© 2010 by NCCD, All Rights Reserved 426 South Yellowstone Drive, Suite 250, Madison, WI 53719 Phone (608) 831-1180 / Fax (608) 831-6446

© 2010 by NCCD, All Rights Reserved

426 South Yellowstone Drive, Suite 250, Madison, WI 53719Phone (608) 831-1180 / Fax (608) 831-6446

www.nccd-crc.org

Children’s Research Center is a nonprofit social science research organization and a division of the National Council on Crime and Delinquency

Structured Decision Making® (SDM) SystemOverview

Presented by Deirdre O’Connor,Children's Research Center

Structured Decision Making® and SDM®

Registered in the U.S. Patent and Trademark Office


SDM® Systems

• Comprehensive case management• Structured critical decision points• Research- and evidence-based assessments


SDM® Systems

• Adult corrections• Juvenile justice• Child protection• Foster care placement support• Adult protection• Economic self-sufficiency (TANF)


“Risk assessment establishes a foundation for virtually everything we do in the child protection system. A meaningful and consistent tool is essential for all of us to do our job properly. [The SDM system] clearly provides us with that tool.”

Judge Michael Nash, Presiding Judge of the Los Angeles Juvenile Court


SDM® Systems

Goals

Reduce subsequent negative event

CPS: harm to child JJ: delinquent act

StabilizeCPS: expedite permanency

JJ: functional behavior

Objectives

Structure critical decision points

Increase consistency in decision making

Increase accuracy in decision making

Target resources to families most at risk

Characteristics

Reliable

Valid

Equitable

Useful


Reduce Subsequent Harm:Outcomes for All Cases in Study, 12-month Follow-up

Referrals Substantiations Placements Injuries0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

14.9%

5.2%3.4%

2.1%

20.4%

11.4%

5.7%

3.6%

SDM® System (N = 920) Comparison (N = 877)

Perc

enta

ge

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


CMC Evaluation Results From Florida Revocation Rates, Community Control Admissions (N = 45,346)

FY 93–94 FY 94–95 FY 95–96 FY 96–97 Average Dif-ference

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

40.2%

49.6% 49.7%45.9% 46.3%

60.6% 61.5%64.3% 62.9% 62.3%

CMC Group Non-CMC Group

Florida Department of Corrections Research and Data Analysis: Leininger, “Effectiveness of Client Management Classification,” December 1998


Expedite Permanency:Recent Research in Los Angeles County

2002 2003 2004 2005 2006 2007 20080

2

4

6

8

10

12

14

16

13.6 13.913.1

10.1

8.3 8.2 8.3

39% Decrease

Median Time to Reunification in Months


Improve Decision Making

All information

Information learned

Information needed for

decision at hand


A Bit More About SDM® Objectives

ObjectivesStructure critical decision points





Structuring Critical Decisions in Juvenile Justice


1. Detention screening2. Risk classification/supervision levels 3. Strengths/needs for case planning 4. Disposition recommendations5. Reassessment of risk and needs6. Institutional placement decisions7. Release/transition decisions

SDM® Assessments: Graduated Sanctions for Juvenile Justice


Response priority

Safety assessment

Initial risk assessment

Family strengths and needs assessment

Screening criteria

Risk reassessmentReunification reassessmentFamily strengths and needs reassessments

Inta

keIn

vesti

gatio

n/

Asse

ssm

ent

Is the child safe?

Is it child abuse/neglect (CA/N)?

How quickly do we need to respond?

What is the likelihood of future maltreatment?

What should the service plan focus on?

Ong

oing

Should the case remain open or be closed?

Structuring Critical Decisions in Child Protective Services



Objectives






Consistency (Reliability)

Research Fresno Washington0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

59.4%

14.1% 12.5%

26.6%

32.8% 37.5%

4 of 4 3 of 4

Agreement on Scores

Sample: Four independent ratings of 80 cases.Child Abuse and Neglect: Improving Consistency in Decision Making, 1997



Objectives






Accuracy (Validity)

Research (N = 929) Fresno (N = 876) Washington (N = 908)0.0%

20.0%

40.0%

7.0%

15.0% 16.0%15.0%

18.0%16.0%

28.0%

18.0% 21.0%

Low

Moderate

High

18-month Substantiation Rates

Sample: Four independent ratings of 80 cases.Child Abuse and Neglect: Improving Consistency in Decision Making, 1997

