structured decision making and critical thinking in child

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Structured Decision Making

and Critical Thinking in

Child Welfare AssessmentVersion 1.2, 2011

Day 1

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Goals for the Training

� Define safety, risk and protective capacity

� Know when to complete standardized assessments

� Identify the Minimum Sufficient Level of Care

� Complete Structured Decision Making Tools

� Value the use of standardized assessment tools throughout the life of every case

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Primary Goal of

Child Welfare Agencies

� To prevent the recurrence of maltreatment of children who come to the agency’s attention

� One key to achieving this goal is accurate and timely assessment

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Decisions Should Not Be…

�Based on a gut feeling

�Based on bias

�Idiosyncratically

�Inconsistently

NCCD/CRC

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Child welfare SDM versus

Standardized Procedures in other Fields

� Medicine

� Insurance

� Aviation

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Structured Decision Making (SDM)

Assessment System

SDM Model +

Critical Thinking +Engagement

= Evidence-based guidance during the

Decision-making Process

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Benefits of Using the SDM Model

1.Fewer subsequent referrals and substantiations

2.Fewer subsequent abuse/neglect injuries

3.Fewer subsequent placements

4.Faster permanency

5.Better consistency, accuracy, and equity

6. Increased efficiency by making the best use of available resources

7. Improved data for program planning and evaluation

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SDM: Increasing

Consistency and Accuracy

Chapin Hall 1997

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Outcomes for All Cases: 12-months Later

The Michigan Department of Social Services Risk Based Structured Decision Making System: An Evaluation of Its Impact on Child Protection Services Cases, 1995

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Disproportionality in Child Welfare

� Children of color, particularly

African-American and Native-

American children, continue to

be over-represented in the child welfare system relative

to their proportion of the

population

� Part of this disproportionality

relates to the ability of the

child welfare system to conduct fair and equitable

assessments throughout the

life of a case

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Improving Consistency with SDM

� Addressing a common set of factors appropriate at each decision point

� Each decision point and each factor is defined so that there is less chance of varied interpretations

� Each tool leads to a presumptive decision

� This creates a situation where the relative weight of each item as it relates to the final decision is consistent

� Note: that the objective is not uniformity

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Improving Accuracy with SDM

� In addition to improving consistency, SDM tools also increase accuracy

� A risk tool’s job is to estimate the likelihood of future maltreatment

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SDM and Usefulness of Aggregated Data

� The SDM data also helps jurisdictions determine the best use of limited resources

� SDM information needed for decisions in each case can be aggregated and prove extraordinarily useful for making decisions at the level of the agency and the community

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SDM as a Guide for Decision Making

� The SDM represents a way of guiding social workers through a decision making process

� It is important to use both the tools AND clinical judgment

� Every policy is a guideline rather than a rule

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The 5 Steps of Decision Making

� Before social workers can successfully use the SDM tools, social workers must be able to work through a decision making process and think critically about the key factors involved in making decisions

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Decision Making Process Activity

� Divide into 2 or 3 groups with about 10 people in each group

� This activity entails making a decision and reaching consensus where all members agree on the decision as a group

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Decision Making Process ActivityI’m calling about Cynthia Wills. She has three kids: Jesse, Santana and Sativa. I don’t know how old they are, but they’re too young for school. They stay home with her all the time, except when she goes out all night. I don’t know who stays with them then. Her apartment is a huge mess and her baby cries all the time. It seems like she just ignores the kids. Last time I looked in her house, there was peeling paint, laundry everywhere, empty bottles, old food and ashtrays everywhere. It just doesn’t seem safe for the kids.

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� Step 1: Information Gathering

� Step 2: Application of Rules or Criteria

� Step 3: Decision/Professional Judgment

� Step 4: Discussion/Feedback

� Step 5: Ongoing Review

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Step 1: Information Gathering

� Gathering and considering extraneous information can introduce bias in the decision making process

� SDM tools help the social worker avoid extraneous information by focusing on the most important factors to consider in making the decision

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Step 1: Information Gathering

� The SDM tools will help the social worker focus on the most relevant information specific to the decision at hand

� Gathering reliable information requires seeking out variety of sources and people in addition to skillful interviewing of children and adults

� Social workers must document the information they gather

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Step 2: Application of Rules or Criteria

� What factors in the picture or audio file concerned you?

� Why did these things concern you?

� How do you know what you are seeing?

� What does the information mean?

� Can you explain the dynamics of abuse?

� How can you tell when a parent may have a mental health issue?

