Patterns of out-of-home placement decision-making in child welfare |
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| Authors: | Ka Ho Brian Chor Gary M McClelland Dana A Weiner Neil Jordan John S Lyons |
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| Institution: | 1. Mental Health Services and Policy Program, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Suite 1200, Chicago, IL 60611, USA;2. Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Rubloff 10th Floor, Chicago, IL 60611, USA;3. University of Ottawa, School of Psychology, Children''s Hospital of Eastern Ontario, Vanier Hall, 4085, Ottawa, Ontario K1N 6N5, Canada |
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| Abstract: | Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state's child welfare system by comparing two models of placement decision-making: a multidisciplinary team decision-making model and a clinically based decision support algorithm. Based on records of 7816 placement decisions representing 6096 children over a 4-year period, hierarchical log-linear modeling characterized concordance or agreement, and discordance or disagreement when comparing the two models and accounting for age-appropriate placement options. Children aged below 16 had an overall concordance rate of 55.7%, most apparent in the least restrictive (20.4%) and the most restrictive placement (18.4%). Older youth showed greater discordant distributions (62.9%). Log-linear analysis confirmed the overall robustness of concordance (odd ratios ORs] range: 2.9–442.0), though discordance was most evident from small deviations from the decision support algorithm, such as one-level under-placement in group home (OR = 5.3) and one-level over-placement in residential treatment center (OR = 4.8). Concordance should be further explored using child-level clinical and placement stability outcomes. Discordance might be explained by dynamic factors such as availability of placements, caregiver preferences, or policy changes and could be justified by positive child-level outcomes. Empirical placement decision-making is critical to a child's journey in child welfare and should be continuously improved to effect positive child welfare outcomes. |
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| Keywords: | Child welfare Out-of-home placements Team decision-making Decision support algorithm Log-linear modeling |
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