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© 2010 by NCCD, All Rights Reserved
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www.nccd-crc.org
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) SystemOverview
Presented by Deirdre O’Connor,Children's Research Center
Structured Decision Making® and SDM®
Registered in the U.S. Patent and Trademark Office
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SDM® Systems
• Comprehensive case management• Structured critical decision points• Research- and evidence-based assessments
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SDM® Systems
• Adult corrections• Juvenile justice• Child protection• Foster care placement support• Adult protection• Economic self-sufficiency (TANF)
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“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
Reduce subsequent negative event
CPS: harm to child JJ: delinquent act
StabilizeCPS: expedite permanency
JJ: functional behavior
Objectives
Structure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
Characteristics
Reliable
Valid
Equitable
Useful
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Reduce Subsequent Harm:Outcomes for All Cases in Study, 12-month Follow-up
Referrals Substantiations Placements Injuries0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
14.9%
5.2%3.4%
2.1%
20.4%
11.4%
5.7%
3.6%
SDM® System (N = 920) Comparison (N = 877)
Perc
enta
ge
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)
FY 93–94 FY 94–95 FY 95–96 FY 96–97 Average Dif-ference
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
40.2%
49.6% 49.7%45.9% 46.3%
60.6% 61.5%64.3% 62.9% 62.3%
CMC Group 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
2002 2003 2004 2005 2006 2007 20080
2
4
6
8
10
12
14
16
13.6 13.913.1
10.1
8.3 8.2 8.3
39% Decrease
Median Time to Reunification in Months
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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
ObjectivesStructure critical decision points
Increase consistency in decision making
Increase accuracy in decision making
Target resources to families most at risk
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1. Detention screening2. Risk classification/supervision levels 3. Strengths/needs for case planning 4. Disposition recommendations5. Reassessment of risk and needs6. Institutional placement decisions7. Release/transition decisions
SDM® Assessments: Graduated Sanctions for Juvenile Justice
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Response priority
Safety assessment
Initial risk assessment
Family strengths and needs assessment
Screening criteria
Risk reassessmentReunification reassessmentFamily strengths and needs reassessments
Inta
keIn
vesti
gatio
n/
Asse
ssm
ent
Is the child safe?
Is it child abuse/neglect (CA/N)?
How quickly do we need to respond?
What is the likelihood of future maltreatment?
What should the service plan focus on?
Ong
oing
Should the case remain open or be closed?
Structuring Critical Decisions in Child Protective Services
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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
Consistency (Reliability)
Research Fresno Washington0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
59.4%
14.1% 12.5%
26.6%
32.8% 37.5%
4 of 4 3 of 4
Agreement on Scores
Sample: Four independent ratings of 80 cases.Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
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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)
Research (N = 929) Fresno (N = 876) Washington (N = 908)0.0%
20.0%
40.0%
7.0%
15.0% 16.0%15.0%
18.0%16.0%
28.0%
18.0% 21.0%
Low
Moderate
High
18-month Substantiation Rates
Sample: Four independent ratings of 80 cases.Child Abuse and Neglect: Improving Consistency in Decision Making, 1997
(n = 138)
(n = 541)
(n = 250)
(n = 442)
(n = 304)
(n = 130)
(n = 202)
(n = 475)
(n = 231)
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Validity in Juvenile Justice:Recidivism by Risk Classification
Percentage of Youth With Subsequent Delinquent Adjudication Within 15 Months
Low Risk (n=181) Medium Risk (n=303) High Risk (n=282) Very High Risk (n=67)0%
10%
20%
30%
40%
50%
60%
70%
6%
25%
38%
63%
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State Commitment SampleWisconsin
Low Moderate High0%
10%
20%
30%
40%
50%
11%
19%
32%
18%
30%
47%
Subsequent Juvenile Felony and Non-felony Return RateOverall Juvenile Reinstitutionalization Rate
Risk Levels
Out
com
es
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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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Targeting Resources Reduces Risk
Low/Moderate High Very High0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
14.1%
27.7%
44.8%
14.6% 15.2%
23.6%
Re-referral Rates for Cases Opened vs. Closed After Investigation: A Two-year Follow-up
Closed (N = 1,014) Opened (N = 216)
Wisconsin Urban Caucus, 1998
(n = 562) (n = 48) (n = 347) (n = 79) (n = 105) (n = 89)
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CMC Research Results Revocation Rates:Milwaukee, Wisconsin
Intensive Supervision With CMC
N = 152
Intensive Supervision OnlyN = 123
Regular SupervisionN = 147
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
19.7%
24.4%
29.9%
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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.
