Use of Standardized Decision Support Instruments to Inform Child Welfare Decision-Making

Background and Purpose

Children entering out-of-home care (OOHC) are at greater risk for significant trauma and resultant behavioral health challenges (Casaneuva et al., 2011). However, child welfare and behavioral health organizations can have issues related to information gathering and exchange that may inhibit integrating evidence-based practices into decision-making for youth OOHC (Humphries et al., 2014). Project SAFESPACE, initially a federal grant project which has been since been sustained statewide for five years, implemented processes designed to promote the use of evidence-based practices to inform decision-making through universal, standardized screening for trauma and behavioral health needs by child welfare workers for youth entering OOHC, standardized functional assessment and progress measurement by behavioral health providers, and use of these data to inform treatment selection and case planning. Data for the current study were collected in 2022 to assess the continued use of these practices to inform decision-making and ways processes can be improved.

Methods

Focus groups were conducted with a purposive sample of child welfare staff (n=49) and behavioral health clinicians (n=50) from each of the nine regions of the state. Researchers employed a semi-structured interview guide using a priori codes. Written transcripts (n=25 artifacts) were de-identified and analyzed using Dedoose software. To mitigate bias, three researchers met weekly to code and categorize data into themes within the responses to each of the interview guide questions. Themes were generated inductively and refined through iterative review and revision of coding. Memoing was used to document the decisions and changes made during the initial and subsequent coding processes. To demonstrate the extent to which specific themes were observed across multiple agencies, frequency counts were used to identify the number of times participants mentioned certain themes.

Results

Child welfare staff use results of screening and assessment in case planning and during supervision and consultation, while behavioral health clinicians incorporate these processes in treatment planning, clinical decision-making, and measuring client progress. While such use was observed, this was not universally observed across all participants and barriers were noted including professional beliefs about standardized instrumentation in clinical decision-making. Ways to improve the use of standardized screening and assessment instrumentation in decision-making include having an internal tracking system or identified staff to manage processes, training on the clinical use of standardized instrumentation, addressing contextual barriers such as use of standardized instruments with some children, and employing a multi-pronged approach in gathering screening and assessment information.

Conclusions and Implications

In these complex fields, organizations struggle with strategies for promoting evidence-informed decision-making within, and collaboratively with, other agencies. While results of this study are encouraging, despite having embedded standardized decision support for over a decade, use of these data as intended remains a challenge in some areas. The results of this study have implications for organizations seeking to reinforce data-informed practices in terms of strategies for addressing barriers on the worker and the agency level. Additional research is needed regarding how managers can establish infrastructure and cultural supports to promote the use of data to inform practice decisions.