supervisor should make a genuine effort to meet staff at their level of worker development and through their respective learning styles and where they are day to day in their hierarchy of needs etc. This is very much the practical application of the skills taught presently in Module Three of the OACAS Manager Training. This approach will enhance the workers’ abilities to do the same with the parents and children. It will also assist them in their hopes and dreams for their career development; staying on top of best practices as outlined in this Position Paper and ultimately help them manage the changes that are about to occur under Child Welfare Transformation.


^ The Supervisor’s Role as a Supporter

This role involves the ability to show the worker a caring about the work that is done and pay attention to both the efforts and results. It is accomplished by giving concrete, structured direction only when it is necessary. It is also demonstrated by the supervisor’s willingness to pitch in with the rest of the unit when there is an overload situation. It can also involve de-Briefing with the worker or unit when there is a tragedy on a case, or even a new or particularly difficult apprehension. Supportive supervisors attend to worker’s well being and by doing so help both themselves and their staff to build resilience.


^ The Supervisor’s Role as a Clinician

In this role the supervisor is aware of parallel processes such as the ones which have been mentioned below. She is aware of various treatment modalities such as the ones which have been outlined in this Position Paper, and they can be a link for workers to others with specific clinical expertise. The Supervisor’s own transparent approach to clinical development can also play a positive role modeling for their workers professional development.


^

Additional Topics requiring further discourse and training to enable effective collaborative supervision:

Resilience.

Training is required to show supervisors how to build their own resilience to the pressures and challenges of their position and then model this to their staff.

^
Parallel Processes

The influence of the supervisory relationship on the worker’s approach to clients has been well documented (Holloway 1997; Kahn, 1979 & Raichelson et al. 1997). The supervisor has a key role in promoting the (e.g. servant leadership) agency culture with front line staff so that it filters down to worker-client relationships. Supervisors have positional, coercive, reward, referent and expert power in the relationship they offer the worker (Kadushin, 1994). They have the opportunity to choose ‘power with the worker’ or ‘power over the worker’. We can hypothesize that a worker’s experience of power in the supervisory relationship may influence their use of power in the client relationship.


The supervisor emulates basic standards of practice by first and foremost joining with and beginning at the supervisee’s level, while incrementally advancing the staff through the layers of autonomy and competent practice. Munson (2002) observes that the dynamics of power and authority are often ignored or overlooked in the supervisors’ relationship with staff. A supervisor who acknowledges the issue of power and shares power prepares a worker to consider and address this issue in the client relationship.


Williams suggests focusing on the “supervisee state” in terms of their experience, their clinical qualifications, their ‘Maslow’ needs, learning styles, and the worker’s interaction styles. All these actions promote and parallel the ‘servant leadership’ notion outlined in the Paper section on agency culture (Section Two). This process models an approach that workers could use effectively in working with their families (Williams 1999).


Supervisors should also focus on ‘activating’ the workers strengths-oriented self-concept so that they can also take that approach out to the client. For example, they should start supervision each time with a discussion of successes rather than problems. As such when dealing with problems, they should also review past coping successes to see what possible interventions might be brought forward to this case (and also subtly reminds of difficult hurdles overcome previously). Beginning where the client is means focusing less on the client’s problems and more on what he or she is doing about it”. (Cohen, page 461)

^
Attunement Parallel

Just as Bowlby identified that a parent must attune to the needs of their infant to ensure secure attachment, the foundation of healthy human relationships, there may be a parallel process between parent and worker and also worker to supervisor. Dr. Diane Benoit in her work on attachment clarifies that the concept of behaviour that relates to Attachment can only occur when infants are ill, injured or in some kind of pain or significant discomfort or distress. In the parent-infant dyad when the infant is crying and in distress, the parent must try to comprehend or attune to what their infant is thinking, feeling, needing and then, consistently respond to meet the need to close the loop for secure attachment to occur. At that moment of truth, the behaviour of the parent to comfort or soothe the infant creates attachment. Attachment does not occur during fun time, play or cuddling when the baby is content – that is essentially good parenting but it does not refer to Attachment as identified in literature. If the parent focuses for instance on their own tiredness when the infant is in distress, while a natural human response when you have been up for 18 hours, it does not bode well for the developing infant’s capacity to attach if it happens on a regular basis. The parent who can rise above their own needs and issues and attune to their infant in a relatively consistent manner (the ‘good enough’ parent), the infant will most likely develop a secure attachment.