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Step 3: Decision/Professional Judgment

� This step is where we pull from our experience, new research and/or professional knowledge and training

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Step 4: Discussion/Feedback

� Feedback may change the decision by providing an alternate perspective or helping us see an unconscious bias

� Feedback may also validate the original decision

� The SDM system incorporates feedback in the decision making process via the research behind the tools and the supervisor approval process

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Step 5: Ongoing Review

� Assessment is ongoingand the SDM tools build in a process to guide regular reassessment

� Note: the SDM does not replace clinical skills

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Minimum Sufficient Level of Care

� In order to effectively use the 5 step decision making process, social workers must be able to understand and assess the minimum sufficient level of care (MSLC)

� The MSLC is:

� The social standard for the minimum of parent behavior below which a home is inadequate for the care of a child

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Minimum Sufficient Level of Care:

Key Aspects

� MSLC is meant as a minimum, not an ideal

� MSLC is case specific

� The MSLC must remain consistent for the duration of the case

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Key Factors in Assessing MSLC

1. The child’s needs in the areas of:

� Physical care

� Emotional wellbeing

� Development

2. Contemporary Social Standards

3. Community Standards

� Many communities have standards that vary from the “Contemporary Social Standards”

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Challenges in Applying

� Standard for removal should not differ from the standards applied to return a child to the parent’s custody, but this sometimes happens

� The values and attitudes of the social worker about what constitutes MSLC can bias the way they think about a family

� Different cultures have different interpretations of what constitutes the MSLC

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Differentiating between Safety and Risk

� The differences between assessing for

� Safety factors: immediate safety compromise

� Risk factors: likelihood of future maltreatment

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Safety threats are:

� Specific threats to a child’s imminent safety

� Decision making based on the presence of imminent and serious harm.

� A judgment about the certainty of severe effects

� Evaluating family situations and behaviors that must be immediately managed and controlled in order for the child to remain in the home now.

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Risk is about:

� The likelihood of future maltreatment

� Decision making based on the likelihood of harm in the next 18-24 months

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Safety and Risk Activity

� Please form pairs by matching the colors of your cards.

� Please review the cards and determine which factors refer to safety and which to risk.

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Each Tool Guides ONLY One Decision

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Each Tool Guides ONLY One Decision

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SDM Manual: California Structured

Decision Making Definitions

� In order to accurately complete the SDM tools, it is important that social workers use the same definitions that the SDM tools use

� For example, the definition of caregiver, family and household

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Hotline Tools

� Hotline tools are intended to help social workers make decisions about how to respond to allegations of abuse and neglect

� Hotline tools are intended to complement professional judgmentand decision making by providing a set of empirically supported decision making paths

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Counties with Differential Response

�No response is needed

from the child welfare

agency

�Path 1 Child Welfare

Response

�Path 2 (combined

CWS/Community response)

�Path 3 (CWS high priority response)

Counties without Differential Response

�No in-person response

needed: the report is

documented and no further

action is taken

�In person response

needed: the hotline social worker determines the in-

person response priority

time

� Within ten days

� Immediate

SDM Manual:

Hotline Policies and Procedures

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Hotline Policies and ProceduresStep One: Appropriateness for Response

CALIFORNIA r: 08-06

HOTLINE TOOLS

Referral Name: _____________________________ Referral #: _______-_______-________-___________

Date: _____/_____/_____ County: _____________________________________________________

If review of screening criteria is not required, go directly to B. Screening Decision.

STEP I. APPROPRIATENESS OF A CHILD ABUSE/NEGLECT REPORT FOR RESPONSE

A. Screening Criteria (Elicit reporter’s concerns and mark all that apply.)

PHYSICAL ABUSE

� Non-accidental injury

� Death of child/another child in home (automatic 24 hour)

� Severe (automatic 24 hour)

� Other injury (go to Physical Abuse Tree)

� Cruel or excessive corporal punishment (go to Physical Abuse Tree)

� Threat of physical abuse (go to Physical Abuse Tree)

� Threats of physical harm

� Dangerous behavior toward child or in immediate proximity of child

� Prior death of a child due to abuse or neglect and new child in the home

EMOTIONAL ABUSE (go to Emotional Abuse Tree):

� Caregiver actions have led to child’s severe anxiety, depression, withdrawal, or aggressive behavior toward

self or others

� Threat of emotional abuse

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Step One: Appropriateness for Response

� There are screening criteria for each type of child maltreatment � physical abuse

� sexual abuse

� emotional abuse

� neglect

� If any criteria are marked, the report should get an in-person response

� There are possible overrides for the in-person response decision

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Hotline Policies and ProceduresStep Two: Response Priority

Physical Abuse

no

no

Is the child under age two years

(or capability equivalent); or does

the child require immediate

medical attention; or were

caregiver actions or threats brutal

or extremely dangerous?

24 Hours

yes

no

yes

Ten Days

yes

24 Hours

yes

Ten Days

no Ten Days

Is there prior history of

physical abuse, current

domestic violence,

caregiver mental health, or

substance abuse concerns?

