Structured Decision Making® (SDM) SystemOverviewPresented by Deirdre O’Connor,Children's Research CenterStructured 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
Reduce Subsequent Harm:Outcomes for All Cases in Study, 12-month Follow-up 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) Florida Department of Corrections Research and Data Analysis: Leininger, “Effectiveness of Client Management Classification,” December 1998
Expedite Permanency:Recent Research in Los Angeles County Median Time to Reunification in Months 39% Decrease
Improve Decision Making All information Information learned Information needed for decision at hand
SDM® Assessments: Graduated Sanctions for Juvenile Justice • Detention screening • Risk classification/supervision levels • Strengths/needs for case planning • Disposition recommendations • Reassessment of risk and needs • Institutional placement decisions • Release/transition decisions
Structuring Critical Decisions in Child Protective Services Is it child abuse/neglect (CA/N)? Screening criteria Intake How quickly do we need to respond? Response priority Is the child safe? Safety assessment What is the likelihood of future maltreatment? Investigation/ Assessment Initial risk assessment What should the service plan focus on? Family strengths and needs assessment Risk reassessment Reunification reassessment Family strengths and needs reassessments Should the case remain open or be closed? Ongoing
Consistency (Reliability) Sample: Four independent ratings of 80 cases. Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
Accuracy (Validity) (n = 138) (n = 442) (n = 202) (n = 475) (n = 304) (n = 541) (n = 231) (n = 130) (n = 250) Sample: Four independent ratings of 80 cases. Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
Validity in Juvenile Justice:Recidivism by Risk Classification Percentage of Youth With Subsequent Delinquent Adjudication Within 15 Months
Targeting Resources Reduces Risk (n = 562) (n = 347) (n = 79) (n = 105) (n = 89) (n = 48) Wisconsin Urban Caucus, 1998
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.
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 assessment implementation 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 • 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
Initial Risk Assessment Is this a family that needs ongoing support/intervention?
Definitions of Key Terms in the SDM® Model:Different Decision Points
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 N = 69,567 2008 California Combined Report
California Risk Study Results 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 (N = 110) (N = 360) (N = 146) (N = 58) (N = 84) (N = 173) (N = 365) (N = 154) N = 1,450 New Mexico, 1997
SDM® Case Open/Close Guidelines *Moderate and low risk cases with unresolved safety issues should always be transferred for ongoing services.
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 Arrangement15 Months After Entering Foster Care Care Arrangement Outcomes (N = 885) (N = 1,222) Michigan Foster Care Evaluation, 2002
Reentry for Children Returned Home (N = 263) (N = 236) (N = 131) (N = 311) Michigan Foster Care Evaluation Addendum, 2002
Reunification Reassessment Is risk low or moderate? Should we continue reunification services? Should we pursue another long-term care goal? No Yes Is visitation adequate? No Yes No Is the child safe or conditionally safe? Yes Reunify
For more information, please contact: Deirdre O’Connor, Senior Researcher Children’s Research Center firstname.lastname@example.org