Strategic Assertive Family Engagement (SAFE) Services

For information or referrals:
David St. John, Program Supervisor
700 University City Blvd.
Blacksburg, VA 24060
dsjohn@nrvcs.org
Phone: 540.357-0958
Fax: 540.961.8462


“…I’ve learned from the SAFE TEAM…how to control my urge to do drugs, by keeping my mind occupied…to try and relax and breathe when I feel overwhelmed…I was really impressed with the dedication they showed toward me and my family. They made me feel that I wasn’t a screw up…and I don’t know what I would have done without the services of the SAFE TEAM.”

– Consumer of SAFE TEAM services

Strategic Assertive Family Engagement (SAFE) teams stemmed from a thorough assessment of need throughout the New River Valley. The premise behind the development of this program is that parent engagement reduces the risk of children entering Foster Care or will assist parents in taking the necessary steps to re-establish custody.

The SAFE Team is not purely a substance use disorder treatment model but a philosophical approach to treating parents that have been difficult to engage in treatment for various reasons. The program strives to overcome unique challenges in engaging these parents by using the essential underpinnings of the Community Reinforcement Approach.

SERVICE POPULATION
Comprehensive clinical and case management services are designed to facilitate treatment engagement and to reduce the risk of children entering Foster Care as well as assist parents in taking the necessary steps to re-establish custody. The program seeks to serve those whose needs are consistent with the service. Accommodations will be made to serve individuals or family members who do not speak English with the provision of a translator or interpreter. Clinicians will accommodate individuals with disabilities by tailoring activities and service delivery to meet the physical or mental needs of the individual.

SERVICES PROVIDED

Clinical Community Treatment Specialist:
• Intensive, evidence-based mental health and substance use individual treatment-2 sessions weekly minimum; drug screening
• Family treatment
• Assessment and evaluation along with recommendations to referral sources as needed
• Recovery Oriented Treatment
• Group Facilitation when appropriate/available

Intensive Family Coordination:
• Case consultation
• Link to resources, services, etc.
• Locating appropriate community supports
• Treatment planning and regular treatment team meetings

Parenting Services:
• Parental Education
• Modeling of specific techniques
• Attendance at Parental Visitations if applicable
• Monthly reports on progress

Family Maintenance Partner:
• Continuation of therapeutic interventions
• Resource assistance
• Daily planning and management
• Maintaining Family engagement

As well as any additional service needed to support the family.

LENGTH OF SERVICE
The initial time frame for delivery of services is considered to be up to twelve weeks.  If a family is considered to be chronically in need of services, services may be requested at FAP Team for an additional twelve weeks.  For long-term families, there is a requirement that progress must be made towards accomplishing the goal in the treatment plan.  To ensure that progress is being made and appropriate and effective treatment is being provided, case are staffed with the SAFE supervisor on a routine basis.

If the family is not making progress or is not cooperating with the services, consideration may be given to terminating the service.  Prior to termination, the family should be staffed with a supervisor and documented in the individual’s chart.  The referral source and the involved FAP Team should be notified soon thereafter in writing.  Planned discharges should involve the identified individual, the family, the referral source and, the FAP Team, and resource linkages should be made prior to discharge.  Planning in these cases is a cooperative endeavor with all involved parties.

SCREENING, EVALUATION, ADMISSIONS and EXCLUSION
SAFE will maintain a viable referral, screening and evaluation process to ensure that admissions to the program are appropriate.  Referrals for SAFE are accepted only from FAP Teams.

The steps in the referral process for SAFE are:
1. The current referral form should be completed and submitted to the SAFE supervisor, indicating the purpose of the referral.

2. SAFE evaluation by the program staff to review admission criteria.  The completed evaluation shall include a statement of the individual’s and the family’s strengths, needs, and culture, as well as the presenting problem, prior treatment efforts, and goals of the family.  Agency requirements for documentation of appropriateness for services will be completed.  Admission will not be denied due to the individual’s age, gender, sexual preference, social preferences, cultural orientation, diagnostic characteristics, physical situation, or spiritual beliefs.  The needs of special populations will be identified during the evaluation and accommodations will be made as much as possible.  Interpreters, translators, and handicapped accessible rooms will be available when needed.  Evaluations by a psychiatrist or psychologist and/or medical personnel will be made available as determined by the team or the supervisor.