In the worker parent dyad, a related process may be at work. If the worker can rise above their own work pressures and demands and attune to the parent – meeting them at their level, then there is an opportunity to potentially forge a trusting relationship. When a parent’s homeostasis is disrupted, crisis theory indicates there is a window of opportunity for change. Crisis theory would likely suggest that when a parent is in crisis, hurting, terrified etc. the support they get at that time would promote a bond to those who helped them work through the problem. If we miss that window, the opportunity to facilitate long-standing or real change in the relationship may be compromised until the next crisis occurs.


Could an analogous process take place in the worker/ supervisor relationship? Our workers deal with clients who are chronically in crisis and emotional pain. The issue of ‘compassion fatigue’ and the fear of not keeping up with demands of the job are evident from time to time with even our most competent staff. If a worker is feeling unsafe, insecure or somehow in emotional pain or discomfort and the agency and/or supervisor ignores that state, the opportunity to forge a stronger relationship and model collaborative work may be lost.


^ Figure 12: Crisis Window for Change



Rocci Pagnello 2005


This opportunity likely exists frequently in the stressful demands of the work in child welfare. For example, de-briefing after a new or stressful experience or particularly difficult apprehension. If we react in a way that shows we are trying to alleviate that pain, distress or discomfort of the worker, there is an opportunity to have created a more collaborative relationship after the crisis is gone. This concept requires much further exploration, however, it does seem to have some potential to influence the way we respond as agencies in the overall supportive role of the supervisor, Human Resources and agency expectations of staff.
^

Building Covey’s Quadrant 2 Focus


Figure 13a: Building Covey’s Quadrant 2 Focus



Rocci Pagnello 2005


Quadrant 2 (not urgent but important) is about planning, relationship building, and re-creating. More activity in this quadrant moves the worker away from ‘putting out the fires’ work that makes up Quadrant 1 (Urgent + Important) and towards more time spent in this more effective quadrant.

Front-line staff need help to do this. Supervisors need to have them recognize that time away from direct client service is time lost to relationship building with them. For the supervisor much of the task to accomplish this is involved in looking at internal administrative or bureaucratic structures that create barriers for more direct time with clients.


Figure 17b: Estimating Risk to a Child



Rocci Pagnello 2005


^
Over-Identification, Boundaries & Transference issues

As we encourage a more collaborative approach, we are moving staff to engage more fully with clients. The question then arises as to how we supervise workers around setting appropriate boundaries. What tools can we give them to set the parameters in building a healthy, helping professional relationship? How also do we then prepare supervisors and staff to recognize signs of over-identification? This is a problem that has to be prevented in the first place, or when it has occurred, how can the supervisor help the worker through the blurred boundaries in order to bring him or her back to mission, vision and the paramouncy of child safety.


Some of the issues around this clinical issue include the risks of over-identifying with the parent or the child or perhaps anger at the parent for what they have done or are doing to the child. There is also the problem of a worker inappropriately disclosing personal experiences that are not of specific benefit to the client. Another possible transference issue surrounds potential rejection of the worker by client. Not all workers understand that it may be the result of the client’s reactivation to previous cycles of rejection that they have experienced from their own parents or from other failures such as those experienced in a previous school setting.