Family
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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 assessmentimplementation statewide
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Louisiana SDM® Assessments
• Screening and response time assessment• Initial risk assessment• In-home risk reassessment• Reunification reassessment
Integrated into Focus on Four initiative
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SDM® Screening and Response Time Assessment
• Screen in or screen out
Screening Criteria
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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
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Elements of a Child Abuse and Neglect Report
• Currently a minor• Minor when alleged incident occurred and allegation
creates concern for another minor
Alleged victim
• 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
Alleged perpetrator
• 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
Abuse or neglect
• 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
Time limits
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INITIAL RISK ASSESSMENTIs 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
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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.
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Risk Level by Initial Safety Assessment
Safe
Conditionally Safe
Unsafe
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
60.4%
37.7%
1.9%
55.4%
39.3%
5.3%
34.7%
39.4%
25.9%
17.8%
30.8%
51.4%
Low Moderate High Very High
N = 69,567 2008 California Combined Report
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California Risk Study Results
Referrals Substantiations Injury Removal0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%18
.5%
7.7%
4.3%
1.4%
27.5
%
13.8
%
7.0%
6.5%
48.0
%
31.6
%
14.4
% 20.4
%
60.1
%
44.3
%
22.7
% 27.8
%
Low (n=352) Moderate (n=1,067) High (n=819) Very High (n=273)
N = 2,511 investigations conducted in 1995, followed for two years.California Risk Assessment Validation: A Retrospective Study, 1998
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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.
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Risk Level vs. Substantiation
Very Low Low Moderate High0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
2.0%
6.0%
22.0%
29.0%
2.0%
8.0%
19.0%
36.0%
Unsubstantiated
Substantiated
Re-substantiation Rate for Substantiated vs. Unsubstantiated Cases: 18-month Follow-up
(N = 110)
(N = 173)
(N = 360)
(N = 365)
(N = 146)
(N = 154)
(N = 58)
(N = 84)
N = 1,450 New Mexico, 1997
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*Moderate and low risk cases with unresolved safety issues should always be transferred for ongoing services.
Final Risk Level Recommended Decision
Very High Open for ongoing services
High Open for ongoing services
Moderate* Close
Low* Close
SDM® Case Open/Close Guidelines
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Ongoing Service Assessments
• In which areas does the family need help?• What strengths can the family draw upon?
Assessment of Family Functioning
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SDM® Reassessment Which Cases Decision
In-home Risk Reassessment
All children remain in the home or have been returned home
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?
Which SDM® reassessment?
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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?
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Reunification Reassessment
• Reduce time to stable, long-term care arrangement
• Achieve reunification whenever it is safe to do so
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New Foster Care Cases With a Return Home Goal:Achievement of Stable, Long-term Care Arrangement
15 Months After Entering Foster Care
SDM® Pilot Group SDM® Comparison Group 0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%67.8%
56.5%
Chart Title
Michigan Foster Care Evaluation, 2002
(N = 885) (N = 1,222)
Care Arrangement Outcomes
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Reentry for Children Returned Home
Outstate Pilot Outstate Compar-ison
Wayne Private Pilot Wayne Private Comparison
0.0%
5.0%
10.0%
15.0%
7.2%
11.4%
4.6%
8.4%
Cases Returned Home Within the First 15 Months of Foster Care: Return to Foster Care in the 12 Months Subsequent to Their Return Home
Michigan Foster Care Evaluation Addendum, 2002
(N = 236) (N = 263) (N = 131)(N = 311)
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Is risk low or moderate?
Is visitation adequate?
Is the child safe or conditionally
safe?
Reunify
Yes
Yes
Yes
No
No
No Should we continue reunification
services?
Should we pursue another long-term
care goal?
Reunification Reassessment
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Building Toward the SDM® Model’s Goal
Completing the tools
Completing tools accurately, supported by narrative evidence
Using tools to guide decisions
Reduced harm