(n = 138)

(n = 541)

(n = 250)

(n = 442)

(n = 304)

(n = 130)

(n = 202)

(n = 475)

(n = 231)


Validity in Juvenile Justice:Recidivism by Risk Classification

Percentage of Youth With Subsequent Delinquent Adjudication Within 15 Months

Low Risk (n=181) Medium Risk (n=303) High Risk (n=282) Very High Risk (n=67)0%

10%

20%

30%

40%

50%

60%

70%

6%

25%

38%

63%


State Commitment SampleWisconsin

Low Moderate High0%

10%

20%

30%

40%

50%

11%

19%

32%

18%

30%

47%

Subsequent Juvenile Felony and Non-felony Return RateOverall Juvenile Reinstitutionalization Rate

Risk Levels

Out

com

es



Objectives






Targeting Resources Reduces Risk

Low/Moderate High Very High0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

14.1%

27.7%

44.8%

14.6% 15.2%

23.6%

Re-referral Rates for Cases Opened vs. Closed After Investigation: A Two-year Follow-up

Closed (N = 1,014) Opened (N = 216)

Wisconsin Urban Caucus, 1998

(n = 562) (n = 48) (n = 347) (n = 79) (n = 105) (n = 89)


CMC Research Results Revocation Rates:Milwaukee, Wisconsin

Intensive Supervision With CMC

N = 152

Intensive Supervision OnlyN = 123

Regular SupervisionN = 147

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

19.7%

24.4%

29.9%


The SDM® System as Part of a Family-centered Practice Framework

• Tools do not make decisions; people do.

• Research and structured tools combine with clinical judgment and experience to support decision making.

• Should be integrated within the context of solution-focused, family-centered practice.

Family


SDM® Implementation in Louisiana

• Fall 2007 OCS workgroups modified:» SDM initial risk assessment» In-home risk reassessment» Out-of-home reunification reassessment

• January 2008 Training for OCS supervisors and trainers

• July 2008 All parish offices trained and using SDM assessments

• August 2009 Initial risk assessment integrated into ACESS, completed on all investigations

• January 2010 Screening and response time assessment field-tested

• June 2010 Screening and response time assessmentimplementation statewide


Louisiana SDM® Assessments

• Screening and response time assessment• Initial risk assessment• In-home risk reassessment• Reunification reassessment

Integrated into Focus on Four initiative


SCREENING AND RESPONSE TIME ASSESSMENT


SDM® Screening and Response Time Assessment

• Screen in or screen out

Screening Criteria


Screening and Response Time Assessment

• Structuring decision to improve consistency

• No change in statutes or policy» Elements of child abuse or neglect report» Specific allegations» Response times

• Change in documentation

• Change in decision-making process

• Expected increase in alternative response assessments


Elements of a Child Abuse and Neglect Report

• Currently a minor• Minor when alleged incident occurred and allegation

creates concern for another minor

Alleged victim

• In a caretaker role (parent, guardian, foster parent, daycare provider)

• Other adult living in the home• Adult in dating relationship with parent (live-in or not)• Daycare home provider

Alleged perpetrator

• Abuse: inflict or attempt to inflict harm that endangers health and safety of child

• Neglect: refusal/unreasonable failure to meet child’s needs, which endangers child’s health or safety

• Incident occurred or substantial risk of harm• Reporter observed incident or has firsthand information

Abuse or neglect

• Current incident or circumstance• Sexual abuse, serious physical abuse within past 12

months• Less serious physical abuse within past 3 months• Neglect within past month• Differ for current/former foster children and certified

foster homes

Time limits


INITIAL RISK ASSESSMENTIs this a family that needs ongoing support/intervention?


Definitions of Key Terms in the SDM® Model:Different Decision Points

Safety:

• Likelihood of immediate harm (current/near term)

Risk:

• Likelihood of future harm (12–24 months following investigation/assessment)

Needs:

• Domains of functioning in which a caregiver must demonstrate behavioral change to increase capacity to meet the safety, well-being, and permanency of his/her children


Actuarial Risk Assessment

• A statistical procedure for estimating the probability that a “critical” event will occur.

• In the auto insurance industry, the critical event is a car accident involving a driver insured by the agency. Among breast cancer patients, the critical event is recurrence of cancer.

