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Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study

Abstract

After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed.

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Acknowledgments

This study was funded by the Illinois Department of Children and Family Services (IDCFS). The authors would like to give special thanks to the Child and Youth Investment Teams (CAYIT), especially Teddy Savas and Lee Annes, for their invaluable insight and input.

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Correspondence to Ka Ho Brian Chor.

Appendix: Child and Adolescent Needs and Strengths (CANS) Algorithm—placement criteria for residential treatment, group home, specialized foster care, and foster care

Appendix: Child and Adolescent Needs and Strengths (CANS) Algorithm—placement criteria for residential treatment, group home, specialized foster care, and foster care

4. Residential treatment center (RTC) criteria

4.1 At least two or more ‘3’ among the following needs

CANS subject CANS 1.0 question # CANS 2.0 question #
Adjustment to trauma 14 14
Psychosis 46 48
Attention deficit/impulse 47 49
Depression 48 50
Anxiety 49 51
Oppositional behavior 50 52
Conduct 51 53
Substance use 52 54
Attachment 53 55
Eating disturbance 54 56
Affect dysregulation 55 57
Behavioral regression 56 58
Somatization 57 59
Anger control 58 60

4.2 Three or more ‘2’ among the following needs

CANS subject CANS 1.0 question # CANS 2.0 question #
Adjustment to trauma 14 14
Psychosis 46 48
Attention deficit/impulse 47 49
Depression 48 50
Anxiety 49 51
Oppositional Behavior 50 52
Conduct 51 53
Substance use 52 54
Attachment 53 55
Eating disturbance 54 56
Affect dysregulation 55 57
Behavioral regression 56 58
Somatization 57 59
Anger control 58 60

4.3 A rating of ‘2’ or ‘3’ on Developmental (32-intellectual/developmental) (CANS 2.0–34).

4.4 At least one ‘3’ among the following risk behaviors.

CANS Subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Delinquency 65 67
Fire setting 67 69

4.5 Three or more ‘2’ among the following risk behaviors.

CANS Subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Runaway 64 66
Delinquency 65 67
Judgment 66 68
Fire setting 67 69
Social behavior 68 70
Sexually reactive behavior 69 71

Referral to a Residential Treatment Center is indicated by a CANS that satisfies the following criteria matching rules:

Rule 1: (4.1 = TRUE OR 4.2 = TRUE OR 4.3 = TRUE) AND (4.4 = TRUE OR 4.5 = TRUE)

Rule 2: Consider a specialty program if

CANS 1.0 CANS 2.0
4.3 OR
(CANS 63 (Sexual Aggression) OR
CANS 36 (Medical) OR
CANS 37 (Physical) OR
CANS 65 (Delinquency) = 2 or 3)
4.3 OR
(CANS 65 (Sexual Aggression) OR
CANS 37 (Medical) OR
CANS 38 (Physical) OR
CANS 67 (Delinquency) = 2 or 3)

3. Group home/treatment group home (GRH/IGH) criteria

A. Child is less than 12 years old.

3a.0 Child is less than 12 years old.

3a.1 At least one or more ‘3’ or two or more ‘2’ among the following needs.

CANS Subject CANS 1.0 question # CANS 2.0 question #
Adjustment to Trauma 14 14
Psychosis 46 48
Attention deficit/impulse 47 49
Depression 48 50
Anxiety 49 51
Oppositional behavior 50 52
Conduct 51 53
Substance use 52 54
Attachment 53 55
Eating disturbance 54 56
Affect dysregulation 55 57
Behavioral regression 56 58
Anger control 58 60

3a.2 A rating of at least ‘2’ on Developmental (32—Developmental/Intellectual)

(CANS 2.0–34)

3a.3 One ‘3’ among the following risk behaviors

CANS Subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Delinquency 65 67
Fire setting 67 69

3a.4 Two or more ‘2’ among the following risk behaviors

CANS Subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Runaway 64 66
Delinquency 65 67
Fire setting 67 68

Group Home Referral rule:

Rule A1: 3a.0 AND (3a.1 OR 3a.2) AND (3a.3 OR 3a.4)

Rule A2: Consider specialty program if

CANS 1.0 CANS 2.0
3a.2 OR
(CANS 63 (Sexual Aggression) OR
CANS 36 (Medical) OR
CANS 37 (Physical) OR
CANS 65 (Delinquency) = 2 or 3)
3a.2 OR
(CANS 65 (Sexual Aggression) OR
CANS 37 (Medical) OR
CANS 38 (Physical) OR
CANS 67 (Delinquency) = 2 or 3)

B. Child is 12 through 14 years old

3b.0 Child’s age is 12 through 14 years

3b.1 At least one or more ‘3’ or two or more ‘2’ among the following needs

CANS Subject CANS 1.0 question # CANS 2.0 question #
Adjustment to trauma 14 14
Psychosis 46 48
Attention deficit/impulse 47 49
Depression 48 50
Anxiety 49 51
Oppositional behavior 50 52
Conduct 51 53
Substance use 52 54
Attachment 53 55
Eating disturbance 54 56
Affect dysregulation 55 57
Behavioral Regression 56 58
Somatization 57 59
Anger control 58 60

