1. 18th National Conference on Child Abuse & Neglect April 18 – 20 Washington, D.C.
Understanding Decision-Making
Donald Baumann
Saint Edwards University
John Fluke & Katherine Casillas
American Humane Association

2. Understanding Decision-Making Overview
Advances Outside Child-Welfare
Assumptions in the Decision Sciences
Heuristics and Biases
Signal Detection Theory
Decision-making Errors
Cumulative Prospect Theory
The Decision-Making Continuum
Models in Child Welfare

3. Understanding Decision-Making Frameworks: Advances Outside Child-Welfare
Engineering Psychology and Economics
Theories of riskless and risky decision-making (decision choice models)
Game Theory (mathematical models of conflict and cooperation)
Bounded rationality (doing “well enough”)
Optimization (maximizing outcomes)
Artificial Intelligence
Network analysis (systems for determining causality)
Expert systems (complex decision-making system that learn)
Medicine
Fuzzy trace theory (understanding the “gist”, values and inference)
Psychology, Statistics and Psychophysics
Heuristics and bias (errors made in decision-making)
Normative approaches (the standards are probability & statistics)
Signal detection theory (analysis of threshold differences)
Fast and frugal reasoning (based on probability cues)
Implicit and explicit judgments (intuition and logic)
Cumulative prospect theory

4. Understanding Decision-Making Frameworks: Advances in Economics and Psychology
Economics and Exchange Theory
Assumption of rationality
People weigh the costs and benefits of a decision and optimize
Herbert Simon and Satisfysing
Bounded rationality- we do “well enough”
Reason is limited and we do not optimize
Tversky, Kahneman and Meehl
Reason is very limited and we are poor decision-makers
Under conditions of uncertainty we use heuristics (rules of thumb) and make errors
Thinking fast and slow under different circumstances
Cumulative Prospect Theory (choices based on gains and losses)
Gigerenzer
heuristics work a lot of the time
Fast and frugal reasoning (based on probability cues)
We make the choice with the best cue

5. Understanding Decision-Making Frameworks: Assumptions
Decisions have psychological (cognitive, motivational and emotional) properties and are at the individual level
Decisions have a context
People have different thresholds for different decisions
People make errors when they make decisions
Sources of error and accuracy can be empirically understood and improved upon

6. Understanding Decision-Making Frameworks: Heuristics and Biases
Overconfidence phenomenon (We overestimate the accuracy of our beliefs and incompetence feeds overconfidence)
Confirmation bias (We look for evidence to justify beliefs rather than falsify them)
Representativeness heuristic (The belief that things belong to a group that is typical)
The availability heuristic (judging the likelihood of an event by how easily it come to mind e.g., vivid instances)
Illusory thinking (The search for order in random events)
Illusory correlation (The perception of a relationship where none exits – usually confirmatory)
Illusion of control (The belief that chance events are subject to our control)
Moods and judgment (good and bad moods bring to mind good and bad associations)

7. Understanding Decision-Making Frameworks: Implicit and Explicit Judgments
Implicit (Intuitive) Judgments
Powers of intuition (fast thinking): Somewhat instantaneous making for efficiency
Limits of intuition: The speed can make us error prone when we need to slow down and think about things more
Explicit Judgments
Powers of explicit judgments (slow thinking): The length of processing can make us less error prone
Limits of explicit judgments: Cognitively labor intensive and inefficient

8. A child Welfare Values Exercise (Dalgleish)

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10. Signal Detection Theory and Decision Errors

11. Sensitivity (true positive)
Child Welfare and the Problem of False Positives- Receiver Operator Characteristics
Accuracy in assessing risk is generally not very good, and false positives are very likely
Furthermore almost all predictive power is tied to prior occurrences
N = 210,642
Sensitivity (true positive)

12. Sensitivity (true positive)
Child Welfare and the Problem of False Positives (assume actual prevelance is 10%)
N = 210,642
Sensitivity (true positive)
Low threshold

13. Effect of Thresholds on False Positives The assessment has an Area Under the Receiver Operator Curve = 63%: Prevalence assumed to be 10%: Applied to 100,000 children
63,000 False Positives
10% of children need to have an action like a placement taken
Green yes to take action and we should’ve taken action – correct decision
Red – no action taken but we should have taken action – false negative
Pink – are situations where we took action, but should not have – false positive
Blue – we took no action and we shouldn’t have taken action- correct decision
LOW THRESHOLD

14. Child Welfare and the Problem of False Positives
Sensitivity (true positive)
High threshold
Low threshold

15. Effect of Thresholds on False Positives The assessment has an Area Under the Receiver Operator Curve = 63%: Prevalence assumed to be 10%: Applied to 100,000 children
34,000 False Positives
10% of children need to have an action like a placement taken
Green yes to take action and we should’ve taken action – correct decision
Red – no action taken but we should have taken action – false negative
Pink – are situations where we took action, but should not have – false positive
Blue – we took no action and we shouldn’t have taken action- correct decision
HIGHER THRESHOLD

16. Child Welfare and the Problem of False Positives
Sensitivity (true positive)
High threshold

17. Effect of Thresholds on False Positives The assessment has an Area Under the Receiver Operator Curve = 63%: Prevalence assumed to be 10%: Applied to 100,000 children
34,000 False Positives
63,000 False Positives
10% of children need to have an action like a placement taken
Green yes to take action and we should’ve taken action – correct decision
Red – no action taken but we should have taken action – false negative
Pink – are situations where we took action, but should not have – false positive
Blue – we took no action and we shouldn’t have taken action- correct decision
LOW THRESHOLD
HIGHER THRESHOLD

18. Cumulative Prospect Theory (Tversky & Kahneman, 1992)
A psychological theory for explaining non-rational decisions under uncertainty
Principles
We make choices based on change in gains and losses relative to a reference point; a reference point based on what we have or know. Child Welfare
Example: a child is safe at home.
Given the choice of a large sure loss compared to a chance that we either might not have a loss or have a large loss, we tend to take the risker option; we take a sure gain and do not take a risk even when a risk might increase our gains. We dislike losing more than we like winning.

