Ongoing Efforts to Develop the Evidence-Base of Team Decisionmaking

Background and Purpose: Team Decisionmaking (TDM) includes a meeting of community representatives, family members, and social workers who review every decision to remove a child from her parents in response to safety concerns or any change of placement including reunification or adoption (Crampton, Usher, Wildfire, Webster, & Cuccaro-Alamin, 2011).  Using specified strategies and skillfully facilitated group process, TDM aims to effectively involve families and their natural support systems in proposing recommendations for youth placement decisions.  TDM has been implemented by child protective agencies in 60 cities across 18 states in the last decade (Crea, Wildfire, & Usher, 2009).  Where TDM has been evaluated, it has shown promising associations with reunification and placement with relatives (Crampton et al., 2011).  However, we know little about what happens in the meetings themselves or what are the characteristics of effective meetings.  Our research program seeks to build on existing research to measure inside the meeting practices for purposes of developing the evidence base of TDM.

 Methods: Research assistants secured permission from TDM meeting participants to audiotape the meetings and then asked the participants to complete questionnaires when the meeting is over.  Analysis compares the questionnaire responses to each other and to the audiotape.  395 questionnaires were completed from 101 meetings and 52 meetings were recorded.

We measured the presence and extent of 24 TDM prescribed practices (e.g. review safety concerns, establish ground rules, record meeting using a visual tool, assign specific tasks to team members) and 8 desirable facilitator practices (e.g. encourage team to listen to each other, acknowledge feelings, maintain focus on placement decision).  We have also analyzed how these meeting characteristics correlate with the previous TDM measures of attendance and short-term outcomes.

Results: We identified elements that are frequently present (brainstorming solutions) and those that are less common (developing back up plans). Most prescribed practices occur consistently across meetings, but a few practices are occurring infrequently.

Conclusions and Implications: The study points to some critical lessons about TDM practice.  For example, we knew anecdotally that some facilitators follow the agenda closely and others do not.  This study describes this variability.  The TDM processes data provides some preliminary findings about whether it is necessary to follow the script in order to achieve process goals like team members being asked for their input. The data can inform key policies such as the necessity of assigning one facilitator per family, across multiple meetings.  When a lot of meeting time is spent on the details of the case, then the need for the team and facilitator to already be familiar with the case becomes more acute. No other study of TDM or any other family meeting practice has ever attempted to measure these meeting elements, or to systematically collect observational data on the adherence to prescribed elements.  This study represents an important step forward in the development of the tools and methodologies needed to more fully evaluate these promising practices.