Reentry into out-of-home care: implications of child welfare workers' assessments of risk and safety.

Author:Wells, Melissa

This longitudinal analysis examined predictors of reentry to foster care among children and youths who entered foster care between 2001 and 2007. Three sources of administrative data (Chapin Hall Center for Children longitudinal files, National Child Abuse and Neglect Data System, and structured decision making) from one state were used to assess whether Child Protective Services workers' risk and safety assessment decisions are predictive of reentry into foster care. Cox regression modeling identified characteristics associated with reentry during this period. Findings suggest that current neglect assessment, problems with parenting skills, motivation to improve parenting, safety assessment decision, length of stay, substantiated allegations, and unsubstantiated allegations were associated with likelihood of reentry. The results suggest that child welfare systems could more effectively use assessment tools to match families with needed services.

KEY WORDS: child maltreatment; foster care; risk assessment; safety assessment; structured decision making


When social workers and other child welfare professionals reunify maltreated children and adolescents with their parents, it is with the expectation that known risks have been minimized and that homes are safe. Decisions to reunify families increasingly rely on child welfare workers' perceptions of both risk of maltreatment and household safety. However, there has been little examination of whether social workers' assessments are predictive of child welfare outcomes such as reentry into care.

Since passage of the Adoption and Safe Families Act (ASFA) in 1997 (H.R. 867, 1991), child welfare agencies have been required to seek more timely permanency for children through family preservation, time-limited reunification efforts, and, when reunification was not possible, through termination of parental fights and adoption promotion and support (Child Welfare League of America, 1997). While promoting family reunification through the provision of services, ASFA reduced the amount of time parents have to reunify with their children from 18 months to 12 months.

ASFA also required the development of performance indicators and outcome measures related to the achievement of timely permanency. These changes in policy and practice, and the outcome measures used to evaluate state performance, have led to increased efforts to quickly reunify families after a child has been removed from a home due to child maltreatment. There is general consensus that in some cases, these reunification efforts are unsuccessful and children reenter out-of-home care after being returned to live with their parents. In an effort to protect children from subsequent maltreatment and to standardize assessment practices, many states have implemented empirically based assessment tools for use in child welfare practice.


Decision Making in Child Welfare

Increasingly, child welfare and juvenile justice agencies are adopting assessment instruments as decision-making tools (DePanfilis & Scannapieco, 1994; Krysik & LeCroy, 2002; Shook & Sarri, 2007). In child welfare agencies, these tools generally focus on family-level risk and environmental factors, whereas in juvenile justice settings, they are used to assess individual behavior (Shook & Sarri, 2007). Literature has suggested that these tools can be used to measure or predict case outcomes (Lyle & Graham, 2000), but there have been few empirical studies using assessment instruments in this manner.

Rather, the literature related to these assessment tools has largely examined four domains: (1) definitions required for assessing risk and safety (DePanfilis & Scannapieco, 1994; English & Pecora, 1994); (2) implementation of specific decision-making systems (Doueck, English, DePanfilis, & Moote, 1993; K. Johnson, Wagner, Scharenbrock, & Healy, 2006); (3) challenges related to the use of existing tools and models, including reliability and validity of instruments (Baird & Wagner, 2000; Baird, Wagner, Healy, & Johnson, 1999; Baumann, Law, Sheets, Reid, & Graham, 2005, 2006; Camasso & Jagannathan, 2000; Dorsey, Mustillo, Farmer, & Elbogen, 2008; English & Graham, 2000; Gambrill & Shlonsky, 2000; W. Johnson, 2006a, 2006b; Knoke & Trocme, 2005); and (4) analyses of results using data collected from these instruments (English & Graham, 2000; English & Pecora, 1994; Lyle & Graham, 2000).

The state in which this analysis was conducted uses structured decision making (SDM) risk and safety assessment instruments as decision-making tools (Children's Research Center, 2008). Literature has identified a reduction in repeated incidents of maltreatment as one of the primary goals of SDM tools (Gambrill & Shlonsky, 2000; W. Johnson, 2006a) and suggested that the use of SDM risk assessment tools has been found to result in better rates of permanency for children reunified with their families (K. Johnson & Wagner, 2005).