19. Cumulative Prospect Theory (Tversky & Kahneman, 1992)
Principles
Given the equal choice of a larger gain and smaller loss we tend to choose neither; asymmetric loss aversion.
Example: There is a 50/50 chance If we provide a specific service a child will be safe for 6 months, or the child will certainly be maltreated again in 4 months.
We tend to make choices based on very unlikely events as if they are more likely; overweighting unlikely events.
Example: Involving the court in a child maltreatment case is a large worry.

20. Relationships of Gains and Losses in Prospect Theory

21. Exercise in Prospect Theory

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24. The Continuum of Child Welfare Intervention
Assessments and decisions are made at key points along the child protection continuum
Each key decision point requires a specific decision and action
Hardiker, et al in 1999 developed a grid for looking at the twin approachs of safeguarding and promoting welfare at different levels of intervention.
My modification is to show that assessment is at the core and informs both needs and risk along the continuum of intervention.
The assessment and addressing of needs can occur before a situation becomes a child protection matter. This is one approach to prevention.
At each key decision point along the continuum, both risk assessments and assessment of needs are performed and they inform each other.
These occur at the key decision points and at reassessments in between to monitor risk and needs.
It is in the addressing of the needs that the risk to the child is managed.
There are many assessments and decisions made. There are ‘big’ decisions - whether to call a case a child protection matter, whether to remove a child from the family, whether to return a child to the family.
There are also many more ‘small’ decisions, based on a needs reassessment about how to meet those needs.
This assessment and decision making is a difficult task.

25. Models of Decision Making in Child Welfare

26. Models of Child Welfare Decision Making
Structures and Systems of Decision Making
Stein T and Rzepnicki T. (1984). Decision Making in Child Welfare Services: Intake and Planning. Boston: Kluwer-Nijhoff Publishing.
Gleeson J. (1987). Implementing structured decision-making procedures at child welfare intake. Child Welfare  66 (2) 
Wells, S. J. (1985). How we make decisions in child protective services intake and investigation. Washington, DC: American Bar Association.

27. System Models of Observed Child Welfare Decision Making Behavior
Rossi, P. H., Schuerman, J. & Budde, S. (1999). Understanding decisions about child maltreatment. Evaluation Review, 23(6)
Baumann, D., Kern, H., & Fluke, J. (1997). Foundations of the decision making ecology and overview. In Kern, H., Baumann, D. J., & Fluke, J. (Eds.). Worker Improvements to the Decision and Outcome Model (WISDOM): The child welfare decision enhancement project. The Children’s Bureau, Washington, D.C.
Dalgleish, L.I. (2003). Risk, needs and consequences. In M.C. Calder (Ed.) Assessments in child care: A comprehensive guide to frameworks and their use. (pp ). Dorset, UK: Russell House Publishing.
Munro, E. (2005) Improving practice: Child protection as a systems problem. Children and Youth Services Review, 27,
Baumann, D.J., Dalgleish, L., Fluke, J., & Kern, H.(2011).The decision-making ecology. Washington, DC: American Humane Association.

28. DECISION-MAKING ECOLOGY (DME)

29. Decision Making Ecology/General Assessment and Decision Making Model
(Baumann, Dalgleish, Fluke &Kern, 2011)
External
Factors
Decision Maker
Organizational
Decision
Making
Outcomes
Influences
Decisions
Case Factors

30. GENERAL ASSESSMENT AND DECISION MAKING (GADM) MODEL: THE PROCESS OF DECISION-MAKING

31. Risk assessment and decision making
In many jurisdictions risk assessment is used as a way to summarise the case information.
How is this assessment turned into a decision about a course of action?
In general, the risk of harm has to be sufficient to warrant taking protective action.

32. Assessments and thresholds are influenced by different factors
The Risk Assessment derives from case information on:
the Child: the Family and the nature of the current and past concerns.
Information organized into operationally defined factors.
From Theory, the Threshold for Action derives from the experiences and history of the worker.
Possible consequences for the different stakeholders.
How the worker values the consequences.

33. Assessment and decision making is a difficult task
Assessments and decisions are based on information that is often unclear, noisy and uncertain.
Sometimes made under time pressure in a highly emotional atmosphere.
There are structural and resource constraints, media interest, unpredictability of outcomes.
This is:
Decision making
under uncertainty.
Assessments and decisions are based on information that is often unclear, noisy and uncertain.
Sometimes they are made under time pressure in a highly emotional atmosphere.
There are structural and resource constraints, media interest, unpredictability of outcomes.
This is:
Decision making under uncertainty.

34. Crucial points: The general model for assessment and decision making.
Separates: The assessment of the situation.
From: The decision to something about it.
Qualitatively different factors influence assessment and decision making.
Distinguishes: The person’s ability to detect the need to take action (how good they are).
From: The person’s willingness to take action (their threshold).
The model
Separates:
The assessment of the situation.
From:
The decision to something about it.
Qualitatively different factors influence assessment and decision making.
Distinguishes:
The person’s ability to detect the need to take action (how good they are).
The person’s willingness to take action (their threshold).
The model for the decision making side is Signal detection theory.
It provides methods for measuring both ability and threshold placement.

35. A General Model for Assessing the Situation
If the Assessment is ABOVE the Threshold, then ACTION is taken.
If the Assessment is BELOW the Threshold, then NO ACTION is taken.
A General Model for Assessing the Situation
and Deciding what to do about it - Dalgleish
Threshold
Factors
Influencing
Threshold for Action
Information from Experiences and Organizational Factors)
HIGH
LOW
Assessment Dimension:
e.g. Risk or ‘Level of Concern’
Assessment
Influencing Assessment.
Information from Current situation being Assessed.
The Case
Factors.
This is a model for decision making under uncertainty.
A distinction is made between making an assessment of the situation and the decision to take action.
Some continuous dimension is assumed to underlie the decision. For example, risk or overall need. Information from the current situation is assessed and aggregated in some way to provide an overall assessment of the situation.
The model links assessments of the situation and decisions about action using a threshold..
An assessment of the situation is made and this is tested against a personal threshold for action.
If the Assessment is ABOVE the Threshold, then ACTION is taken.
If the Assessment is BELOW the Threshold, then NO ACTION is taken.
The factors influencing the placement of the threshold come from the experiences and history of the decision maker.
The risk assessment systems and needs assessment systems focus on how to arrive at an assessment.