^
Motivation, Maslow, and Client Engagement

Maslow’s perspective on motivation can be very helpful in gauging where a parent is at and hence, how we need to intervene to assist them in moving up the hierarchy of needs. In that respect, Module Three of the OACAS Management Training needs to enhance its use and interpretation of Maslow’s Hierarchy of Needs. Reviewing staff concerns from this point of view can also help supervisors gauge where staff are at in terms of their current readiness to develop more collaborative relationships. For instance, if a worker’s concerns or complaints are centered on job security and physical safety, they are likely not at level that is required for incorporating a commitment to collaborative relationship building. Maslow postulates that human beings always seek to improve on life, therefore, we will always have concerns or complaints – it is just that these complaints occur at different levels. We should not expect that people complain, but rather delight when those complaints reveal they are operating at a higher level of unmet need. The role of the leader is to help their people move up the hierarchy to levels that enhance the agency’s capacity to collaborate and create the opportunity for positive change. (Maslow et al 1998 page 266)


Figure 14: Motivation, Maslow, and Client Engagement



Rocci Pagnello 2005


^
Questions that Promote Collaborative Practice

One of the best ways supervisors can encourage social workers to respect, listen to, and involve family members is by exhibiting these attitudes in their discussions with workers about specific families. The following questions, which employ elements of scaling and strengths-based techniques, ask the supervisor to adopt a “not knowing” stance that will encourage workers to come up with their own family-centered solutions (Alderson & Jarvis, 2003).


How can we reunify the family and build a safety net for the child?

If you were _____________(birth father, foster parents, etc.), what would you want to see happen?

Describe a resolution in which everyone wins.

What has happened so far on this case?

What information are we missing?

On a scale of 1 to 10, how ready is mom to parent?

What are the birth mother’s strengths?

How can we build on her strengths?

What would it take for dad to show he’s overcome his substance abuse problem?

How willing are the birth family and the foster parents to participate in a child and family team meeting?

What would such a meeting look like?

How can I help you bring together the team?

How can we help the child feel more connected to both the birth family and the foster parents?

How do you (as worker) see your role in helping this plan come together?

How do you think others (the grandmother, the mother, other agencies, the court) see as their roles?

Always ask yourself: “Is this how I would want to be treated if this was happening to me?” This question will help you assess your interactions with families and with workers you supervise. (Alderson and Jarvis, 2003)

^
Survey of Supervisor’s in the field - Possible Questions for Supervisor’s Focus groups

Another set of questions that may aid supervisors to make the transition to a greater collaborative point may be for them to self-reflect on what their values are and why they entered the profession of child welfare. These Questions drafted for Supervisory Focus Groups are simply examples to use, edit or ignore should you choose to survey supervisors about the hopes and fears of supervisors and the meaning of their work.


What brought you to the field of Child Welfare in the first place?

What were your hopes & dreams when you first got promoted to the role of a supervisor?

What were your biggest fears?

What keeps you in the field?

What approaches do you use in supervision that helps you engage your staff?

What works for you in various situations (crisis consultation)?

Do you approach new workers and experienced workers in the same way?

What would your workers say you do really well in supervision?

What was the most important thing you learned from a supervisor when you were on the front-line?

What do you think about the following: Supervision should focus on supervising the worker; not the work?

How do you manage up i.e. how do you interact with the person who you report to in your agency?

What advice would you give to a new supervisor just starting out?

What is the best question(s) you use in supervision to lead or focus your staff?

How do you know when your supervision is having a positive impact on clients?

What do you feel are the most salient factors that create or increase disillusionment in our workers?

What are the most dominant or frustrating barriers for you in being a supervisor?

What could the agency do to enable you to provide the kind of supervision you want to provide?

If you were to write your career epitaph or eulogy – what would it be? OR What would you want the field or your colleagues to say about you as child welfare professional if you happen to leave the field?

Write the going away speech you would like to hear from your colleagues and supervisee’s.

Do you have any other comments?




With all of the above discussion on clinical supervision, the field must not lose sight of the significant role of the instrumental needs of staff and supervisors. The most crucial of these is the precious and expensive commodity of time. With a heavy workload and all the urgent and important demands on staff time, the pressure on workers and supervisors to be all things to all parents and children can sometimes mean all the best intentions around relationship building does not make the priority list.


Just as workers should not forget the immense value in some practical or instrumental assistance to parents and how that plays a role in relationship building – (summer camps, drives, clothing, advocating for services etc.), the field and funders should not forget the reality of the instrumental needs of the worker to spend time with the parents and the supervisor to spend clinical time with the workers.


References
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