Transcript Structured Decision Making

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) System
Overview
Presented by Deirdre O’Connor,
Children's Research Center
Structured Decision Making® and SDM®
Registered in the U.S. Patent and Trademark Office
426 South Yellowstone Drive, Suite 250, Madison, WI 53719
Phone (608) 831-1180 / Fax (608) 831-6446
www.nccd-crc.org
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SDM® Systems
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Comprehensive case management
Structured critical decision points
Research- and evidence-based assessments
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SDM® Systems
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Adult corrections
Juvenile justice
Child protection
Foster care placement support
Adult protection
Economic self-sufficiency (TANF)
© 2010 by NCCD, All Rights Reserved
“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
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SDM® Systems
Goals
Objectives
Characteristics
Reduce subsequent
negative event
Structure critical
decision points
Reliable
JJ: delinquent act
Increase consistency in
decision making
Valid
Stabilize
Increase accuracy in
decision making
Equitable
Target resources to
families most at risk
Useful
CPS: harm to child
CPS: expedite
permanency
JJ: functional behavior
© 2010 by NCCD, All Rights Reserved
Reduce Subsequent Harm:
Outcomes for All Cases in Study, 12-month Follow-up
25.0%
20.4%
20.0%
Percentage
15.0%
14.9%
11.4%
10.0%
5.7%
5.2%
5.0%
3.4%
2.1%
3.6%
0.0%
Referrals
Substantiations
SDM® System (N = 920)
Placements
Injuries
Comparison (N = 877)
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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CMC Evaluation Results From Florida Revocation
Rates, Community Control Admissions (N = 45,346)
70.0%
64.3%
61.5%
60.6%
62.9%
62.3%
60.0%
40.0%
49.7%
49.6%
50.0%
45.9%
46.3%
40.2%
30.0%
20.0%
10.0%
0.0%
FY 93–94
FY 94–95
CMC Group
FY 95–96
FY 96–97
Average
Difference
Non-CMC Group
Florida Department of Corrections Research and Data Analysis: Leininger, “Effectiveness of Client Management
Classification,” December 1998
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Expedite Permanency:
Recent Research in Los Angeles County
Median Time to Reunification in Months
16
14
13.6
13.9
13.1
39% Decrease
12
10.1
10
8
8.3
8.2
8.3
2006
2007
2008
6
4
2
0
2002
2003
2004
2005
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Improve Decision Making
All information
Information
learned
Information
needed for
decision at hand
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A Bit More About SDM® Objectives
Objectives
Structure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
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Structuring Critical Decisions in Juvenile Justice
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SDM® Assessments:
Graduated Sanctions for Juvenile Justice
1.
2.
3.
4.
5.
6.
7.
Detention screening
Risk classification/supervision levels
Strengths/needs for case planning
Disposition recommendations
Reassessment of risk and needs
Institutional placement decisions
Release/transition decisions
© 2010 by NCCD, All Rights Reserved
Ongoing
Investigation/
Assessment
Intake
Structuring Critical Decisions
in Child Protective Services
Is it child abuse/neglect (CA/N)?
Screening criteria
How quickly do we need to
respond?
Response priority
Is the child safe?
Safety assessment
What is the likelihood of future
maltreatment?
Initial risk assessment
What should the service plan
focus on?
Family strengths and needs assessment
Should the case remain open or
be closed?
Risk reassessment
Reunification reassessment
Family strengths and needs reassessments
© 2010 by NCCD, All Rights Reserved
A Bit More About SDM® Objectives
Objectives
Structure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
© 2010 by NCCD, All Rights Reserved
Consistency (Reliability)
Agreement on Scores
100.0%
80.0%
26.6%
60.0%
40.0%
59.4%
32.8%
37.5%
14.1%
12.5%
Fresno
Washington
20.0%
0.0%
Research
4 of 4
Sample: Four independent ratings of 80 cases.
Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
3 of 4
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A Bit More About SDM® Objectives
Objectives
Structure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
© 2010 by NCCD, All Rights Reserved
Accuracy (Validity)
18-month Substantiation Rates
40.0%
28.0%
21.0%
18.0% 18.0%
20.0%
15.0%
16.0%
15.0%
16.0%
7.0%
0.0%
Research (N = 929)
Fresno (N = 876)
Washington (N = 908)
Low
(n = 138)
(n = 442)
(n = 202)
Moderate
(n = 541)
(n = 304)
(n = 475)
High
(n = 250)
(n = 130)
(n = 231)
Sample: Four independent ratings of 80 cases.
Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
© 2010 by NCCD, All Rights Reserved
Validity in Juvenile Justice:
Recidivism by Risk Classification
Percentage of Youth With Subsequent Delinquent Adjudication
Within 15 Months
70%
63%
60%
50%
38%
40%
30%
25%
20%
10%
6%
0%
Low Risk (n=181)
Medium Risk (n=303)
High Risk (n=282)
Very High Risk (n=67)
© 2010 by NCCD, All Rights Reserved
State Commitment Sample
Wisconsin
50%
47%
40%
30%
Outcomes
30%
18%
20%
32%
19%
11%
10%
0%
Low
Moderate
High
Risk Levels
Subsequent Juvenile Felony and Non-felony Return Rate
Overall Juvenile Reinstitutionalization Rate
© 2010 by NCCD, All Rights Reserved
A Bit More About SDM® Objectives
Objectives
Structure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
© 2010 by NCCD, All Rights Reserved
Targeting Resources Reduces Risk
Re-referral Rates for Cases Opened vs. Closed After Investigation:
A Two-year Follow-up
50.0%
44.8%
40.0%
27.7%
30.0%
23.6%
20.0%
14.1%
14.6%
(n = 562)
(n = 48)
15.2%
10.0%
0.0%
Low/Moderate
(n = 347)
(n = 105)
High
Closed (N = 1,014)
Wisconsin Urban Caucus, 1998
(n = 79)
(n = 89)
Very High
Opened (N = 216)
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CMC Research Results Revocation Rates:
Milwaukee, Wisconsin
35.0%
29.9%
30.0%
24.4%
25.0%
20.0%
19.7%
15.0%
10.0%
5.0%
0.0%
Intensive Supervision With CMC
N = 152
Intensive Supervision Only
N = 123
Regular Supervision
N = 147
© 2010 by NCCD, All Rights Reserved
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.
Research
Experience
Family
Structured
Tools
• Should be integrated
within the context of
solution-focused, familycentered practice.
Clinical
Judgment
© 2010 by NCCD, All Rights Reserved
SDM® Implementation in Louisiana
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Fall 2007
OCS workgroups modified:
» SDM initial risk assessment
» In-home risk reassessment
» Out-of-home reunification reassessment
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January 2008
Training for OCS supervisors and trainers
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July 2008
All parish offices trained and using SDM assessments
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August 2009
Initial risk assessment integrated into ACESS,
completed on all investigations
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January 2010
Screening and response time assessment field-tested
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June 2010
Screening and response time assessment
implementation statewide
© 2010 by NCCD, All Rights Reserved
Louisiana SDM® Assessments
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Screening and response time assessment
Initial risk assessment
Integrated into
In-home risk reassessment
Focus on Four
Reunification reassessment
initiative
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SCREENING AND RESPONSE TIME
ASSESSMENT
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SDM® Screening and Response Time Assessment
•Screen in or
screen out
Screening
Criteria
Response
Time
•How
quickly to
go out?
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Screening and Response Time Assessment
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Structuring decision to improve consistency
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No change in statutes or policy
» Elements of child abuse or neglect report
» Specific allegations
» Response times
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Change in documentation
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Change in decision-making process
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Expected increase in alternative response assessments
© 2010 by NCCD, All Rights Reserved
Elements of a Child Abuse and Neglect Report
Alleged
victim
Alleged
perpetrator
Abuse or
neglect
Time limits
• Currently a minor
• Minor when alleged incident occurred and allegation creates concern
for another minor
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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
• 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
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•
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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
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INITIAL RISK ASSESSMENT
Is this a family that needs ongoing support/intervention?
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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
© 2010 by NCCD, All Rights Reserved
Actuarial Risk Assessment
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A statistical procedure for estimating the probability that a
“critical” event will occur.
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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.
© 2010 by NCCD, All Rights Reserved
Risk Level by Initial Safety Assessment
1.9%
Unsafe
5.3%
Conditionally Safe
37.7%
Safe
0.0%
25.9%
51.4%
39.3%
60.4%
39.4%
55.4%
30.8%
34.7%
17.8%
10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
Low
Moderate
High
Very High
N = 69,567
2008 California Combined Report
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California Risk Study Results
60.1%
70.0%
27.8%
6.5%
1.4%
20.4%
22.7%
7.0%
4.3%
10.0%
13.8%
7.7%
20.0%
18.5%
30.0%
27.5%
40.0%
14.4%
31.6%
50.0%
44.3%
48.0%
60.0%
0.0%
Referrals
Low (n=352)
Substantiations
Injury
Moderate (n=1,067)
High (n=819)
Removal
Very High (n=273)
N = 2,511 investigations conducted in 1995, followed for two years.