36. The Process of Decision Making: The Threshold Concept
High
If threshold low, W1 needs little evidence before taking action.
Threshold W2 No
W2 Assessment.
W1 Assessment.
If threshold high, W2 needs much evidence before taking action.
Let us consider an illustration of this.
Consider two workers making assessments and decisions about action.
They make their assessment of the level of risk or of need along some defined continuum.
Worker 1 has a low threshold and needs little evidence before taking action.
Worker 2 has a high threshold and needs a lot of evidence before taking action.
However, even if they agree on an assessment of a case,
they will disagree about taking action.
Yes
Even if they agree on the assessment,
Threshold W1
they disagree about taking action.
Low
Assessed level of risk or need
*From Len Dalgleish, 2000

37. The Structured Decision Making System (SDM)®

38. The National Council on Crime and Delinquency, founded in 1907, is a nonprofit organization that creates just and innovative solutions to complex social problems, and works to improve the lives of all people through research, public policy

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41. A research and evidence-based decision-support system
What is the SDM system?
A research and evidence-based decision-support system

42. What is SDM? TOOL DESIGN Case Process Screening & Response Priority
Assessment
Family
Strengths &
Needs
Assessment
Safety
Assessment
Risk
Assessment
Reunification Assessment
Risk Re-assessment
Case Process
TOOL DESIGN
One decision: one tool
How can research inform tool?
Clear presumptive decision
Overrides (measure!)

43. Kinds of Evidence Do the tools work? Validity Construct validity
Inter-rater reliability
Do people use the tools?
Completion rates
Process changes
Worker/ family surveys
Do outcomes change?
Outcomes

44. What is SDM? PRACTICE SKILLS Case Process Screening & Response
Priority
Assessment
Family
Strengths &
Needs
Assessment
Safety
Assessment
Risk
Assessment
Reunification Assessment
Risk Re-assessment
Case Process
PRACTICE SKILLS
Use content (DEFINITIONS) to focus information gathering
Think through with family, team
Discuss results with family, team
Plan collaboratively

45. Risk assessment is about likelihood and probability
The SDM Risk Assessment Answers this questions:
Based on the family’s characteristics, how likely are they to abuse and neglect their children in the next 24 months?

46. California Risk Study Results
N = 2,511 investigations conducted in 1995, followed for two years.
California Risk Assessment Validation: A Retrospective Study, 1998

47. “Final decisions should be left to formulas, especially in low-validity environments.”

48. Typical risk assessment presumptive decisions
What is the probability of future abuse or neglect?
LOW
close
MODERATE
HIGH
open
VERY HIGH

49. Risk Level by Initial Safety Assessment
2011 California Combined Report
N = 67,140

50. Important Distinctions
Danger/ safety
Immediate
Serious
Guides decisions about placement
Risk
There is time to change the course
Any level of abuse/neglect
Guides decisions about case open/close
Need
Conditions that appear to be barriers to increased safety and reduced risk
Focus of intervention

51. Key Concept Threat of Danger? + Vulnerable child? -
Protective Capacity? =
“unsafe child”

52. Present danger
Present danger is an immediate, significant and clearly observable family condition occurring in the present tense, already endangering or threatening to endanger a child. This phenomenon is also referred to as immediate harm; immediate severe harm; or imminent harm. It is important to understand that the primary criterion that qualifies present danger is what is happening that endangers a child is happening now; it is currently in process of actively placing a child in peril.

53. Impending danger
Impending danger is associated with a child living or being in a state of danger; a position of continual danger. Danger may not exist at a particular moment or be an immediate concern but a state of danger exists. Impending danger is not necessarily active in the sense that a child might be hurt immediately like is true of immediate, present danger. When a child lives in impending danger one can expect severe harm as a reasonable eventuality.
Impending danger refers to threats to a child’s safety that exist; are insidious; but are not immediate, obvious, or active at the onset of CPS intervention.
Impending danger refers to threats that eventually are identified and understood upon more fully evaluating and understanding individual and family conditions and functioning.

54. Safety (Danger) versus Risk
Safety  concerned about imminence and severe consequences due to things being out of control
Risk  broad concept regarding whether something might occur if there is not intervention; risk may be low, moderate, high.

55. Vocabulary: Safe and Unsafe Child
“Vulnerable” children are safe when there are no “threats of danger” within the family or home OR when the caregivers possess sufficient “protective capacity” to manage or control any threats.
Unsafe child
Children are unsafe when they are “vulnerable,” there are “threats of danger” within the family or home AND the caregivers have insufficient “protective capacities” to manage or control the threats, making outside intervention necessary..

56. Three Types of Protective Capacity
Cognitive
knowledge
understanding
perceptions
Behavioral
actions
activities
performance
Emotional
feelings
attitudes
identification

57. In home safety plan
Safety Plans
combination
Out of home safety plan

58. actions and services that will temporarily substitute for lacking parental protective capacity to control the threat of danger
Safety Plan

59. Current decision-making tools
Intake (Minnesota intake screening guidelines) North Carolina Structured Intake report (very extensive)
Safety assessment (first contact)
Safety plans (first contact-Alaska example)
Safety assessment (end of investigation and life of case); Safety assessment Nebraska (includes information standards; threshold criteria and supervisory review of safety assessment decision and process)
Safety plan (not first contact)
Risk assessment
Risk re-assessment
Protective capacity assessments
Case plan

60. Current decision-making tools
Family assessments (often for Differential Response) (Ohio example)
Concurrent planning (Idaho) includes ICWA considerations; 3 month intervals up to 22 months.
Educational neglect (home schooling) Idaho
Pediatric symptom checklist (Maine)

