How Do We Decide When to Open a Child Welfare Case?
Since joining the NCCD Children’s Research Center (CRC), I have been a trainer, coach, and consultant for social workers and child welfare agencies. However, before I came to CRC, I spent close to 20 years working with children, youth, and families in a variety of direct-service settings. I worked in clinics as a family therapist, in emergency room settings as a crisis counselor and evaluator, and in a foster care setting as supervisor of a child welfare team. My favorite direct-service job, though, was being a member of a home-based outreach team working with families involved in the child welfare system.
There is something special about reaching out and meeting with families in their own homes. It can be hard, and families are often understandably angry and scared when a child welfare professional first begins working with them. With effort, heart, and skill, however, a legitimate and authentic working relationship can be built, and families can begin to experience their connections with child welfare professionals as helpful and supportive.
This work is delicate. Family members are essentially letting you into their home, into their stories, and into their lives. I always saw this as an honor—one that needed to be handled with the utmost respect and care.
I remember a particular family I worked with. There were two parents and five children, ranging in age from 6 to 16 years old. The father held down two security guard jobs and was caring but often distracted; he had difficulty consistently meeting the basic needs of his family. The mother struggled with mental illness and frequently lived on the street and away from her family. When she took her medication regularly she was wonderful with her children, but she hated how her medication made her feel, and I think she chose to be away from her children rather than scare them when she wasn't stable. Both parents adored their kids, and while there were no immediate dangers to the children, there were long stretches when difficulties in the household took hold: Food was hard to come by, getting the children to school regularly was difficult, and the house became highly cluttered and chaotic.
In one of these moments the family was referred to the local child welfare department, which was how I came to meet with them at their home. I remember feeling nervous, wondering: Would they want me there? Would they be angry? Could I be helpful? I remember our first difficult conversations when I tried to introduce myself, the team I worked with, and the ways we tried to work with families. During many visits, I simply tried to learn more information about what they wanted, what they believed would make a difference, and what was getting in their way. Both parents slowly began letting me know what they thought would help, and I did my best to let them know what I thought we could do that would help. We slowly started developing a collaborative plan together.
Still, there were many times my team and I wondered whether we should be involved with this family at all. Was involvement with the child welfare system really the best way for them to get what they needed? I knew the parents were beginning to see me and my team as allies and didn’t want us to go away, but I didn’t always know if we were the right people and if we were giving them the kind of help they needed.
The Structured Decision Making® (SDM) risk assessment is designed to aid workers like me in moments like these. The risk assessment is often considered the cornerstone of the SDM® system. It has been built and refined over the last 25 years at NCCD and painstakingly developed by researchers, program staff, and NCCD’s partners in child welfare agencies around the world. There is a legacy of critical thinking, deliberation, and rigor involved in developing this assessment that continues to be built upon today.
The SDM risk assessment is an actuarial risk assessment. It was created through studying large data sets from child welfare work and asking: What characteristics are most present in families’ lives when there are ongoing difficulties? These characteristics, or “risk factors,” are then grouped together in the assessment to help child welfare workers, supervisors, and ultimately families determine whether ongoing help by a child welfare agency could be useful.
The risk assessment is not a crystal ball, but it does help everyone understand the likelihood that a particular family is going to continue to need assistance to keep children safe, promote their well-being, and prevent future child abuse and/or neglect. A family with many of the risk factors identified on the risk assessment is likely to be classified as high risk. Families with few of these risk factors will be classified as low risk. In this way, the SDM risk assessment functions similarly to risk assessments used in the medical field for problems such as heart disease or cancer. Just like the SDM risk assessment, these medical risk assessments use characteristics (shown by research) that identify individuals most likely to struggle with difficulties in the future and who would benefit from assistance or behavioral changes now.
The SDM risk assessment can help in situations like the kind I was in with this family—where there is no immediate danger for the children, but where a decision needs to be made about the potential benefit of a meaningful, ongoing child welfare intervention. It also can help provide a baseline that helps workers and families see when progress is made.
In this case, we determined that ongoing help was needed, and we continued to work with this family for some time. It wasn’t always easy. Both parents struggled. They also both loved their children tremendously and made progress over time. The mother found a psychiatrist she had more faith in and began to take her medication more regularly. The father became better aware of his children’s needs and how to respond to them. Even today, I remember both of these parents and how courageously they opened their door to a stranger to work together to make things better for their children.
Phil Decter is director of the NCCD Children’s Research Center