19, No. 1
NC's System-Level Efforts to Strengthen Assessments
Elsewhere in this issue we explore ways individuals can improve outcomes by strengthening child welfare assessments. But the way we assess families can be changed at the agency and system level as well. This article reflects on several examples of this type of change that have taken place in North Carolina.
Multiple Response System (MRS)
What. North Carolina's system-level shift to differential response in child protective services (CPS), which enables agencies to conduct less adversarial, more holistic assessments of some families reported to CPS. MRS encourages family engagement not just during CPS assessment, but in every interaction from intake through case closure.
Why. Dissatisfied with its one-size-fits-all investigative CPS response, our state sought a more family-centered approach. Differential response, a promising practice used in several other states, was seen as a way to improve family engagement, thereby making services more effective while continuing to ensure child safety.
The Process. In 2001 NC's legislature mandated a pilot of differential response. In 2003 the pilot expanded to include 48 county DSS agencies. In 2006 differential response and the other features of MRS became policy statewide. Implementation succeeded due to the vision and support of the legislature and innovation, collaboration, and mutual support on the part of the NC Division of Social Services and county DSS agencies.
Impact on Outcomes. Multiple evaluations of MRS by Duke University's Center for Child and Family Policy found that using differential response does not adversely affect child safety (CCFP, 2004; 2006). Indeed, their 2011 evaluation noted that the steady decline in re-assessment rates since 2001-2002 suggests that child safety in North Carolina is continuing to increase. The 2004 evaluation also found that frontloading services works: the more time spent on assessment, the less time families spend in CPS in-home services.
Structured Decision Making
What. North Carolina's system-level adoption of Structured Decision Making (SDM), a model that can be used to (1) assist social workers in making accurate and consistent decisions about the levels of risk for maltreatment found in families, (2) provide guidance about service provision, and (3) assist with reunification and permanency planning. SDM was developed by the Children's Research Center (CRC). The California Evidence-Based Clearinghouse for Child Welfare rates SDM as having "promising research evidence" with a high relevance for child welfare.
Why. Desire to provide structure for critical decision points, to increase consistency and validity of decisions about families, and to focus resources on families most at risk. Desire for improvement in these areas was fueled in part by our state's performance on the 2001 federal Child and Family Services Review.
The Process. In 2002, as part of its federal Program Improvement Plan our state adopted SDM statewide. Tools introduced at that time included: Structured Intake, Safety Assessment, Risk Assessment, Family Assessment of Strengths and Needs, Case Decision Summary, Risk Reassessment, Family Reunification Assessment.
The SDM tools were originally developed by looking at risk factors of families substantiated for maltreatment in Michigan in the 1990s. In 2008 the Division contracted with CRC to conduct a validation study to ensure that our tools are based on current data from a wider range of families in our own state, where demographics and child welfare practices are different. Based on that validation study, North Carolina revised the Risk Assessment (DSS-5230) and Risk Reassessment (DSS-5226) in 2009.
Impact on Outcomes. There have been no formal studies of the use of SDM in North Carolina. However, Johnson and Wagner (2005) found that counties using SDM in Michigan had a significantly higher percentage of permanent placements than did comparison counties. SDM counties in the study also had lower rates of re-entry into foster care, although this difference was not statistically significant.
What. This multi-faceted project seeks to improve the well-being of NC children and families through the development of a trauma-informed child welfare system. It is funded through the Department of Health and Human Services, Administration for Children and Families, Children's Bureau (Grant # 90CO1058).
Most relevant to this article is that the project's nine participating counties are making a concerted effort to screen for trauma exposure and trauma symptoms whenever children are placed in foster care. Children with trauma exposure are then referred to a mental health professional for a clinical assessment and, if appropriate, trauma-informed treatment.
Why. Left untreated, trauma can have a profound, negative impact on children's behavior, learning, health, and well-being not just in the short term, but for the rest of their lives.
The Process. This project began in 2011 and will run through September 2016. Nine demonstration counties (Buncombe, Craven, Cumberland, Hoke, Pender, Pitt, Scotland, Union, and Wilson) have begun this important work. The plan is to learn how best to implement trauma-informed practices and then incorporate these practices statewide.
We will never be complacent when it comes to our performance or to our goal of achieving the outcomes we seek for children and families.