Standard 7 Ongoing Service Case Management


When the investigation disposition is to transfer a case to ongoing services, the focus of ongoing services is on protecting child(ren) and engaging families in CAS services and other community supports in order to reduce the likelihood of future harm to child(ren). This standard includes a number of requirements related to the provision of ongoing services, in particular with respect to the following:


The intent of the standard is to ensure a collaborative and respectful assessment of the family’s strengths and needs is undertaken and a service plan developed to guide the subsequent interventions intended to mitigate risk to the child (or children). It is intended that engagement with the family is undertaken on a continual basis during the provision of ongoing services to monitor the child’s safety and well-being and to provide support to the family. The child protection services provided to the family are meant to be purposeful, goal-oriented, and outcomes focused. It is intended that the appropriateness of the services and the family’s progress is reviewed and evaluated at regular intervals.

The standard promotes the engagement of the family during the assessment, service planning and decision making processes. Emphasis is placed on ensuring the family understands the child protection concerns, the outcome of all assessments, what their child protection worker and all others participating in the service plan will do to resolve the child protection concerns, and how the family’s progress will be measured. There is also a continuous focus on the child’s need for a safe, stable, reliable and permanent placement.

Standard #7 Ongoing Service Case Management

The First Month of Ongoing Services

The focus of the first month of ongoing child protection services is on:

Monitoring the Safety Plan

If there have been changes to any of the safety threats identified in the safety assessment completed during the investigation or in the ability of the interventions to assure safety, the ongoing child protection worker will together with the family develop an alternative safety plan. Any new safety plan which is developed is approved by a supervisor prior to its implementation and documented on the next working day.

Conducting the Family and Child Strengths and Needs Assessment

An assessment of the family’s and the child’s strengths and needs is completed on every case receiving ongoing protection service prior to the development of the service plan. The assessment assists in developing a service plan that utilizes family strengths and targets areas of need.

The results of the family and child strengths and needs assessment are discussed with the family during the service planning process.

Developing a Service Plan

The child protection worker who will implement and manage the service plan develops the service plan with the family within the context of a family-centred conference. The initial service plan is completed within thirty (30) days of the completion of the investigation, or within thirty (30) days of the date of the case transfer following the initial investigation.

It is anticipated that the vast majority of these conferences will be facilitated by the family’s own worker, who invites the child, family and their chosen circle of support in regular service planning and review. CASs are also required to have a family-centred conferencing model available for case planning purposes, and policies and procedures related to its use. The use of traditional conferencing/healing models or methods (e.g. talking circles) is preferable for Aboriginal children and their families.

Participants in the service planning process include:

The service plan minimally contains:

Ongoing Service Case Management (After the first month and beyond)

Following the development of the initial service plan with the family, the service plan is implemented and managed. The role of the worker is to:

The minimum standard for visits with families in their home is once per month. However, more frequent visits should take place in certain circumstances. When deciding whether more frequent visits are required the worker considers:

The frequency of visits is also reviewed by the child protection worker and their supervisor during supervision.

The child victim(s) is/are interviewed privately either at home or in another setting. Non-verbal children are directly observed in their own home environment and particularly as they interact with their parent/caregiver.

Unannounced visits are required when:

Reviews, Consultations or Approvals by the Supervisor

Every ongoing child protection case is reviewed in a supervision session minimally once every six (6) weeks. Cases with a higher degree of risk or complexity are reviewed more often.

Case Review and Evaluation

Formal case review and evaluation takes place every six (6) months following the development of the initial service plan. The formal review requires completion of the following assessments:

Information collected by the child protection worker from the family and collaterals regarding the family’s progress throughout the case management process will be reviewed in the context of a family-centred conference which involves all family members and their support persons who participated in the service plan, including other service providers whenever possible. The unavailability of other service providers will not delay the service plan review.

A service plan is also reviewed and revised when the reunification tools have been completed and the child will or has been reunited with his or her family.

Concurrent Planning

At the time of the first case review and all subsequent reviews following a child being placed in out-of-home care, it is critical to consider what the prognosis is for the family to achieve reunification. If the protection concerns and needs of the family are significant, the family has made little or no progress in achieving its goals/objectives and the prognosis is poor, an alternate permanent plan is developed with the family. A reunification assessment guides these decisions. It is important to involve all interested extended family members, relatives or other family support persons including a representative chosen by the Band. The worker should conduct a thorough, continuous search for persons who may commit to participation in a permanent plan for the child. Wherever possible, the child should be placed with a family who is willing to work cooperatively with the child’s parent/primary caregiver toward reunification but is also willing to become the child’s permanent family if needed.

Case Review or Termination Documentation

At the time of case review or termination, the following documentation is to be contained in the case record:

New Referral regarding a Case Receiving Ongoing Children’s Aid Society Service

When new referrals about protection concerns are received on a case receiving ongoing services (which do not relate to a known incident or condition for which the family is already receiving service), standard #1 applies to the assessment of the referral and in determining the referral disposition.

When a child protection investigation is conducted on a case receiving ongoing child protection services, it is planned and conducted in accordance with standard 2. The worker also:

*The service plan is updated only when new risk factors have emerged. The current service plan is enhanced to specifically manage these new risk factors until the next regularly scheduled service plan review.
Practice Notes
Intensity of Service during the First Month of Ongoing Services

The ongoing child protection worker’s level of contact with the family is generally highest during the first month of ongoing service. The first month of ongoing services is the foundation for all subsequent casework decisions and activities (interventions). An effective use of self by the worker is required to engage families in CAS services and with community supports.