61. Current decision making tools
Maine signs of safety
UNCOPE- screening tool for drugs/alcohol (Maine)
Abandonment screening tool (Nebraska)
Dependency screening tool (Nebraska)
Idaho safety decision tree

62. Current Decision-making tools
New resource – NRCCPS website

63. 18th National Conference on Child Abuse & Neglect April 18 – 20 Washington, D.C.
What We Know and Current Challenges
Tamara Fuller
University of Illinois
Donald J. Baumann
Saint Edwards University

64. What We Know and Current Challenges: Overview
Tying Tools and Practices into Improved Outcomes
Implementation and Decision-Making
What do we Need to Know: Challenges for Research

65. What We Know and Current Challenges: Tying Tools and Practices into Improved Outcomes
The Assessments
Safety
Risk
Family
What are the key decisions?
Investigation
Substantiation
Service provision
Placement into care
Reunification
Relative Care
Adoption
The Instruments
CERAP
SDM
Concept Guided (Texas and Georgia)
Other

66. Illinois Child Endangerment Risk Assessment Protocol
Safety assessment instrument
14 safety factors that focus on readily observable and harmful behaviors
Family strengths and mitigating circumstances
Safety decision
Safe: No children likely to be in immediate danger of moderate to severe harm
Unsafe: A safety plan must be developed OR one or more children must be removed from the home because without the plan they are likely to be in immediate danger of a moderate to severe nature

67. CERAP
Safety Plan
What actions have or will be taken to protect each child in relation to current safety concerns?
Who is responsible for implementing each plan component?
How will the plan be monitored and by whom?
What must happen in order to terminate the plan?
What time frames have been imposed by this plan?

68. CERAP
CERAP intended as a “life of case” instrument, and should be completed at several case milestones:
Initial investigation
Investigation closure/case opening
Ongoing safety plan monitoring
Unsupervised visits
Reunification
Case closure

69. What We Know and Current Challenges: Reviewing of the Status of Decision-Making Research
Factors that Relate to Different Decision Points
Case characteristics
Organizational characteristics
External characteristics
Decision-maker Characteristics

70. What We Know and Current Challenges: Reviewing of the Status of Decision-Making Research
Factors that Relate to Different Decision Points
Where are the decision-making errors
The threshold shift from child protection (more false positives) to family preservation (more false negatives)
The middle of the safety and risk continuums probably has greater threshold variability than the extremes
The Harm Evidence model for substantiation decision (Drake, 1998 suggests we must have: (1) sufficient risk of harm coupled with (2) evidence to show it. This would suggest a high threshold, more false positives and fewer false negatives
Some evidence suggests the decision-making threshold for reunification is higher than for placement. This would indicate the possibility of more protection, more false positive and fewer false negative errors.
The fallibility of decision aids (e.g., risk and safety instruments)
They only predict a small amount of the variability in decisions
They don’t tell us what the errors are but they do tell us how much
Important to focus our attention on understanding and practical utility

71. What We Know and Current Challenges: Issues With Instruments
Evaluating Risk and Safety Assessment Instruments
Scientific Integrity
Face validity
Content validity
Construct validity
Practical Utility
Influence
Accessibility
Efficiency

72. Evaluating the CERAP
Implementation evaluations have examined how workers using the CERAP
Outcome evaluations have examined whether CERAP implementation has impacted child safety

73. Impact evaluation The CERAP was implemented statewide in December 1995
Therefore, a true experimental design to assess its impact on safety was not possible
A time series analysis was used to examine differences in child safety before and after CERAP implementation
Additional analyses attempted to rule out alternative hypotheses

74. Impact evaluation
The outcome of interest is child safety, defined in these evaluations as the number and percentage of children with an indicated report of maltreatment within 60 days of an initial report

75. 60-day recurrence rates (1995-2001)
Implementation Year

76. Extended Secular Trend Analysis
To strengthen the validity of the inference about CERAP effectiveness, the trend analysis was extended several years before CERAP implementation to assess whether the decline in recurrence rates was a reversal of an earlier pattern or a continuation of past trends.

77. 60-day recurrence rates (1986-2002)

78. CERAP Completion Rates by Milestone
Intact Family (n=273)
Substitute Care
(n=288)
Within 24 hours after the investigator first sees the victim
93%
69%
Within 5 days of case opening or transfer
73%
45%
Every six months for intact family cases
67%
n/a
Commencement of unsupervised visits
48%
Before an administrative case review
50%
77%
Prior to returning home
Prior to closing a case
87%
100%
When child’s safety is in jeopardy
90%
81%

79. CERAP Section Completion Rates
Intact Family
Substitute Care
Safety Factor Checklist
94%
86%
Family Strengths
90%
88%
Safety Decision
95%
91%
Safety Protection Plan
78%
Plan identifies specific actions
73%
63%
Plan identifies who will implement
59%
Plan identifies who will monitor
38%
39%

80. Summary
CERAP completion by workers in the field is consistently high during the investigation (97%), moderately high at case transfer and case closing (70%), and much lower at other milestones. When completed, the CERAP tends to be completed in its entirety, although safety plans may not be completed according to instruction.

82. 18th National Conference on Child Abuse & Neglect April 18 – 20 Washington, D.C.
Group Decision-Making Process
Donald Baumann
Saint Edwards University
Lisa Merkel-Holguin
American Humane Association

83. Group Decision-Making Processes Overview
Principles of Group Decision-Making
Family Involvement Models Used in Child Welfare Decision-Making Lisa will discuss later this afternoon

84. Principles of Group Decision-Making: Assumptions
Our decisions are influenced by groups: We have evolved to function in groups
More hands makes for light work
Interactions between group members will move initial extreme positions toward the middle
Coming to consensus is a good way for groups that are already cohesive to make decisions
Groups make better decisions than individuals

85. Principles of Group Decision-Making: Understanding Sources of Errors in Groups
The Influence of Groups on Decisions:
Groups have influence even by their mere presence: We are affected by the presence of others, even unconsciously. We do better in the presence of others when we have learned how to do something well. When we have not, we do worse
More Hands Makes for Lighter Work
Many hands can make for social loafing: Collective efforts result in less than the sum of individual effort under some circumstances (additive task, unchallenging tasks, not being held accountable, etc.)
Interactions Make for Compromise
Interaction between group members with different positions produces group polarization: Interaction tends to intensify opinions for the like- and unlike-minded: They shift to more extreme positions because informational and normative influences.