OR

Is the child fearful or

vulnerable?

Does the alleged perpetrator

have access to the child

within the next 10 days?

Is there a protective adult in

the home?

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Step Two: Response Priority

� When an in-person response is indicated, there are separate decision trees for the different types of child maltreatment

� Begin with the most serious allegation

� Continue with all decision trees until a 24 Hours is reached or all are completed

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Hotline Policies and ProceduresStep Three: Differential Response Path Decision

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Step Three: Differential Response Path

Decision

� Option A: Path Decision for Evaluate Out (this will help the social worker decide if the referral will receive a community response or no response)

� Option B: Path Decision for In-person Response (this will help the social worker decide if the referral will have a path 2 or path 3 response)

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SDM Hotline Tools:

Documentation

� Screener narrative in CWS/CMS is used to document the allegations made by the reporting party

� If an override decision is made, the facts supporting the override should be noted in the screener narrative

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Activity: Hotline Tools

The Conseco/Velasquez case

� Read the case example

� Work as table groups to complete the screening and response priority sections of the hotline tools

� Groups should come to consensus about each item

� Prepare to have one group member share your answers for each section

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SDM Hotline Tools:

Consistency

� Achieving the goal of consistency in practice requires consistency in the development and use of definitions related to the families assessed

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� Who: The social worker to whom the referral is assigned is responsible for completing the hotline tools

� Which: Every time a referral is created in CWS/CMS, the social worker should use the hotline tools

� When: The hotline tool should be completed immediately upon receipt of the report

SDM Hotline Tools:

Who, Which, When

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SDM Safety Assessment

� Review of the tool, including Safety Plan

� Small group work to complete the Safety Assessment for the Conseco/Velasquez case

� Large group discussion of the small group responses.

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� Goal of Tool: To increase consistency when assessing safety and ensure that every social worker in every case considers all critical safety threats and all possible protective factors

� Key question: Is it safe (or can it be made safe with a safety plan) to leave this child in this situation right now?

� Remember to utilize Decision Making steps and MSLC


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� The consistent use of definitions ensures that the partnership between the tool’s guidance and your clinical judgment will be focused on the appropriate individuals and households

SDM Safety Assessment:

Definitions

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1. Child Vulnerabilities• Critical thinking

2. Safety Factors• Safety compromise exists

SDM Safety Assessment Tool

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SDM Safety Assessment Tool

3. Protective Capacities• Possible mitigating factors

4. Safety Interventions• Covers a safety factor

5. Safety Decision• Safe, safe with interventions, or need for removal

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Activity: Conseco/Valesquez Case


� Work as table groups to complete the Vulnerabilities and Safety Threats sections using the definitions

� Groups should determine the appropriate response and come to consensus as a group

� If unable to reach consensus, the group should vote

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� Resume working in your small groups, focusing on the Protective Capacities, Interventions and Safety Decision sections using the definitions



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Safety Plan

1. Safety threat (from safety assessment)

2. Family-friendly description

3. Safety intervention

4. Monitoring

5. Signatures

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Policy

� Purpose: To determine whether there are conditions that place a child in danger of immediate harm and identify protective capacities the family may possess to keep the child safe

� A safety assessment is required:

� For every in-person investigation, including investigations conducted on open cases

� Any time a social worker becomes aware of changes that may affect safety

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Safety Assessment Practice:Incorporating the Safety Assessment Tool

� SDM forms are not:

� Designed to be completed by the family

� “Interview guides”

� SDM forms are:

� Tools the social worker uses to focus on the most critical information and then to collect that information

� The form should be completed within 2 working days of the first contact

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� Explaining the Safety Assessment to a family – the threats that indicate a child is in immediate danger

� How might a social worker interview or observe in order to complete a safety assessment?

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SDM Risk Assessment Tool� Risk Assessment estimates the probability that maltreatment of any severity will occur in this family in the future

� Used to guide two key decisions:

� Whether or not to open

an ongoing services case after the referral

investigation and, if so..

� What service intensity to

provide

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� Two Indices: Neglectand Abuse

� It is important to complete both indices for each case regardless of the reason for the current investigation

�Why are both indices necessary?

SDM Risk Assessment Tool

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SDM Risk Assessment Tool



� Work as table groups to complete the Risk Assesment using the Risk Assessment definitions



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� Who: The social worker responsible for creating the tools may vary depending on the situation and by county

� When:

� Following the determination of substantiated, inconclusive or unfounded at the conclusion of the investigation

� AFTER determining the allegation conclusion, but BEFORE making the decision about whether to open an ongoing case

� Not too early - must take the time to accurately

determine answers for all of the questions.

SDM Risk Assessment:

Policy and Procedures

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� Would you expect that ongoing social workers currently spend exactly the same amount of time each month with every family on your caseload? Which cases get more of your time?

