Safely Increasing Connection to Community-Based Services: A Study of Multi-Disciplinary Team Decision-Making for Child Welfare Referrals

Background/Purpose: Initial child welfare screening decisions determine whether or not a family will receive further intervention by child protective services. Traditionally, child welfare screening decisions are made by an individual caseworker in collaboration with a supervisor, and the focus is solely on risk and safety. However, a novel multi-disciplinary team approach is gaining traction; it emphasizes a more thorough assessment of needs and strengths, thereby leading to a more thoughtful response for families. The multi-disciplinary team is typically composed of 5-10 individuals from the child welfare agency, community-based organizations (CBOs), and specialty providers from fields such as domestic violence, mental health, and nursing. Together, they determine the best course of action for non-emergency referrals. Few studies have examined the effectiveness of this approach, however. This study examines outcomes in a sample of maltreatment-referred families randomized to the multi-disciplinary team decision-making approach versus the traditional screening approach. Compared to families assessed using the traditional method, we expected that families assessed by multi-disciplinary teams would be more likely to: (1) be referred to CBO services, (2) engage with CBO providers, and (3) have improved child safety outcomes.

Methods: In this study, conducted in collaboration with a public child welfare agency and local CBOs in a Western state, 159 child welfare referrals handled by multi-disciplinary teams (treatment group) were compared to 331 referrals handled via the traditional approach (comparison group). The study mimicked a randomized controlled trial: referrals logged on 2.5 days of the week were randomized to the treatment group, and referrals that were logged on the remaining days of the week were randomized to the comparison group. Administrative data from the child welfare agency and CBOs were utilized, and a series of chi-square, t-tests, and logistic regressions were conducted to answer the research questions. Additionally, a qualitative process evaluation was conducted to explore how the implementation of multi-disciplinary teams impacted agency operations.

Results: Logistic regression analyses indicated the treatment group was more than four times as likely as the control group to be referred to CBOs (OR=4.15, p<0.001) and twice as likely as the control group (OR=2.08, p<0.05) to receive a joint response meeting (wherein the child welfare worker meets with the referred family together with a CBO staff member). There were no significant differences between groups in families’ engagement with CBOs or child welfare outcomes (e.g., maltreatment re-referral). The process evaluation highlighted a potential shift toward greater trust and collaboration between CBOs and child welfare staff.

Conclusions and Implications: The multi-disciplinary team approach increased the likelihood of referral to CBOs and a joint response meeting, but overall it did not impact the proportion of families who engaged in services nor subsequent child welfare outcomes. Multi-disciplinary teams are a promising step in the initial process of connecting families to community-based services, and the child welfare agency where this research was conducted has used the knowledge from this study to improve collaboration with CBOs; however, additional work is needed to improve family engagement and effectively serve families in the community.