86. Principles of Group Decision-Making: Understanding Group Influence
Consensus Decisions
Consensus can produce groupthink: High cohesiveness, group insulation, the lack of procedures for appraisal and directive leadership leads groups to poorer decisions. Group preferences for supportive vs. challenging information, as well as the need for acceptance or approval, helps facilitate groupthink.
Group vs. Individual Problem Solving
Though people feel more productive when solving problems in a group, people working alone or in two’s generate more good ideas. Large brainstorming groups are especially ineffective.
Among the ways this can be overcome are to combine group and solitary brainstorming, or have members first write then read (as in networked computers), rather than speak, then listen.

87. A Brief Exercise in Setting Action Thresholds

88. Case Vignette
Mother tested positive for marijuana at the birth of the child. The child was not tested. Mother admits to using marijuana weekly. Mother and the biological father reside together and have all items to meet the baby’s basic needs. Mother has two other children who are not in her care. They were committed to the legal custody of mother’s mother. That arrangement was done privately with no Agency court involvement. The Agency did substantiate Neglect in that case, but the grandmother filed on her own. Mother has been diagnosed with Major Depressive Disorder. Mother is not receiving counseling services nor is she on medication. Mother states she uses marijuana to help with her mental health. Mother has been uncooperative with the Agency in the past, but has now agreed to do a drug and alcohol assessment. Mother has resided out-of-state and has just returned to their home town in November. Father is employed and is cooperative with the Agency. He participated in a drug and alcohol assessment after admitting to past use of marijuana. Mother would be the primary caretaker of the child while the father is at work. WOR’s home visit revealed no concerns about provisions for the baby, but some concerns about caring for the baby given mother’s mental health and history of drug usage.

89. The Process of Decision Making: The Threshold Concept
High
If threshold low, W1 needs little evidence before taking action.
Threshold W2 No
W2 Assessment.
W1 Assessment.
If threshold high, W2 needs much evidence before taking action.
Let us consider an illustration of this.
Consider two workers making assessments and decisions about action.
They make their assessment of the level of risk or of need along some defined continuum.
Worker 1 has a low threshold and needs little evidence before taking action.
Worker 2 has a high threshold and needs a lot of evidence before taking action.
However, even if they agree on an assessment of a case,
they will disagree about taking action.
Yes
Even if they agree on the assessment,
Threshold W1
they disagree about taking action.
Low
Assessed level of risk or need
*From Len Dalgleish, 2000

90. Vocabulary: Safe and Unsafe Child
“Vulnerable” children are safe when there are no “threats of danger” within the family or home OR when the caregivers possess sufficient “protective capacity” to manage or control any threats.
Unsafe child
Children are unsafe when they are “vulnerable,” there are “threats of danger” within the family or home AND the caregivers have insufficient “protective capacities” to manage or control the threats, making outside intervention necessary..

91. Implementation Science: an introduction to key concepts

93. National implementation Research Network

94. Don’t forget: You can copy-paste this slide into other presentations, and move or resize the poll.
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95. From Paper to Performance
The “how”
Effective
Not effective
Good implementation
Good outcomes
Poor implementation
Poor outcomes
The “what”
Fixsen et al (2005), p. 69

96. Implementing Best Practices
Outcomes/ evaluation
Systems intervention
Facilitative administration
Decision support data system
Selection
Training
coaching
INTEGRATED & COMPENSATORY
Staff competence
Organizational supports
Leadership
Adaptive
Technical
Fixsen & Blase , 2008

97. Stages of implementation
Exploration
Design/ installation
Initial implementation
Full implementation
Innovation
Sustainability
Fixsen et al (2005),

98. West Virginia Safety Assessment and Management System
Purpose: To implement a new (CPS) safety assessment and intervention system that:
Utilizes a change management approach to fully implement the system
Permanently changes practice in WV
Results in better outcomes for children ad families

99. SAMS Mission
The successful implementation of SAMS resulting in an improved system of intervention based on consistent standards; focused and efficient information collection; and a family-centered approach that will improve caregiver and family functioning and increase safety, permanency and well-being.

100. SAMS
A comprehensive CPS assessment process from initial intake to case closure and a more precise way to determine safety and respond to unsafe children
Will improve safety outcomes for children and families by:
Focusing services more on safety
Focusing on the protective capacities of caregivers
Improving family engagement

101. SAMS: Key to Success
Fidelity – using the decision-making model as designed. Blame cannot be placed on deficiencies of the model if it is not used as designed
Understanding a form cannot change practice by itself
Understanding that learning takes time.

102. West Virginia’s Application of NIRN Drivers Practitioner Selection
All CPS supervisors and staff implementing the SAMS model according to the Implementation Schedule.
Bureau decision to utilize the concept of “Special Forces.”
 A group of Program Managers, Supervisors, and Trainers who are the primary purveyors of the model and responsible for building practice competence with staff and supervisors.
 Members selected to represent the best and brightest of West Virginia’s Child Welfare workforce.
Working on long-range plans for staff recruitment, selection and allocation including interviewing questions based on SAMS competencies.

103. West Virginia’s Application of NIRN Drivers Training
Intense focus on staff training and professional development.
NRCCPS/ACTION trains and mentors SAMS Special Forces
ACTION and SAMS Special Forces train supervisors
SAMS Special Forces and supervisors train, mentor and guide staff
Targeted training prior to SAMS training on identified issues that could negatively impact SAMS implementation.
Targeted training after SAMS implementation on issues that need more clarification or understanding.
- Ongoing skills training to improve interviewing and family engagement skills.