• In this case, the critical event is the likelihood of future child maltreatment.


Risk Level by Initial Safety Assessment

Safe

Conditionally Safe

Unsafe

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

60.4%

37.7%

1.9%

55.4%

39.3%

5.3%

34.7%

39.4%

25.9%

17.8%

30.8%

51.4%

Low Moderate High Very High

N = 69,567 2008 California Combined Report


California Risk Study Results

Referrals Substantiations Injury Removal0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%18

.5%

7.7%

4.3%

1.4%

27.5

%

13.8

%

7.0%

6.5%

48.0

%

31.6

%

14.4

% 20.4

%

60.1

%

44.3

%

22.7

% 27.8

%

Low (n=352) Moderate (n=1,067) High (n=819) Very High (n=273)

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


Informing Decisions and Targeting Resources

• Risk classifies families by likelihood of subsequent abuse/neglect.

• High and very high risk families are significantly more likely to experience subsequent maltreatment.

• Using risk to decide whether to provide services, and the intensity of services, can reduce repeat maltreatment.


Risk Level vs. Substantiation

Very Low Low Moderate High0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2.0%

6.0%

22.0%

29.0%

2.0%

8.0%

19.0%

36.0%

Unsubstantiated

Substantiated

Re-substantiation Rate for Substantiated vs. Unsubstantiated Cases: 18-month Follow-up

(N = 110)

(N = 173)

(N = 360)

(N = 365)

(N = 146)

(N = 154)

(N = 58)

(N = 84)

N = 1,450 New Mexico, 1997


*Moderate and low risk cases with unresolved safety issues should always be transferred for ongoing services.

Final Risk Level Recommended Decision

Very High Open for ongoing services

High Open for ongoing services

Moderate* Close

Low* Close

SDM® Case Open/Close Guidelines


Ongoing Service Assessments

• In which areas does the family need help?• What strengths can the family draw upon?

Assessment of Family Functioning


SDM® Reassessment Which Cases Decision

In-home Risk Reassessment

All children remain in the home or have been returned home

Remain open for services or not?

Intensity of services

Out-of-home Reunification Reassessment

Cases in which at least one child in out-of-home placement has a goal of reunification

Considering risk, access, and safety, can child be reunified with parent?

Which SDM® reassessment?


In-home Cases

RISK REASSESSMENT


Risk Reassessment

• What is the new risk level?

» Research-based items with strongest relationship to outcomes

» Assessment of progress

» New incidents

• Should case continue to receive services or be closed?

• If services continue, what level of services should be provided?


Foster Care

REUNIFICATION REASSESSMENT


Reunification Reassessment

• Reduce time to stable, long-term care arrangement

• Achieve reunification whenever it is safe to do so


New Foster Care Cases With a Return Home Goal:Achievement of Stable, Long-term Care Arrangement

15 Months After Entering Foster Care

SDM® Pilot Group SDM® Comparison Group 0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%67.8%

56.5%

Chart Title

Michigan Foster Care Evaluation, 2002

(N = 885) (N = 1,222)

Care Arrangement Outcomes


Reentry for Children Returned Home

Outstate Pilot Outstate Compar-ison

Wayne Private Pilot Wayne Private Comparison

0.0%

5.0%

10.0%

15.0%

7.2%

11.4%

4.6%

8.4%

Cases Returned Home Within the First 15 Months of Foster Care: Return to Foster Care in the 12 Months Subsequent to Their Return Home

Michigan Foster Care Evaluation Addendum, 2002

(N = 236) (N = 263) (N = 131)(N = 311)


Is risk low or moderate?

Is visitation adequate?

Is the child safe or conditionally

safe?

Reunify

Yes

Yes

Yes

No

No

No Should we continue reunification

services?

Should we pursue another long-term

care goal?

Reunification Reassessment


Building Toward the SDM® Model’s Goal

Completing the tools

Completing tools accurately, supported by narrative evidence

Using tools to guide decisions

Reduced harm


For more information, please contact:

Deirdre O’Connor, Senior ResearcherChildren’s Research Center

[email protected]

Documents

© 2010 by NCCD, All Rights Reserved 426 South Yellowstone Drive, Suite 250, Madison, WI 53719 Phone (608) 831-1180 / Fax (608) 831-6446