3b.2 A rating of ‘2’ or ‘3’ on Developmental (32 - Developmental/Intellectual)

3b.3 One ‘3’ among the following risk behaviors

CANS Subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Delinquency 65 67
Fire Setting 67 69
Sexually reactive behavior 69 71

3b.4. Two or more ‘2’ among the following risk behaviors

CANS subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Runaway 64 66
Delinquency 65 67
Fire Setting 67 69
Sexually reactive behavior 69 71

3b.5 A rating of ‘3’ on at least two or more of the following:

CANS Subject CANS 1.0 question # CANS 2.0 question #
School attendance 41 43
Judgment 66 68
Social behavior 68 70

Group Home Referral rule:

Rule B1: 3b.0 AND (3b.1 OR 3b.2) AND (3b.3 OR 3b.4 OR 3b.5)

Rule B2: Consider specialty program if

CANS 1.0 CANS 2.0
3b.2 OR
(CANS 63 (Sexual Aggression) OR
CANS 36 (Medical) OR
CANS 37 (Physical) OR
CANS 65 (Delinquency) = 2 or 3)
3b.2 OR
(CANS 65 (Sexual Aggression) OR
CANS 37 (Medical) OR
CANS 38 (Physical) OR
CANS 67 (Delinquency) = 2 or 3)

C. Child is aged 15 or above

3c.0 Youth’s age is 15 or above

3c.1. Attachment (CANS 53) (CANS 2.0: 55) is rated as a ‘2’ or ‘3’

3c.2 Meets criteria for Specialized Foster Care (FHS)

3c.3 Parenting Role (CANS 86 (CANS 2.0: 89) rated a ‘2’ or ‘3’

Group Home Referral rule:

Rule C1: 3c.0 AND ((criteria for section B above) OR (3c.1 AND 3c.2) OR 3c.3)

Rule C2: Consider specialty program if

CANS 1.0 CANS 2.0
3c.2 OR
3c.3 OR
(CANS 63 (Sexual Aggression) OR
CANS 36 (Medical) OR
CANS 37 (Physical) OR
CANS 65 (Delinquency) = 2 or 3)
3c.2 OR
3c.3 OR
(CANS 65 (Sexual Aggression) OR
CANS 37 (Medical) OR
CANS 38 (Physical) OR
CANS 67 (Delinquency) = 2 or 3)

2. Specialized foster care (FHS) Criteria

2.1 A rating of ‘2’ or ‘3’ on one of the following.

CANS subject CANS 1.0 question # CANS 2.0 question #
Medical 36 37
Physical 37 38
Somatization 57 59

2.2 At least one ‘2’ or ‘3’ on one of the following

CANS subject CANS 1.0 question # CANS 2.0 question #
Adjustment to trauma 14 14
Psychosis 46 48
Attention deficit/impulse 47 49
Depression 48 50
Anxiety 49 51
Oppositional behavior 50 52
Conduct 51 53
Substance use 52 54
Attachment 53 55
Eating disturbance 54 56
Affect dysregulation 55 57
behavioral regression 56 58
Anger control 58 60

2.3 A rating of ‘3’ on at least one of the following:

CANS subject CANS 1.0 question # CANS 2.0 question #
Intellectual/developmental 32 34
Motor 70 72
Sensory 71 73
Communication 72 74
Failure to thrive 73 75
Regulatory problems 74 REMOVED
Substance exposure 78 79
Independent Living Skills 84 87

2.4 A rating of ‘3’ on at least one of the following.

CANS subject CANS 1.0 question # CANS 2.0 question #
School behavior 39 41
Social behavior 68 70
Sexually reactive Behavior 69 71

2.5 A rating of ‘2’ or ‘3’ on at least one of the following.

CANS subject CANS 1.0 question # CANS 2.0 question #
Suicide risk 59 61
Self mutilation 60 62
Other self harm 61 63
Danger to others 62 64
Sexual aggression 63 65
Runaway 64 66
Delinquency 65 67
Fire setting 67 69

Specialized Foster Care referral rule:

2.1—Medically complex

OR.

2.2 and (2.3 OR 2.4 OR 2.5)—Mental Health

1. FOSTER HOME (FHB/FHP) Criteria

The only rule for recommended placement into FHB or FHP is that if Child and Youth Central Information System indicates this as the current placement type, and no other part of the algorithm suggests another Level of Care, then we use the Child and Youth Central Information System placement type.

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Chor, K.H.B., McClelland, G.M., Weiner, D.A. et al. Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study. Adm Policy Ment Health 42, 70–86 (2015). https://doi.org/10.1007/s10488-014-0545-5

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  • DOI: https://doi.org/10.1007/s10488-014-0545-5

Keywords

  • Child welfare
  • Out-of-home placements
  • Team decision-making
  • Decision support algorithm
  • Outcomes