104. West Virginia’s Application of NIRN Drivers Supervision and Coaching
Major focus: build the knowledge, skills, and abilities of CPS supervisors to supervise and coach their staff.
Receive SAMS training first that includes building supervisor competencies related to SAMS.
Attend SAMS training with their staff and take a lead role in case discussions.
Attend Action field consultation to discuss implementation of the model with actual cases.
Trained on the Action Supervisor Guide this summer that discusses consultative supervision.
Developing “mini-trainings” for supervisors to use in staff meetings.

105. West Virginia’s Application of NIRN Drivers Performance Assessment
Mastery of a new system of decision making and delivery occurs over time with focused consultation, supervision and quality improvement.
Fidelity monitoring integrated into clinical case consultation through the use of a standardized review instrument.
Low fidelity areas addressed through Local Maintenance Plans and Special Forces consultation.
Ongoing evaluation to be integrated into OPQI reviews.

106. West Virginia’s Application of NIRN Drivers Systems Intervention
Initially not enough attention paid to stakeholder perception and understanding.
Internal stakeholders
BCF Managers, Supervisors, and Staff (Child Welfare as well as other program staff); DHHR Secretary and Other Bureaus; Special Forces; Implementation and Steering Committees

107. West Virginia’s Application of NIRN Drivers Systems Intervention
External stakeholders
Legislature; Court System; Education System; Health Care System; Private Agencies; Service Providers; Advocacy and Professional Organizations

108. West Virginia’s Application of NIRN Drivers Systems Intervention
Implemented activities in a variety of venues for increasing stakeholder buy-in for SAMS.
Communication with the Legislature including SAMS pocket cards.
SAMS training for the legal community conducted by Regional Attorneys.
Presentations at statewide conferences and events, like NASW.
Joint trainings with service providers and staff on safety services.
Presentations at the Court Improvement Board and judicial cross- training events.
Presentations at professional and community group meetings.
Web-based course providing an introduction to SAMS for all staff.
Discussion on SAMS required at all district and regional staff meetings.

109. West Virginia’s Application of NIRN Drivers Facilitative Administration
Made changes to policies and procedures to align with SAMS, including creation of transitional policies.
Organizational structure refined to support SAMS.
Director and Coordinator, funded through ACCWIC.
SAMS Implementation Team.
CPS Steering Team.
Feedback from the field brought back to Implementation and Steering to address barriers and facilitate implementation.
Restructuring of office procedures, unit procedures, and staff assignments at the local level.

110. West Virginia’s Application of NIRN Drivers Facilitative Administration
State, regional, and district administrators prepared for SAMS through statewide meetings and training sessions.
Pre- and post-implementation meetings held with every district administrator.
Pre-implementation meetings with supervisors and administrators, conducted by Action.
Post-implementation consultation with supervisors and administrators, conducted by Action and Special Forces.
State, regional, and district administrators attend SAMS
training and consultation with their supervisors and staff.

111. West Virginia’s Application of NIRN Drivers Data Decision Systems
West Virginia’s SACWIS system, FACTS, currently making changes to the system to support the SAMS assessments.
Because of delays to FACTS implementation, decision made to use a paper assessment system until FACTS changes could be made.
Staff still responsible for entering NCANDS and AFCARS information into the current system until FACTS changes are complete.

112. West Virginia’s Application of NIRN Drivers Data Decision Systems
SAMS Fidelity Monitoring System developed with ACCWIC to collect practice-relevant fidelity data to inform implementation.
Data system currently housed with ACCWIC during development but will transition to OPQI.
Data discussed at Implementation, Management, and Special Forces meetings to identify gaps and determine necessary actions to take.
Fidelity data will be integrated into dashboards along with federal outcomes data.

113. West Virginia’s Application of NIRN Drivers Data Decision Systems
Dashboards developed with TA from NRC on Data and NRC Organizational Improvement.
Will measure CFSR outcomes and fidelity data by region, county, and judicial district.
Will show information on cases that do not meet standards for managers to use to evaluate and improve performance.
West Virginia has initiated a bureau-wide effort to make better use of data in management decisions.

114. West Virginia’s Application of NIRN Drivers Leadership
One of West Virginia’s strengths is the involvement of key leaders in the implementation of SAMS.
Commissioner and Deputy Commissioner take a lead role and actively participate in Implementation and Steering.
Reports on SAMS progress provided at each Leadership Team and Field Operations Management Team meeting.
SAMS discussion required at all regional and district meetings.
- Commissioner, Deputy Commissioner, and Regional Directors visiting districts that are implementing and meeting with staff.
Community Services Managers attending training with their supervisors and actively involved in community education.

115. What do we need to know: challenges for research?
Basic Research on Decision Making in Child Welfare
Improved Assessment
Improvements Decision Making Information
Improving the Utility of Decision Making Supports
Workforce Development
Improved Implementation

116. Children’s Hospital Colorado
Particularly African American and Native American children
U.S. state data indicate that while the rates at which children are referred to CPS vary somewhat across the nation, they are similar in the overrepresentation of non-White children.
Katherine Casillas
The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect
Children’s Hospital Colorado
Denver, CO

117. What effects decision making in child welfare, and what can we do to change negative influences?

118. Effects on the Decision Threshold
Case
Factors
Individual
Factors
Outcomes
Decision
Threshold
Organizational
Factors
Intervention
Influences
Outcomes

119. Case Factors The Child The Family Gender Level of Risk Age Income
Behavioral Problems
Medical Problems
Race/Ethnicity
The Family
Level of Risk
Income
Number of Children
Marital Status
Race/Ethnicity

120. Effects on the Decision Threshold
Case
Factors
Individual
Factors
Outcomes
Decision
Threshold
Organizational
Factors
Intervention
Influences
Outcomes

121. Individual Factors Decision Making Skills (e.g., good judgment)
Case Skills (e.g., fact finding)
Knowledge of Placements
Cultural Sensitivity (e.g., awareness)

122. Effects on the Decision Threshold
Case
Factors
Individual
Factors
Outcomes
Decision
Threshold
Organizational
Factors
Intervention
Influences
Outcomes

