Program Goals/Program Theory
Structured Decision Making (SDM) is a case management system that provides objective and structured assessment tools and decision-making guidelines for child welfare agencies that handle cases of child abuse and neglect. The purpose of the model is to increase the level of consistency and validity of decisions through the use of evidence-based assessments, improve the decision-making process by introducing structure at critical decision points for a case and ensure that the limited resources available in the system are targeted to families with the highest likelihood of subsequent abuse or neglect of a child.
SDM operates under the theory that the systematic use of structured case assessment and decision-making procedures should improve the services delivered to children and families and ultimately produce better case outcomes. A fundamental principle of the SDM model is that an important first step in developing decision-making procedures is to break down large, complex decisions into their basic parts. The model provides caseworkers with different tools to use for each decision point, because there are different issues that are addressed at each stage of the case.
The SDM decision support system includes several components. One component is a series of tools that child welfare workers can use to assess families and organize a response at specific decision points in the case, from intake to reunification. When a child first enters the foster care system because of allegations of abuse or neglect, child welfare workers conduct a family risk assessment to determine parents’ strengths and needs in 12 areas of parent or family functioning (such as substance abuse and parenting skills) that are important to ensuring a child’s safety and well-being. The assessment helps caseworkers develop a treatment plan that builds on parents’ strengths while also addressing potential barriers to reunification in the parents’ functional areas. Caseworkers develop a similar treatment plan for children as well.
In addition to the initial assessment, caseworkers complete a three-part reunification assessment that evaluates the progress of the treatment plan at subsequent case reviews. The assessment involves an evaluation of the family’s current functioning and any progress made to reduce barriers to reunification, an evaluation of parental visitation based on the frequency and quality of contact with children, and a safety assessment of the family’s home. The safety assessment allows caseworkers to determine if there is any imminent threat to a child’s safety and well-being if they are returned to the parents’ home.
After completing the reunification assessment, workers consult a decision tree that provides structured guidelines about updating the treatment plan and case goals, based on the assessment findings and the length of time children have spent in placement. The decision tree incorporates a welfare agency’s policies regarding the use of the reunification assessment findings to make decisions about returning a child home or seeking another form of permanency.
SDM includes two management-related components as well. One component is a workload measurement and accounting system, which ensures an equitable workload among case workers based on their needs for workload demand. The other component is management information the uses various types of data (such as aggregate family assessment data and workload data) to assist managers in planning, monitoring, budgeting, and evaluation.
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Johnson and Wagner (2005) found that 15 months after entering foster care, children served by agencies in pilot counties that had implemented Structured Decision Making (SDM) achieved permanency rates at a significantly higher rate than children in the comparison counties (68.6 percent versus 61 percent). In addition, children in the pilot counties were more likely to be returned home, adopted, or placed for adoption than children in comparison counties.
Logistic regression confirmed the positive results. The odds ratio indicated that a child served by an agency in a pilot county during the follow-up period had a significantly greater likelihood of being in a permanent placement within 15 months of case opening than their comparison counterparts.
The authors did note, however, that the return-home rate among children in the pilot counties did not significantly change over time from the 18-month period before SDM was implemented to the 18-month period after implementation. In the preimplementation period, 28.4 percent of children in pilot counties were returned home, compared to 27.2 percent in the postimplementation period. For children in the comparison counties, the rate of being returned home actually decreased, from 33.6 percent to 23.3 percent, although the authors could not explain why this drop occurred.
Reentry After Reunification
Of the 214 children aged 14 years or younger who were returned home in the SDM counties, only 7.9 percent reentered foster care within 12 months. In the comparison counties, 10.7 percent of the 187 reunified children reentered placement, although the difference was not significant. Additional analysis using logistic regression showed that being served in the pilot counties did not significantly affect the likelihood of reentry. Children who were returned home in SDM counties were no more likely than children returned home in comparison counties to reenter foster care.