The SDM Model

The SDM model consists of a set of assessment instruments augmented by management components that provide accountability, quality assurance, and planning, budgeting, and evaluation data. Each assessment tool is designed specifically for use at a key decision point in the life of a CPS case. By focusing on particular decision points rather than attempting to address multiple issues with a single tool, the SDM model enhances clarity and allows agencies to more effectively monitor compliance with established policies and procedures. Although SDM tools identify the critical assessment factors for each decision point, the model also includes ways to account for unique case characteristics that may not have been captured on the assessment instrument. Most SDM tools incorporate an override provision that allows workers to change the assessment-indicated decision, when necessary. SDM does not replace worker judgment; instead, it provides an objective framework within which to articulate agency policy, thereby helping ensure that “best practices” are applied to all cases.

The primary tools used in SDM sites are discussed below.

Response Priority Assessment

Most jurisdictions begin the SDM assessment processes after deciding to investigate a referral. At this point, a set of decision trees (see figure 3) guides caseworkers through key questions that allow them to determine how quickly to respond to the referral. For example, Cuyahoga County, OH, sorts all investigations into three groups: Priority 1 (those requiring a response within 1 hour), Priority 2 (response within 24 hours), and Priority 3 (response within 72 hours). Different decision trees are used to address different types of maltreatment (e.g., neglect, physical abuse, sexual abuse).

Figure 3: Response Priority Decision Tree: Physical Abuse Cases (Example) * If unable to determine the nature of prior investigated allegations, circle “yes.” Source: Children’s Research Center, 2001.

Figure 3 illustrates a response priority system for use in cases of alleged physical abuse. Under this system, the answer to each question directs the worker to the next question to be asked and, rather quickly, to a presumptive response level. Because of differences in State statutes and agency policy, response priority systems vary somewhat among jurisdictions. All systems, however, ensure that workers systematically apply certain key criteria to every case.

CRC researchers have assessed the effectiveness of response priority tools using SDM management data in California (Children’s Research Center, 2000). The research questions were whether and to what extent the child removal (i.e., out-of-home placement) rate was higher in cases that required an “immediate response” than the rate in cases that had been assigned a lower priority. Since the tools are designed to prioritize referrals based on the seriousness of the allegations, one would expect—if the tools are valid—to see a much higher rate of removal in the “immediate response” cases. The results provided strong support to the design of the response priority tools. They showed that over a 6-month period, the proportion of removals in the immediate response cases was four times higher than it was in the cases that were given lower priority (13 percent versus 3.2 percent).

Safety Assessment

When a CPS investigator first makes contact with a family, the worker must determine whether there are any immediate, pressing conditions that threaten the safety of the child. An SDM safety assessment generally consists of three parts. The first is a list of potential threats to children in the family—that is, conditions that would place a child in danger of immediate harm. Figure 4 shows an example of the first section of a safety assessment. The second section is an identification of the short-term interventions selected by the worker (e.g., monitoring by a neighbor or relative), which will constitute a safety plan, and the third is simply a record of the final decision.

Figure 4: Section 1: Safety Assessment (Example) Source: Children’s Research Center, 2001.

Safety assessments should be completed during a CPS investigator’s first face-to-face contact with the family. If safety issues are present, workers are directed to consider a series of potential in-home interventions, beginning with the least restrictive. If in-home interventions are unavailable, refused, or insufficient to mitigate identified safety issues, placement emerges as the only alternative. All protective placements are based on the determination that available in-home interventions would fail to offer adequate protection for the child.

Although safety assessments may be characterized as simple checklists, their value cannot be overstated. Simplicity is, in fact, key to successful implementation, because CPS investigators are required to make decisions within very limited timeframes. By allowing investigators to focus on a relatively small set of important factors, safety assessments help investigators avoid mistakes and improve consistency.

Like the response priority decision trees discussed earlier in this Bulletin, safety assessments help ensure that CPS staff assess all cases based on a standardized set of issues. Safety assessments also require that agencies have a safety plan whenever any safety factor (i.e., a condition that threatens immediate harm) has been identified, thereby adding accountability to the process.