California Risk Assessment Validation: A Retrospective Study, 1998
© 2010 by NCCD, All Rights Reserved
Informing Decisions and Targeting Resources
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Risk classifies families by likelihood of subsequent
abuse/neglect.
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High and very high risk families are significantly more likely to
experience subsequent maltreatment.
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Using risk to decide whether to provide services, and the
intensity of services, can reduce repeat maltreatment.
© 2010 by NCCD, All Rights Reserved
Risk Level vs. Substantiation
Re-substantiation Rate for Substantiated vs. Unsubstantiated Cases:
18-month Follow-up
40.0%
36.0%
35.0%
29.0%
30.0%
25.0%
22.0%
19.0%
20.0%
15.0%
10.0%
5.0%
6.0%
2.0%
8.0%
2.0%
0.0%
Very Low
Low
Moderate
High
Unsubstantiated
(N = 110)
(N = 360)
(N = 146)
(N = 58)
Substantiated
(N = 173)
(N = 365)
(N = 154)
(N = 84)
N = 1,450
New Mexico, 1997
© 2010 by NCCD, All Rights Reserved
SDM® Case Open/Close Guidelines
Final Risk Level
Recommended Decision
Very High
Open for ongoing services
High
Open for ongoing services
Moderate*
Close
Low*
Close
*Moderate and low risk cases with unresolved safety issues should always be transferred
for ongoing services.
© 2010 by NCCD, All Rights Reserved
Ongoing Service Assessments
Case Plan
• In which areas does the
family need help?
• What strengths can the
family draw upon?
• Should the case remain
open or be closed?
• What is the family trying
to achieve?
• Can children be returned
to the removal home?
• What services will help
them get there?
Assessment of Family
Functioning
Risk Reassessment
OR
Reunification Reassessment
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Which SDM® reassessment?
SDM® Reassessment
In-home Risk
Reassessment
Which Cases
All children remain in the
home or have been returned
home
Decision
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?
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In-home Cases
RISK REASSESSMENT
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Risk Reassessment
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What is the new risk level?
» Research-based items with strongest relationship to
outcomes
» Assessment of progress
» New incidents
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Should case continue to receive services or be closed?
•
If services continue, what level of services should be
provided?
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Foster Care
REUNIFICATION REASSESSMENT
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Reunification Reassessment
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Reduce time to stable, long-term care arrangement
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Achieve reunification whenever it is safe to do so
© 2010 by NCCD, All Rights Reserved
Care Arrangement Outcomes
New Foster Care Cases With a Return Home Goal:
Achievement of Stable, Long-term Care Arrangement
15 Months After Entering Foster Care
80.0%
70.0%
67.8%
56.5%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
SDM® Pilot Group
(N = 885)
Michigan Foster Care Evaluation, 2002
SDM® Comparison Group
(N = 1,222)
© 2010 by NCCD, All Rights Reserved
Reentry for Children Returned Home
Cases Returned Home Within the First 15 Months of Foster Care: Return to
Foster Care in the 12 Months Subsequent to Their Return Home
15.0%
11.4%
10.0%
8.4%
7.2%
4.6%
5.0%
0.0%
Outstate Pilot
(N = 236)
Outstate Comparison Wayne Private Pilot
(N = 263)
(N = 131)
Wayne Private
Comparison
(N = 311)
Michigan Foster Care Evaluation Addendum, 2002
© 2010 by NCCD, All Rights Reserved
Reunification Reassessment
Is risk low or
moderate?
No
Yes
Is visitation
adequate?
No
Yes
No
Is the child safe
or conditionally
safe?
Should we continue
reunification
services?
Should we pursue
another long-term
care goal?
Yes
Reunify
© 2010 by NCCD, All Rights Reserved
Building Toward the SDM® Model’s Goal
Completing
tools
accurately,
supported by
Completing narrative
the tools
evidence
Using tools
to guide
decisions
Reduced
harm
© 2010 by NCCD, All Rights Reserved
For more information, please contact:
Deirdre O’Connor, Senior Researcher
Children’s Research Center
[email protected]
© 2010 by NCCD, All Rights Reserved