� Risk-based contact guidelines do two things:

1. Acknowledge that some cases require more time

than others

2. Increase the likelihood that the cases receiving the

most time are the cases where the investment of

time has the greatest potential to reduce future harm

SDM Risk Assessment

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Revisiting Learning Goals

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The Difference between

Risk and Safety

�Why is it important to identify the difference?

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Review:


� Step 1: Information Gathering

� Step 2: Application of Rules or Criteria

� Step 3: Decision/Professional Judgment

� Step 4: Discussion/Feedback

� Step 5: Ongoing Review

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Purpose of SDM Tools

� The SDM model is a set of tools to guide you –not forms just to be completed

� The SDM model guidesdecisions; social workers makedecisions

� Always use the definitions to ensure consistency

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SDM Family Strengths

and Needs (FSNA) Assessment

� Purpose of the FSNA:

� Identify the priority needs of a family to be addressed in a case plan

� Ensure that the strengths of a family are also observed

� Provide a comprehensive overview of family functioning in areas related to their ability to adequately parent and protect their children

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FSNA Assessment and

Documentation

� Support of FSNA item responses should be reflected in case notes

� Particular attention should be paid to documenting priority strengths and needs, including evidence of the professional observations that led to the responses for each item

� Writing Court Reports

� Linking the SDM model to Case Plan writing

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SDM Family Strengths

and Needs (FSNA) Assessment

� Two parts of the FSNA:

1. Caregiver Factors

2. Child Factors

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SDM FSNA Assessment



� Work as table groups to complete the Caregiver portion of the FSNA Assessment using the FSNA definitions



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FSNA Assessment:


� Who: Whoever is responsible for developing the case plan completes the FSNA

� Which cases:

� Only completed on cases that will be opened

� Sometimes with other families for the purpose of making detailed referrals, but not required

� When:

� Prior to completing the case plan

� Repeated in conjunction with each review, which is every six months

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Risk Reassessment for In-Home Cases

� Provide an opportunity to measure progressand make decisionsabout whether to close a case or continue to provide services

� Not used on all cases -only ongoing family maintenance (FM) cases during the six and twelve month review

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Risk Reassessment for In-Home Cases:

Definitions

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Risk Reassessment for In-Home Cases:

Definitions

�R1, R2 and R3 refer to historical factors

�R4 refers to child characteristics

�All remaining items, (except R8primary caregiver mental health problem) refer to progress since the last assessment

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� Work as table groups to complete the Risk Reassessment for In-Home Cases using the definitions



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� Who: The case-carrying social worker completes the Risk

Reassessment tool

� Which cases: only for cases in which ALL children are in

the home

� When:

� Division 31 requires a review of each case at least every six

months

� Voluntary Cases

� No more than 30 calendar days prior to completing each case plan

� No more than 30 calendar days prior to recommending case closure

� Involuntary Cases

� No more than 65 calendar days prior to completing each case plan

� No more than 65 calendar days prior to recommending case closure

� All Cases: Sooner if there are new circumstances or new

information that would affect risk


Policy and Procedure

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� Read each piece of the vignette individually

� Work as table groups to complete:

� Hotline, Safety Assessment, Risk Assessment and FSNA Tools

� Remember:

� Use Definitions

� Come to consensus as a group

� Complete 2 Risk Assessment tools


Practice Activity: Harding/Layer

Case

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Reunification Assessment

� Designed to:

� Systematically evaluate each family with children placed outside the home in an effort to reduce the time to achieve permanency

� Achieve reunification whenever it is safe to do so

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Reunification Assessment

� Families who demonstrate compliance with all three

components assessed in

the reunification assessment (risk, visitation, and

safety) have significantly

better outcomes for children

� Rate of re-entry

decreases significantly when more of the

components are in

compliance prior to making

the reunification decision

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Reunification Assessment Tool

� Section A:Reunification Risk Reassessment

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� Section B:Visitation Assessment

� Section C: Reunification Safety Assessment

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� Section D:Reunification Timeline

� Section E: Recommendation Summary

� Section F:

Sibling Group

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Activity: Harding/Layer Case


� Work as table groups to complete the 6-month Reunification Reassessment Tool with the Harding/Layer case, using the definitions



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Activity: Harding/Layer Case


� Work as table groups to complete the 12-month Reunification Reassessment Tool with the Harding/Layer case, using the definitions



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� Who: The ongoing social worker completes this

reassessment

� Which cases: All families

where at least one child is in

out-of-home care

� When:

� Division 31 requires a review at least every six months

� No more than 65 calendar days prior to completing each case plan or recommending reunification or change in permanency planning goal

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Testing, testing…

Training Evaluation

structured decision making and critical thinking in child

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