Two studies conducted to date have identified a positive relationship between the safety-related issues typically incorporated in safety assessments and subsequent harm (Illinois Department of Children and Family Services, 1997; Wagner and Caskey, 1998). For example, researchers in Illinois used a pretest-posttest design to determine whether rates of child injuries that occur within 60 days of a CPS investigation declined after the Illinois Department of Child and Family Services began using its safety assessment. Compared with the period prior to implementation, use of the safety assessment appears to have reduced subsequent child injuries (Illinois Department of Children and Family Services, 1997).²

Risk Assessment

The heart of the SDM model is its research-based risk assessment tool. Although other components of the model are based on a general consensus (often informed by available research) of what constitutes best practice, SDM risk assessment tools are based on the outcomes of actual cases. To develop a risk assessment tool, CRC and agency staff jointly identify a list of potential risk factors. These potential factors are based on literature, experience, and previous CRC research results. CRC researchers then review a large sample of case records (e.g., 1,000) and code them for the presence or absence of the factors, based on what was known about each family at the time of the sampled investigation. Case records are further explored to identify families that experienced reinvolvement with the agency after the sampled investigation. The definition of “reinvolvement” generally includes subsequent CPS referrals, subsequent substantiations of maltreatment, subsequent child injuries, and subsequent CPS placements. The research process then examines the statistical relationship between case characteristics and case outcomes to identify the variables that are most closely associated with risk. The set of risk factors that most effectively divides families into three or four different risk groups constitutes the risk assessment tool. Figure 5 presents a risk assessment scale that is used in California.

Figure 5: California Family Risk Assessment Scale Source: Children’s Research Center, 1998a.

The test of any risk assessment tool is how well it classifies families based on their likelihood of subsequently maltreating their children. Families identified as “high risk,” for example, should be expected to have re-referral (and/or resubstantiation) rates that are significantly higher than those in families that the tool classifies as “low risk.” Figure 6 illustrates this principle using the results of the California risk scale. The data show a strong relationship between risk classification and outcomes. For example, after a 2-year followup period, the California families that were assessed as low risk had a resubstantiation rate of less than 8 percent. In contrast, among families classified as very high risk, the resubstantiation rate was 44 percent or more than five times the rate found for low-risk cases.

Figure 6: Subsequent Substantiation Rates by Risk Classification: California (2-Year Followup) Source: Children’s Research Center, 1998a.

The 11 risk assessment studies that CRC has completed to date lead to the following conclusions:

• A child’s risk of subsequent abuse and his or her risk of subsequent neglect are best approached as separate issues. Although some risk factors relate to both types of maltreatment (and, indeed, some families both abuse and neglect children), there are enough differences between the family characteristics and dynamics associated with abuse and those associated with neglect to warrant the use of separate scales to address each type of maltreatment.

• Risk instruments developed in one jurisdiction appear to transfer well to other locations. For example, the risk assessment instrument developed in Michigan has been shown to effectively classify families based on risk in California, Florida, and Missouri (Baird and Wagner, 2000), and a risk tool developed in Wisconsin has proved effective with a predominantly Hispanic population in Texas (Wood, 1997). Still, when an agency adopts another jurisdiction’s risk assessment instrument, it is critical that the agency routinely collect data to validate (and, if necessary, revise) the instrument within 2 years of implementation.

Prediction versus classification. The risk level assigned to a case is not a prediction that a family will or will not maltreat a child in the future. Instead, a risk level designation simply denotes a case’s inclusion in a group of families with relatively high or low historical rates of subsequent maltreatment. Accurate prediction in any field is difficult; prediction of human behavior is especially complex because many factors contribute to determining how individuals will act. Classification, on the other hand, is simply a systematic arrangement of clients into groups or categories according to established criteria. In the CPS context, classification is meant to assign cases to different risk categories based on observed outcome rates. Knowing that cases with certain similar characteristics have recidivism rates of 5 percent, 25 percent, or 50 percent helps social workers (and agencies) determine appropriate levels of intervention and allocate scarce resources in an effective manner.