Decision theory, based on the principle of breaking down complex decisions into smaller components, is generally considered the foundation for SDM and similar assessment systems (Children's Research Center, 2008; Schwalbe, 2004). Decision theory assumes that statistical models can be used to develop standards and that those standards can be the basis for consistent decision making (Lindley, 1985). In this context, SDM instruments provide child welfare workers with a standard that can be used for consistent decision making in child maltreatment assessments. Actuarial or empirically based instruments attempt to predict future maltreatment in a consistent, research-based manner, as compared with consensus-based instruments, which rely more on clinical judgment (Children's Research Center, 2008; D'Andrade, Austin, & Benton, 2008; Knoke & Trocme, 2005; Shlonsky & Friend, 2007).

SDM instruments include both empirically based and consensus-based measures. This analysis used data collected using two specific SDM instruments, the safety assessment tool and the risk assessment tool. The SDM safety assessment tool is a consensus-based instrument, used to evaluate current circumstances for children and families (Children's Research Center, 2008). The SDM risk assessment tool is actuarial, in the sense that it provides a score, and also empirically based, in that it was developed using statistical analyses of risk factors.

Safety Assessment Instruments. Safety assessments are designed to identify those children currently facing an imminent threat of harm (Children's Research Center, 2008). In this state, the safety assessment instrument is generally completed within 24 hours of the first contact with a family and provides a tool for workers to use in making decisions about immediate removal from the home. The SDM safety assessment tool includes a checklist designed to assist workers in assessing the current situation of children to ensure safety (Children's Research Center, 2008). In this state, child welfare workers can complete more than one safety assessment, but generally, one such instrument is completed for each child maltreatment assessment.

Risk Assessment Instruments. Once initial safety concerns have been addressed, generally at the conclusion of an assessment, child welfare agencies using SDM tools evaluate family risk. Risk is considered to be associated with the "long-term likelihood of child maltreatment" and subsequent placement in out-of-home care (Children's Research Center, 2008, p. 9). Therefore, these tools are logical indicators of potential for reentry to foster care.

Reentry into Out-of-Home Care

In 2005, over 500,000 children and youths were living in out-of-home care and of that population, the case plans for over half of these children and youths identified reunification with their biological family as the primary goal (U.S. Department of Health and Human Services, Administration for Children & Families, 2005). However, even when reunification does occur, children may subsequently return to care. In California, Courtney (1995) and Courtney, Piliavin, and Entner Wright (1997) found that, on average, about 19% of foster youths reentered out-of-home care within two to three years of being reunified with their parents. In similar studies, investigators found that around 14% of foster youths reentered foster care after being reunified with their biological parents (Shaw, 2006; Wells & Guo, 1999). Miller, Fisher, Fetrow, and Jordan (2004) conducted a small study and found that of the 16 family reunifications studied, five youths (31%) reentered. Festinger's (1994) study of reunified children in New York found that about 13% of children reentered care within one year.

Predictors of Reentry into Out-of-Home Care

Predictors of reentry to care vary and have included variables reflecting child characteristics, structural features of families, and case characteristics. However, few studies have examined how child welfare workers' perceptions of risk and safety may be associated with reentry into out-of-home care.

Child Characteristics. Some findings have suggested that race and ethnicity are strong predictors of reentry, with African American children and youths reentering at the highest rate (Courtney, 1995; Courtney et al., 1997; Jones, 1998; Shaw, 2006; Wells & Guo, 1999) or that being other than white is associated with reentry (Jones, 1998). Others have not found significant differences between African American children and white children (Terling, 1999). Poverty has also been associated with reentering out-of-home care, in that investigators found that children in Temporary Assistance for Needy Families- or Aid to Families with Dependent Children--eligible families returned to care at a much higher rate than children in noneligible families (Courtney, 1995; Courtney et al., 1997; Jones, 1998).

Research is unclear as to whether age is a predictor of reentry into foster care. Courtney (1995) originally found that...

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