Decision support in case management for high risk families

Accurate safety and risk assessments are essential for intensive case work with high risk families. The level of intensity of the intervention should match a child’s risk of child maltreatment. Risk assessment is the... [ view full abstract ]

Accurate safety and risk assessments are essential for intensive case work with high risk families. The level of intensity of the intervention should match a child’s risk of child maltreatment. Risk assessment is the essential first step in intensive case work with these families. Assessment contains distinct aspects: 1) immediate child safety (safety assessment), 2) predicting future child maltreatment (risk assessment) in order to determine intervention urgency and intensity, and 3) identifying targets for interventions in order to individualize case planning (needs assessment).
Several methods for risk assessment and case planning exist, such as clinical judgment – where the scoring of risk factors is done in a subjective way - and actuarial risk assessment, where factors are scored according to a fixed algorithm, meaning that professionals use the same objective scoring rules, regardless their expertise (e.g., Dawes et al., 1989; Gambrill & Shonsky, 2000). Many studies have consistently shown that actuarial methods perform better than clinical judgment in risk assessment.
At Youth Protection Region Amsterdam, case workers (bachelor level social workers) did not perceive their risk assessment tool as supportive in their decision making process, they regarded them as burdens or checklists without any clinical relevance. In this paper we show what it takes to develop a risk assessment tool, according to the principles of evidence based practice. We created a tool with high feasibility and credibility for professionals, to use in daily practice.

To strengthen case workers in their decision making, an actuarial risk assessment instrument was developed. We followed the principles of evidence based practice. Researchers, case workers and psychologists gathered and combined scientific knowledge, empirical evidence and clinical expertise. Input of case workers and psychologists was essential to increase the instrument’s feasibility and credibility. Via train-the-trainer workshops all professionals started working with the new tool. In daily practice, the psychologist in the team support the case workers in the decision making process during weekly case meetings. A continuous evaluation takes place of the use and usefulness of this decision making supporting tool.

More than a year after the introduction of the instrument, evaluation showed that all 300 case workers use the instrument in daily practice and in the weekly case meetings to support the decision making and case planning. The ecological validity of the tool is considered high. Next to the direct relevance for case workers to use the outcome for individual cases, the instrument is used for continuous feedback loops and learning purposes on team level. Currently, based on knowledge and experience, more steps are taken to strengthen the decision making in case work with high risk families. At the same time, youth and child care organizations in Amsterdam and other parts of the Netherlands, have decided to start the enrollment of the new instrument in their daily practice as well. During the conference we will give an update on the results.