123. Organizational Factors
Supervision
Agency Policy
Availability of Placements
Workload

124. The influence of disproportionality and disparities

125. Can the process be changed?
Are racial and ethnic groups disproportionately represented in Child Protective Services (CPS)?
Can the process be changed?
125

126. The Continuum of Intervention
Assessments and decisions are made at key points along the child protection continuum
Each key decision point requires a specific decision and action
Hardiker, et al in 1999 developed a grid for looking at the twin approachs of safeguarding and promoting welfare at different levels of intervention.
My modification is to show that assessment is at the core and informs both needs and risk along the continuum of intervention.
The assessment and addressing of needs can occur before a situation becomes a child protection matter. This is one approach to prevention.
At each key decision point along the continuum, both risk assessments and assessment of needs are performed and they inform each other.
These occur at the key decision points and at reassessments in between to monitor risk and needs.
It is in the addressing of the needs that the risk to the child is managed.
There are many assessments and decisions made. There are ‘big’ decisions - whether to call a case a child protection matter, whether to remove a child from the family, whether to return a child to the family.
There are also many more ‘small’ decisions, based on a needs reassessment about how to meet those needs.
This assessment and decision making is a difficult task.

127. Understanding Trends
National level data can be misleading when attempting to understand and improve child welfare at the local level.
Racial disproportionality and disparate outcomes data must be analyzed and understood at the local level.
Disparity-related dynamics can be very different from one jurisdiction to the next, even when the jurisdictions share similar characteristics.

128. Enumerating Disparities and Disproportionality in Decision Points
Population Based Denominator Ratios
Based on data from one child welfare decision (e.g., new placements/population)
Easiest to obtain
Decision Based Denominator Ratios
Based on data from at least two child welfare decisions (e.g., new placements/opened cases)
Disparity: Relative to another group

129. Colorado Child Population / Race & Ethnicity Legend
2010 Population Under 18
Black
Black alone, not Hispanic or Latino
49967
White
White alone, not Hispanic or Latino
710280
Hispanic
Hispanic or Latino
374225
Asian
Asian alone, not Hispanic or Latino
32225
AI_AN
American Indian and Alaska Native Alone, Not Hispanic or Latino
7298
NH_OPAC
Native Hawaiian and other Pacific Islander, not Hispanic or Latino
1557
Multi
Two or more races, not Hispanic or Latino
47285

130. Children in Referrals FY 2011 (Jul, 1 2010 - June, 30 2011)
Children in Referrals
Child Population
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
Total
126734
103.40
Black
8471
17.0%
6.7%
49967
4.1%
169.53
2.57
White
46857
6.6%
37.0%
710280
58.0%
65.97
1.00
Hispanic
33791
9.0%
26.7%
374225
30.5%
90.30
1.37
Asian
628
1.9%
0.5%
32225
2.6%
19.49
0.30
AI_AN
430
5.9%
0.3%
7298
0.6%
58.92
0.89
NH_OPAC
180
11.6%
0.1%
1557
115.61
1.75
Multi
3014
6.4%
2.4%
47285
3.9%
63.74
0.97
Missing
33363 *

131. Children in Assessments
FY 2011 (Jul, June, )
Children in Assessments
Child Referred
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
Total
64657
126734
510.18
Black
4572
54.0%
7.1%
8471
6.7%
539.72
0.96
White
26246
56.0%
40.6%
46857
37.0%
560.13
1.00
Hispanic
19887
58.9%
30.8%
33791
26.7%
588.53
1.05
Asian
381
60.7%
0.6%
628
0.5%
606.69
1.08
AI_AN
244
56.7%
0.4%
430
0.3%
567.44
1.01
NH_OPAC
105
58.3%
0.2%
180
0.1%
583.33
1.04
Multi
1714
56.9%
2.7%
3014
2.4%
568.68
1.02
Missing
11508
34.5%
17.8%
33363
26.3%
344.93
0.62

132. Children in Substantiated Cases
FY 2011 (Jul, June, )
Children in Substantiated Cases
Child Assessed
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
Total
10713
16.6%
64657
165.69
Black
920
20.1%
8.6%
4572
7.1%
201.22
1.07
White
4956
18.9%
46.3%
26246
40.6%
188.83
1.00
Hispanic
4035
20.3%
37.7%
19887
30.8%
202.90
Asian 73
19.2%
0.7%
381
0.6%
191.60
1.01
AI_AN
29.9%
244
0.4%
299.18
1.58
NH_OPAC 17
16.2%
0.2%
105
161.90
0.86
Multi
392
22.9%
3.7%
1714
2.7%
228.70
1.21
Missing
247
2.1%
2.3%
11508
17.8%
21.46
0.11

133. Children Removed Within 90 Days
FY 2011 (Jul, June, )
Children in Removed Within 90 days
Children Served
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing
Number of Eligible Children
% Of (Total Minus Missing
Rate Per 1000 of Eligible Children
Compared with White
Total
2415
6796
Black
245
40.4%
3.6%
607
20.1%
403.62
1.14
White
1114
35.5%
16.4%
3141
18.9%
354.66
1.00
Hispanic
899
13.2%
2534
20.3%
354.78
Asian 9
23.1%
0.1% 39
19.2%
230.77
0.65
AI_AN 31
50.8%
0.5% 61
29.9%
508.20
1.43
NH_OPAC 3
42.9%
0.0% 7
16.2%
428.57
1.21
Multi
110
43.1%
1.6%
255
22.9%
431.37
1.22
Missing 4
2.6%
152
2.1%
26.32
0.07

134. First Placement: Congregate Care
FY 2011 (Jul, June, )
First Placement Congregate Care
Children Removed
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
First Placement
Congregate Care
Total
207
2415
Black 32
13.1%
0.5%
245
20.1%
130.61
1.46
White
100
9.0%
1.5%
1114
18.9%
89.77
1.00
Hispanic 71
7.9%
1.0%
899
20.3%
78.98
0.88
Asian 9
19.2%
AI_AN 31
29.9%
NH_OPAC 3
16.2%
Multi 4
3.6%
0.1%
110
22.9%
36.36
0.41
Missing
2.1%

