Vol. 24, No. 2
May 2019

SDM: Tools to Support Decision Making in North Carolina

An issue about assessing safety and risk 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 (NCDSS, 2017).

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.

Adapted from Children's Services Practice Notes vol. 22, no. 2 (May 2017).

References for this and other articles in this issue