The Assessment and Service Planning Process

The worker gathers all information that can assist in formulating an accurate and comprehensive assessment of the family’s and the child’s strengths as well as any issues or risk factors that may affect child safety. The worker seeks to be holistic in his/her approach, obtaining knowledge and understanding of the child and family. This is done by considering the family’s uniqueness, including ethnicity, culture, religion, regional differences and relationship to the family’s extended family and community.

The assessments completed at the ongoing stage of service will incorporate information from:

Family and Child Strengths and Needs Assessment

The family and child strengths and needs assessment is designed to assist the worker to identify the presence of caregiver and child strengths and resources as well as to identify the underlying needs of family members that are associated with safety threats or longer-term risk of maltreatment.

The process of assessment is an interactive one that includes all members of the family, extended family (where appropriate) and any community service providers who have been involved with the family in the past and present. The child protection worker engages the family in a dialogue, using the process of completing the family and child strengths and needs assessment to help the family identify its strengths, challenges/needs and goals regarding change. The information gathered while completing the assessment is analyzed, and interpreted by the worker and reviewed with a supervisor.

The child protection worker formulates an assessment of the child and family by:

Link Between Assessment and Service Planning

Prior to the worker and family developing specific interventions, there must be a complete and thorough examination and understanding of the family functioning that includes the family’s strengths and needs. The assessments which are completed will support the development of a service plan that can target the areas of need. Through reassessments, the family strengths and needs assessment tool permits workers to assess changes in family functioning and the impact of service provision.

The worker analyzes the information gathered through the assessment process, and shares this analysis with the family prior to or at the time of the service planning process. The worker encourages a full discussion of the analysis.

The service plan is the link between assessment and intervention. It is an action plan that guides the family, child protection worker, other service providers and all casework activities toward well-defined goals and outcomes against which progress can be measured over time.

The Service Planning Process

The result of the service planning process is a service plan document that is a record of clear and measurable goals, objectives and activities that are assigned to the participants, with timeframes for completion.

When explaining the concept of service planning, the worker:

The process of completing the service plan includes an honest, open and clear discussion between the child protection worker and the family that results in the identification of specific goals, activities and outcomes for the family to achieve. The service plan process provides a vehicle for sharing issues and looking for solutions. Together, the worker and the family identify intervention strategies and services that would assist in the reduction and/or elimination of risk, and would increase the safety and well-being of the child. The service plan also provides a way to measure the family’s progress.

The child protection worker develops a service plan by:

Although achieving the agreement of the family to the service plan significantly improves the chances of its successful implementation, it should be noted that the child protection worker will not endorse any plans that he/she does not feel would adequately address child safety simply for the sake of achieving agreement with the family.

Family-Centred Conferencing

The child-focused and family-centred approach to service delivery is both a philosophy and a practice that supports active and meaningful participation of families and their support system in case planning and when service decisions are being made. Family-centred conferencing is rooted in the premise that family input in the design and provision of service is important and is valued. The philosophy recognizes that families are “experts” in knowing what interventions will be most supportive to them. It also believes that individuals within a family have strengths upon which they can draw as they work toward positive change that will influence and improve child safety as well as the family’s overall well-being.

In keeping with the values of family-centred practice, various forms of conferencing including Aboriginal healing traditions and talking circles are encouraged as techniques to ensure that the child protection worker and the family together actively participate in the development of the service plan. Such conferencing may also be used more generally at points throughout the duration of service. There is a wide range of family involvement models available to use when developing a service plan with the family. Within that range of options, it is important to select and implement the most appropriate conferencing choice. Case conferencing enables the extended family, community and professionals to come together directly with the child and family to openly discuss concerns, identify strengths, and seek realistic solutions. These discussions result in a service plan that contains specific and deliberate expectations allowing progress to be measured.

Family-centred conferences should be used for situations requiring significant decisions in the life of a case, such as:

The level of complexity of a case will determine what type of family-centred conference will be most helpful based on the worker’s clinical analysis. It is best practice to use a neutral facilitator in cases involving:

Implementing, Managing and Reviewing the Service Plan

Implementing and managing the service plan involves continuous, purposeful and focused discussion with the family members. The family’s ability and willingness to follow the action plan and meet the goals laid out in the service plan may vary from time to time. It is important for the child protection worker and family to have honest and open dialogue when this occurs. It may be that the service plan requires adjustment to better fit the relevance to, and/or needs of, the child and family circumstance at a particular time.

The child protection worker provides service and supports to the family and assists them to access the services that were identified as being required in the service plan. The worker needs to have a good knowledge of the family’s community and services or resources that are available.

There may be a need for the CAS to conduct home visits more frequently than the minimum standard of once per month. Frequency of visits should be reviewed in supervision and decisions made based on the unique circumstances of the case. For example, more frequent visits should take place:

The child protection worker formally reviews the service plan with the family every six (6) months to assess the family’s progress. Together the worker and the family will:

The child protection worker keeps the family and all other participants in the service plan informed of any changes to the service plan. Doing so will ensure that all the participants in the service plan clearly understand the common goals and objectives of the plan, and what is expected of each participant.

When a Subsequent Investigation on an Ongoing Case is not Required

New information about a known incident or condition that may provide additional information about a child and family’s strengths and needs does not require a child protection investigation. It is discussed with the family at the next possible opportunity as part of the ongoing assessment process, and integrated in the reassessment at the time of the next formal review.

Option to Complete a New Safety Assessment when Changing Circumstances

A safety assessment may be implemented at any point during ongoing service provision in situations where changing circumstances known to induce stress have been identified (e.g. loss of income, moves and illness of caregiver or child, a change in family composition such as a new caregiver or the loss of a protective caregiver from the home). If new safety threats are identified, a safety plan is implemented to mitigate those safety threats.