Structured Decision Making: Background

The primary goals of the Structured Decision Making model are to (1) bring a greater degree of consistency, objectivity, and validity to child welfare case decisions and (2) help CPS agencies focus their limited resources on cases at the highest levels of risk and need. Structured assessment tools are used at various points in the case decision-making process (e.g., initial response to allegations, child removal, case opening/closing, and reunification). Each tool incorporates decision protocols—based directly on assessment results—to guide the agency’s response to each family. One of the key assessment tools is a research-based risk assessment that classifies families according to their likelihood of continuing to abuse or neglect their children.

SDM, then, focuses on how case management decisions are made and how agency resources can best be directed. Ultimately, SDM is a strategy designed to reduce subsequent maltreatment rates by improving both the efficiency and effectiveness of CPS agencies. To the extent that SDM accomplishes these goals—and available research indicates that it does—the system will have the added benefit of reducing the rate at which maltreated children subsequently become involved in the juvenile and/or criminal justice system.

Origins of SDM

In addition to its use in addressing the link between childhood maltreatment and subsequent delinquency, SDM has another tie to the juvenile justice system. A core component of SDM is the use of research-based risk assessment tools. The risk assessment methodology was originally developed to classify juvenile offenders according to their likelihood of committing additional offenses. In 1986 (in Alaska) and 1988 (in Michigan), the Children’s Research Center (CRC), a division of NCCD, worked with State agencies to develop a research-based risk assessment tool for use with their delinquent populations. In both States, the agency that was responsible for juvenile justice also administered CPS. Knowing the value of risk assessment to decision making and resource utilization in the juvenile justice system, the Alaska and Michigan administrators raised the question of whether a similar tool could be used to identify which CPS families with at least one known incident of maltreatment were at highest risk of future maltreatment. Such a tool, the States reasoned, could help them make better decisions about which families to serve. In response, CRC staff conducted research in both States and found that fairly simple and highly effective tools could be constructed to identify families with low, moderate, and high risk of reabuse (Baird, Wagner, and Neuenfeldt, 1992).

Shortly before the CRC studies in Alaska and Michigan, Will Johnson conducted similar research in Alameda County, CA, and reached the same conclusion (Johnson and L’Esperance, 1984). It is not surprising that two independent studies confirmed the effectiveness of research-based risk assessment for CPS agencies. Although a substantial body of literature has demonstrated the effectiveness of empirical risk assessment in other human service fields, many in the child welfare field felt that the risk of childhood maltreatment was too complex an issue to be distilled to a short list of variables. However, it is precisely because human behavior is so complex that assessments based on a simple tool are generally more accurate than those based on clinical judgment (Dawes, Faust, and Meehl, 1989).

Since 1988, when CRC implemented the first research-based risk assessment scale for child welfare in Alaska’s CPS system, it has conducted 11 risk studies in jurisdictions ranging from Rhode Island to California to South Australia. As the use of research-based risk assessment spread, it became evident that although risk assessment provided critical information for some CPS decisions, other key decision points required different types of structured assessments. Hence, the SDM model has been expanded to address most vital decisions, from the initial decision of whether to initiate an investigation to the final decision of when to close a case. Not all of these decisions lend themselves to the use of research-based assessment methodologies; some require consensus-based approaches. However, all decision points in the child welfare case management process can use structured assessment tools that clearly identify what factors need to be considered by all staff and how those factors relate to the decision.

The Need for SDM in Child Welfare Services

The number of abuse and neglect allegations nationwide has risen dramatically during the past two decades. Most child welfare agencies have been hard pressed to respond effectively, as new demands have outpaced available resources. As a result, the Nation has seen class action lawsuits challenging the quality of services provided in more than 30 States, media exposés resulting from child deaths, increased concerns over worker and agency liability, and a continuous search for new strategies and resources to address the burgeoning problem.

Child welfare agencies’ need for additional resources is obvious but not the only issue. Increasing pressures have highlighted a problem that has long plagued human services agencies in general and child welfare agencies in particular: the need for more efficient, consistent, and valid decision making. Child protection workers must make extremely difficult decisions. Yet, in many agencies, workers have widely different levels of training and experience. Consequently, decisions regarding case openings, child removal and reunification, and service provision have long been criticized as inappropriate and/or inconsistent. In fact, research has clearly demonstrated that decisions regarding the safety of children vary significantly from worker to worker, even among those considered to be child welfare experts (Rossi, Schuerman, and Budde, 1996). As the pressure to make critical decisions affecting children and families rises, so does the potential for error. Inappropriate decisions can be costly and may result in the overuse of out-of-home placements or, tragically, the injury or death of a child.

Problems of increasing referrals, limited resources, and liability exposure are inextricably linked with decision-making issues. Agencies overwhelmed by heavy workloads need to be able to consistently and accurately determine which cases should be investigated, which children need to be removed from their homes, and which families require the most intensive services. Clearly, new methods are required to help agencies and workers make decisions as efficiently and effectively as possible. Tools are also needed to help workers make accurate and reliable assessments of both immediate safety issues and long-term risk. Decision-making strategies are needed to help agencies focus limited resources on those families at the highest level of risk. These decision-making tools must be embedded in case management systems that incorporate clearly defined service standards, mechanisms for frequent reassessments, methods for measuring workload, and procedures for ensuring accountability and quality control.

How child welfare decisions are made and how agencies use resources are the key questions addressed by CRC’s SDM model. The SDM model provides a comprehensive, systematic approach to case management, resource management, performance monitoring, quality assurance, and program and policy evaluation. The four principles that form the foundation of SDM are presented in the next section, followed by an indepth discussion of the major components of the model.

Principles of the SDM Model

The SDM model is based on four primary principles.

First, because decisions can be significantly improved when they are structured appropriately, every worker in every case must consider specific criteria through highly structured assessment procedures. Failure to clearly define decision-making criteria and identify how workers should apply these criteria results in inconsistency and, sometimes, inappropriate case actions.

Second, priorities assigned to cases and service plans (or responses) must correspond directly to results of the assessment process. The assessment process has little meaning unless its results lead directly to an appropriate decision. Decisions should be structured to ensure that the agency’s highest priority is given to the most serious and/or the highest risk cases. Moreover, if agencies are to translate priority setting into practice, they must have clearly identified and consistently implemented service standards—differentiated by level of risk—for each type of case. Such differential service standards help focus how resources are used and provide a degree of accountability often missing in human services agencies. To ensure that the assessment process results in improved service, expectations for staff regarding the process must be clearly defined and practice standards must be readily measurable.

Third, virtually everything that an agency does—from providing services in an individual case to budgeting for treatment resources—should be a response to the assessment process. Risk and needs assessments, for example, should be linked directly to service plans. In the aggregate, assessment data also will help indicate the range and extent of service resources needed in a community. Similarly, assessment and case classification results are directly related to agency service standards, which in turn drive staff workload and budgeting requirements.

Fourth, a single, rigidly defined model cannot meet the needs of every agency. Not all State and county child welfare agencies are organized to deliver services in the same way. Nor do they always share similar service mandates. As a result, the CRC approach to designing an SDM system is collaborative and engages agencies in a joint development effort. Each system is built on a set of principles and components that are then adapted to local practices and mandates. The development process incorporates a great deal of input from local managers and staff. The result is a site-specific system that is “owned” by the agency and builds on its particular strengths as a service organization.

Preventing Delinquency Through Improved Child Protection Services	Juvenile Justice Bulletin • July 2001