Decisions affected by risk assessment. Agencies typically use risk assessment results to guide decisions about whether families should have their cases opened for ongoing CPS services (e.g., moderate and high risk) or not (e.g., low risk). For cases that are opened, risk results are also typically used to determine the level of intervention required. The link between risk levels and service standards is discussed in greater detail later in this Bulletin.

Agencies should rely primarily on safety assessment results, rather than the risk assessment, to make protective placement decisions. Even among very high-risk families, about half will not have another substantiated incident of maltreatment. A policy that required protective placement of all very high-risk children, therefore, would lead to overuse of such placements, resulting in a crushing demand on scarce resources and unduly increasing the number of children and families who must endure the emotional impact that such placement brings.

Family Strengths and Needs Assessments

For families receiving ongoing CPS services, staff must decide precisely what services to provide and what the case plan objectives are. A family strengths and needs assessment (FSNA) covers a comprehensive array of critical domains of family life that affect the care of children (e.g., substance abuse, parenting skills, domestic violence). Families are rated on each domain along a continuum from strength to severe need. Definitions for each item and rating level help reduce subjectivity in these assessments. Items are weighted so that once completed, the assessment can identify a family’s three most critical needs. Case plans, by policy, are to address those critical needs. With FSNAs, case plans are less likely to omit critical needs. Conversely, FSNAs help prevent case plans from including voluminous recommendations that are overwhelming for families.

More recent applications of the FSNA reflect the trend toward strength-based practice, requiring workers to identify a family’s greatest strengths. Even though the literature has promoted strength-based practice for some time, the philosophy is rarely applied in the field. Including strengths in the SDM model helps make the practice more routine.

In sum, FSNA instruments do the following:

• Ensure that all CPS workers consistently consider each family’s strengths and weaknesses in an objective format when assessing the family’s need for services.

• Provide workers and first-line supervisors an important case planning reference that eliminates long, disorganized case narratives and reduces paperwork.

• Provide a basis for monitoring whether appropriate service referrals are made.

• Through initial needs assessments followed by periodic reassessments, permit caseworkers and supervisors to easily evaluate change in family functioning and thus monitor the impact of services on the case.

• Provide management with profiles containing aggregate information on the issues that client families face. These profiles can be used to develop resources to meet client needs.

One purpose of the FSNA is to allow caseworkers to consistently identify critical concerns facing families. Services provided to enhance child safety should not vary based on which worker has been assigned to a case. To what extent do these tools, in fact, promote consistency in the assessment process? Reliability testing has demonstrated a relatively high rate of interrater reliability for most items on SDM strengths and needs assessment instruments. Research conducted in California (Children’s Research Center, 1998b) found that for caseworker assessments of whether a need existed, without regard to the severity of the need, most items had interrater reliability rates above 80 percent. For items that address some of the most critical issues facing CPS populations, such as substance abuse and mental health problems, rates of agreement were at or near 90 percent.

When the measure of agreement was based on workers’ scoring of “needs” exactly the same along a four-point continuum (from “strength” to “severe need”), rates of agreement declined to some degree but remained high for key issues such as substance abuse (85 percent agreement), family relationships (70 percent), domestic violence (69 percent), and parenting skills (64 percent).

Risk and Needs Reassessment

Initial assessments of a family’s risk level and service needs are followed by routine reassessments, conducted at established intervals (generally every 90 days) for as long as the case is open. Reassessment ensures that any potential changes in the family’s risk level or service needs will be considered in subsequent stages of the service delivery process and that case decisions will be made accordingly. Case progress determines whether a lower or higher level of service is needed or whether the case can be closed. In most agencies, risk and needs assessment and reassessment instruments have become formal case planning documents and thus reduce the need for long case narratives and other paperwork.

Periodic reassessment also allows agencies to monitor important case outcomes on an ongoing basis. Such outcomes include new abuse or neglect incidents, changes in out-of-home placement status of children in the family, changes in a family’s service utilization pattern, and changes in the severity of identified needs. In short, reassessing each family at fixed intervals provides direct service workers and their supervisors with an efficient mechanism for collecting and evaluating information necessary to effectively manage their cases.