3. When appropriate, the chairperson of the FAP Team which authorized the service will be notified of the completed evaluation.  When a referral has been made as a result of a FAP Team discussion as part of a service plan, even when no payment is authorized, the clinician working with the family will submit reports in a timely manner to the team. SAFE supervisors will inform FAP Teams about service initiation.

4. In the event that an individual does not meet the admission criteria, the referral source and the parent will be advised regarding possible appropriate services.  Documentation of these recommendations will be maintained.

5. The clinician or supervisor assigned as case manager for the family will assure that agency guidelines are implemented as to orientation, treatment planning, and program licensing and will review the case on a regular basis with the referral source and the family in a treatment team staffing when possible in order to assess progress and to monitor ongoing coordination.  In addition, the case manager for the individual will have access to a comprehensive file of community resources. Welcome packets which include information about the services and informed consent will be reviewed with the individual by the clinician assigned.  In the event that the individual is not accepted for services, formal recommendations will be made to the referral source in writing.

ADMINISTRATIVE INTAKE
For individuals referred to SAFE, a face to face evaluation must be completed by the SAFE Clinician or Supervisor and paperwork related to coordination with other services should be completed relating to the goals expressed by the FAP Team.

PROGRESS NOTES
Clinicians will utilize progress note forms when documenting activity with parent and/or family, or with collateral or case management activities. Agency documentation practice will be followed. The following information is considered appropriate to document:

1. Telephone calls with individuals or concerning individuals.
2. Results of individual staffing within the agency or with others.
3. Information obtained regarding individuals from other services, family members, teachers, etc. in the service of the individual.
4. Case management activities.
5. Family and individual sessions.

WAITING LISTS
In the event of the need for a waiting list, due to the capacity of the staffing pattern, the supervisors of SAFE program will keep a log of the individuals who have been referred and are waiting for services, the date the individual was referred, and any contacts with the referral source.  The referral source as well as the individual will be advised of the availability of other services and of emergency help.  The waiting list will be monitored weekly, and individuals will be assigned to a case manager/clinician by need and with input from the team.  The goal for SAFE waiting list is less than 2 weeks.

STAFFING PATTERNS AND OTHER RESOURCES
Each family is supported by both a licensed (or licensed eligible) clinician and a case manager. Treatment planning is both family-centered and goal-oriented. Providers will be Qualified Mental Health Professionals monitored by supervisors who are QMHPs and/or LMHP-Type.

DISCHARGE AND TRANSITION
In most cases, discharge of an individuals from these services will involve transitions to services that are less restrictive in nature (i.e., outpatient therapy, case management) or more restrictive in nature (i.e., out of home placement).  A discharge plan is to be established with the family within the first 30 days of treatment, and is to be included in the treatment plan.  The plan should identify the need for another level of care, and should provide for continuity of care.  Individuals who are receiving psychiatric services through NRVCS will need to be followed by case management, mental health supports, or outpatient services to ensure appropriate monitoring of individual.  Individuals who choose to terminate treatment from the entire agency will be advised of the necessity of consulting with the physician to ensure that medication is tapered and discontinued safely, or that individual has a supply of medication and referral to other providers of psychiatric care. Clinicians will be available for consultation after the close of a case.  The following procedures apply to discharge and follow-up:

1. Clinician/case manager assigned to the individual, the individual and individual’s family will determine that program/treatment goals have been met, deleted, or changed, documented in the review or the discharge summary.           

2. Termination session is held to review progress toward goals and to make recommendations.

3. Paperwork is completed by the clinician or case manager to transfer or terminate individual, including the established agency discharge summary.

4. After discharge, a contact may be made with the family to evaluate the current level of functioning.