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Family and Children's
Resource Program

Vol. 22, No. 2
April 2017

SDM: Tools to Support Decision Making in North Carolina

An issue about decisions in child welfare in our state would be incomplete if it did not mention SDM (Structured Decision Making). North Carolina began using this set of research-based, actuarial risk assessment tools in 2002 in an effort to:

  • Structure critical decision points
  • Help social workers make accurate and consistent decisions about the levels of risk for maltreatment found in families
  • Provide guidance about service provision, and
  • Assist with reunification and permanency planning.

Actuarial risk assessments like SDM are objective classification tools that help estimate the likelihood of future harm (Mendoza, et al., 2016).

SDM was first developed in the 1990s by the Children's Research Center (CRC). In 2008 the NC Division of Social Services contracted with CRC to conduct a validation study to ensure the tools used in this state are based on current data about North Carolina families. In 2009, in response to that validation study, the Division updated the Risk Assessment (DSS-5230) and Risk Reassessment (DSS-5226).

SDM and Outcomes
North Carolina uses SDM because evidence shows that doing so can improve outcomes for families. For example, Wagner, Hull, and Luttrell (1995) found that agencies using SDM had lower referral rates, removal rates, substantiation rates, and fewer child injuries. Johnson and Wagner (2005) found agencies using SDM had a significantly higher percentage of permanent placements.

SDM may also lead to more consistent decisions about service provision. For example, Johnson (2011) found California workers using SDM were more likely to provide in-home services to families with higher risk scores.

Monitoring Team Tips
As part of the assistance it provides to counties, the NC Division of Social Services' Child Welfare Monitoring Team often selects and reads case records. As the box below shows, the Monitoring Team asks specific questions to determine whether an agency's practice is in keeping with mandated standards around SDM.

Based on the records it reviewed in 2016, the Monitoring Team strongly urges county child welfare agencies to carefully and consistently follow SDM tool instructions. This isn't always done. For example, Monitors often see problems with identifying well-being needs of the parents on the Family Assessment of Strengths and Needs (DSS-5229). They have also seen evidence of confusion about well-being versus safety on the DSS-5229, even though these terms are clearly outlined in the instructions.

The Monitors stress how important it is to thoroughly capture the rationale for social work decisions in the case narrative as well as on SDM tools and summaries (NC DSS, 2017c).

But SDM Is Only a Tool
While the Risk Assessment and other SDM tools can promote accuracy and consistency, they can't make our decisions for us. They exist to support good clinical judgment, not replace it. In the end, decisions and judgments about children and families always come down to workers and their supervisors.

References for this and other articles in this issue

SDM-Related Questions Asked by NC DSS Monitoring Team During Case Reviews


  • Was a Safety Assessment (DSS-5231) completed for the initial report?
  • Did the social worker include the parents/primary caretakers in developing the safety agreement?
  • Does the information on the DSS-5231 correlate with the information obtained from the interview(s) and observations?
  • Was the safety agreement adequate to ensure safety?
  • If the safety assessment was safe with a plan or unsafe, did the family sign the DSS-5231?
  • If a safety agreement was needed, did the alleged perpetrator participate and sign the DSS-5231?
  • If new information was uncovered during the assessment or the situation changed, was a new DSS-5231 and agreement completed?
  • Did the supervisor review, sign, and date each DSS-5231 within 24 hours?
  • Does documentation include a Risk Assessment (DSS-5230)?
  • Does documentation include a Case Decision Summary/Initial Case Plan (DSS-5228)?
  • If there was a decision to transfer to CPS In-Home Services or Foster Care, does documentation include the Family Assessment of Strengths and Needs (DSS-5229)?

In-Home Services

  • Were the Risk Re-Assessment (DSS-5226) and Assessment of Strengths and Needs (DSS-5229) used according to policy?
  • Were well-being needs, or lack of needs, documented in the well-being section of the DSS-5229?

Foster Care Services

  • Were well-being needs, or lack of needs, documented in the (DSS-5229)?
  • Was the Family Reunification Assessment (DSS-5227) used according to policy?