135. First Placement: Foster Care
FY 2011 (Jul, June, )
First Placement Foster Care
Children Removed
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
First Placement
Foster Care
Total
1266
2415
Black
124
50.6%
1.8%
245
20.1%
506.12
0.97
White
581
52.2%
8.5%
1114
18.9%
521.54
1.00
Hispanic
460
51.2%
6.8%
899
20.3%
511.68
0.98
Asian 4
44.4%
0.1% 9
19.2%
444.44
0.85
AI_AN 26
83.9%
0.4% 31
29.9%
838.71
1.61
NH_OPAC 1
33.3%
0.0% 3
16.2%
333.33
0.64
Multi 66
60.0%
1.0%
110
22.9%
600.00
1.15
Missing
100.0%
2.1%
1.92

136. First Placement: Other Care
FY 2011 (Jul, June, )
First Placement Other Care
Children Removed
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
First Placement
Other Care
Total 57
2415
Black 6
2.4%
0.1%
245
20.1%
24.49
1.09
White 25
2.2%
0.4%
1114
18.9%
22.44
1.00
Hispanic 20
0.3%
899
20.3%
22.25
0.99
Asian 1
11.1%
0.0% 9
19.2%
111.11
4.95
AI_AN
3.2% 31
29.9%
32.26
1.44
NH_OPAC 3
16.2%
Multi 4
3.6%
110
22.9%
36.36
1.62
Missing
2.1%

137. First Placement: Relative Care
FY 2011 (Jul, June, )
First Placement Relative Care
Children Removed
Disparity Indices
Type of Analysis
Ethnicity
Children
% of Eligible
% of (Total Minus Missing)
Number of Eligible Children
% Of (Total Minus Missing)
Rate Per 1000 of Eligible Children
Compared with White
Total
870
2415
Black 83
33.9%
1.2%
245
20.1%
338.78
0.95
White
399
35.8%
5.9%
1114
18.9%
358.17
1.00
Hispanic
342
38.0%
5.0%
899
20.3%
380.42
1.06
Asian 4
44.4%
0.1% 9
19.2%
444.44
1.24
AI_AN
12.9% 31
29.9%
129.03
0.36
NH_OPAC 2
66.7%
0.0% 3
16.2%
666.67
1.86
Multi 36
32.7%
0.5%
110
22.9%
327.27
0.91
Missing
2.1%

138. What can we do?: Explaining Removals at the Worker Level
Disparity Index
Percent on Caseload
Skills (AA only)
Removals
Workload (worker)
Community Resources (worker)
Family Poverty
Family Risk Level - - - - +
AA Only + +

139. Organizational Interventions and the Removal Rates for African American Children Pre and Post
In four of the five counties where the effort has been most intense have lowered African American removal rates

140. Discussion
Are there key decision points where we should be focusing our attention?
What are the explanatory factors that we should attend to?
What are some suggested policy revisions that could mitigate factors in child welfare?
How do we make progress in integrating and improving clinical/professional judgment in the assessment process?
What are the best ways to influence decision actions?

141. Decision Making Café Please Self Select a Discussion Topic
Table 1 – Tools
Table 2 – Policy and Workforce
Table 3 – Implementation
Table 4 - Research

142. Family Group Decision Making and Family Engagement in Decision Making

143. Description of the “It”
What it is:
An opportunity for the family group to gather all the needed information about the agency’s concerns in order to make well-informed decisions.
Family-driven decision making planning
Family as the expert
What it is not:
Mediation
Conflict resolution process
An opportunity for families to come together to hear agency professionals’ solutions
Guidelines for Family Group Decision Making in Child Welfare, 2010

144. Terminology Family Involvement and Decision Making Models:
Family Group Conference or FGC (New Zealand, 1989)
Family Unity Meeting Model or FUM (Oregon, 1990)
Family Team Conferencing (FTC) as developed by the Child Welfare Practice and Policy Group
Team Decision Making (TDM)
Family Team Meetings (FTM)
Rapid Case Planning Conference
Hybrid Models that combine FGC, FTC, FUM, and other models

145. Five Core Elements of FGDM
An independent Coordinator
Family group as key decision making partner—resources put towards finding and preparing
Private family time
When plan meets agency concerns, preference to family plan
Services and resources available to meet agreed upon plans
American Humane Association (2008)
Case-carrying staff are unlikely to have the time and flexibility to coordinate
When agency staff are given positions as coordinators without cases, other staff may believe this structure increases their own caseloads
When coordinators are contracted and paid per conference: they may not have sufficient internal systems support to do their jobs; referrals may decrease; workers may see it as an add-on.
Question debated in North America: Should the Coordinator be internal or external to the public child welfare agency?

146. Family Voice in Decision Making System Voice in Decision Making
Family Involvement Continuum1
Family Voice in Decision Making System Voice in Decision Making
1Taken from: Merkel-Holguin, L. and Wilmot, L. (2005). Analyzing family involvement approaches in J. Pennell & G. Anderson (Eds.), Widening the circle: The practice and evaluation of family group conferencing with children, young persons, and their families. Washington, DC: NASW Press.
May be reproduced and distributed with appropriate citation.

147. Participation Satisfaction and Communication Benefits
Family satisfaction
Conflict decreased
Felt empowered
Worker satisfaction
Felt children would be better protected and greater confidence in child safety
Improved relationships with child welfare agency
Felt listened to
Better understood agency’s concerns

148. Resources for Families
More quickly linked to services
Received more individualized resources
More likely to receive counseling for children and mental health and parenting services for adult caregivers

149. Child welfare outcomes
Placements
More stable
Less likely to be placed in institutions
More likely to be placed with extended family
Beneficial impacts: more stability, better adjustment, ties to culture and traditions
Fewer temporary moves
More likely to maintain connections to siblings
Achievement of permanency sooner and less time in out-of-home care
Improved child safety
Reduced disproportionality