Risk-Based Service Standards

Not all families that have been referred to CPS for child abuse or neglect require the same level of child welfare services. Yet, in terms of case assignment and resource allocation, many child welfare agencies treat all cases the same. Hence, agencies sometimes provide services to families that may not need them and at the same time fail to provide other, higher risk families with the resources needed to adequately protect children.

Risk assessment provides CPS agencies an objective framework within which to make service decisions. It also allows them to allocate service resources more efficiently. A primary mechanism for focusing resources is the use of differential service standards, under which the mandated frequency of caseworker-family contact is tied to the family’s level of risk. Low-risk families do not need the same amount of agency resources (i.e., case-worker time) as high-risk families because the former are much less likely to maltreat their children again. When an agency establishes and uses differential service standards based on risk, existing service resources can reach farther and better results are possible. Figure 7 shows how the Michigan Family Service Agency has defined and differentiated service standards by risk level. Many other agencies have implemented similar standards.

Figure 7: Michigan Contact Standards for CPS Workers by Risk Level * Families Together Building Solutions. Source: Michigan Family Independence Agency, 1996.

SDM for Children in Out-of-Home Care

CRC also has applied the principles of standardized assessment and structured decision making to families that have children in foster care. SDM’s foster care component is designed to ensure that State and Federal policies regarding reunification of families, permanency planning for children, and termination of parental rights are translated effectively into practice. To this end, the SDM model’s presumptive guidelines for children in foster care are based on children’s risk of future maltreatment, the safety of the home environment, and demonstrated parental interest and involvement in the lives of their children. The SDM foster care guidelines are a “best practice” tool that will facilitate implementation of new Federal legislation while leading to more consistent and appropriate decision making. Although every agency needs to modify this component of the SDM model to include its own assessment instruments, policies, and terminology, the overall logic of the component is universally applicable.

SDM guidelines governing children in out-of-home care are based on the following assumptions:

• When a family reduces risk to an acceptable level and maintains appropriate visitation with a child, the child should be returned home if the home is judged to be safe.

• When risk remains high, the home remains unsafe, or parents fail to meet their visitation responsibilities for a specified period (as set by Federal guidelines and/or agency policy), the goal for the case changes from returning the child home to developing another plan for permanency.

In SDM’s foster care model, the initial risk level is established by using the research-based risk assessment instrument. The risk reassessment will reflect a reduced level of risk if the family has made significant progress toward treatment goals. However, the reassessment scoring system generally precludes a family from receiving a lower risk score if there has been any new substantiation of maltreatment of any child in the household since the previous assessment.

The reunification model consists of four assessment components:

• A structured risk reassessment.

• A structured evaluation of parental compliance with visitation schedules.

• A reunification safety assessment.

• Structured guidelines for changing the permanency planning goal.

As shown in figure 8 (presented as an example), results of the structured assessments (risk, visitation compliance, and safety) are considered jointly to guide decisions regarding a child’s return to the home or changes in the permanency plan. In practice, CRC staff work with each agency to develop a protocol incorporating criteria that reflect key local policies and regulations.

Figure 8: Placement/Permanency Plan Guidelines (Example) * Agency policy will determine number of assessments conducted before a change in the permanency plan is indicated. Source: Children’s Research Center, 2001.

Summary

The heart of SDM is a series of assessment tools and associated decision-making protocols that are designed to bring greater structure, objectivity, and consistency to child welfare practices. The model is also designed to assist agencies in systematically identifying the most problematic cases—and focusing resources on those families—in an effort to reduce the incidence of subsequent maltreatment. SDM assessment tools incorporate four qualities that are essential to improved decision making in child welfare: reliability, validity, equity, and utility. Reliability reduces the extent to which decisions vary simply because different workers bring different perspectives to CPS decision making. Validity helps ensure the accuracy of the decision-making process. Equity ensures that families are treated fairly, regardless of race or ethnicity. Finally, the tools must be useful both for workers making day-to-day decisions and, through the aggregate data generated by the system, for administrators making policy, program, and budget decisions. The utility of SDM for child welfare management practices is discussed in the following section.

Preventing Delinquency Through Improved Child Protection Services	Juvenile Justice Bulletin • July 2001