The Relationship between Assessment and Prescribed Treatment for Child Welfare-Involved Youth with Identified Trauma, Behavior, or Substance Use Problems

Background:

Youth served by the child welfare system and placed in out-of-home care often have exposure to significant trauma and possess behavioral health needs impacting their wellbeing and stability. Once connected to needed treatment by the child welfare worker or caregiver, evidence-based practice (EBP) models recognize the importance of treatment decision-making being informed by data collected during a structured assessment, as well as clinical expertise and client values. However, despite the centrality of standardized assessment to EBP and its critical role in helping the practitioner identify relevant empirically supported interventions to meet youth’s needs, the subject has received minimal attention in the scholarly literature.

The purpose of this presentation is to explore the use of a structured decision-support tool to inform evidence-based treatment planning for youth served by the child welfare system. The presentation will report on the relationship between dimensions of trauma exposure, behavior problems, and substance use problems, and prescribed empirically-supported interventions (ESI).

Methods:

This cross-sectional study utilized secondary data from a statewide sample of youth in out-of-home care. Dimensions of trauma exposure, behavior problems, and substance use problems were derived from the Child and Adolescent Needs and Strengths assessment (CANS) completed by the clinician after referral for assessment by the child welfare worker. Treatment approaches were categorized into one of three dichotomous focus-of-treatment variables: trauma-focused, behavior-focused, and substance use-focused, allowing for a crosswalk between the CANS outcomes, and prescribed treatment. Bivariate ANOVA, chi-square tests and multivariate binary logistic regression models were employed.

Results:

Results suggest clinicians use information from the CANS decision-support tool to varying degrees when making treatment recommendations. For trauma-focused dimensions, Nagelkerke pseudo R square accounted for more than 27% of the variance in the prescription of a trauma-focused treatment. As the intensity of trauma-related problems increased, so did the odds of receiving an ESI intended to address trauma. The majority of the sample was prescribed a behavior-focused treatment while only a fraction was prescribed a substance-focused treatment. Nagelkerke pseudo R square accounted for less than 15 percent of the variance in the prescription of a behavior-focused or substance use-focused ESI. At the same time, as assessed emotional/behavior problems or substance use issues increased, the probability of being prescribed a related ESI also increased. Assessment data appears to be a minor, yet salient, factor in the decision-making process for these two treatment domains.

Conclusion:

Findings have training and supervision implications for child welfare and behavioral health providers, and can aid in understanding the characteristics and needs of the youth served. As treatment decision-making practices and processes used by clinicians are identified, they can serve as benchmarks for systemwide enhancement of assessment-driven, evidence-based treatment recommendations. Agencies that are prepared to provide a range of specialized, empirically supported interventions or offer empirically supported interventions may have better capacity for serving the child welfare population, suggesting the need for collaboration between the child welfare workforce and behavioral health clinicians to meet the needs of these youth through trauma-responsive interventions to promote placement stability, prosocial functioning and wellbeing.