Decision-Making Guidelines

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In October 1997, Seattle-based Casey Family Programs and the Baltimore-based Annie E. Casey Foundation awarded American Humane Association and three other agencies -- the American Bar Association Center on Children and the Law, Casey Family Services, and the Institute for Human Services Management -- $300,000 to launch the Casey Outcomes and Decision Making Project. The goal of the project was to help child welfare agencies implement performance-based contracting and managed care initiatives.

National statistics reveal that child welfare has become a big and troubled business with an estimated 903,000 children confirmed as abused or neglected and 542,000 children residing in foster care settings in 2001.

Child welfare professionals must make critical decisions about children and families every day:

  • What kinds of services do this child and family need?
  • Should I remove this child from her home?
  • What is the most appropriate out-of-home placement for this child?
  • How long should this child remain in foster care and what services do I need to put in place to support the placement?

Because caseworkers and their supervisors often make these decisions without the benefit of standardized guidelines, outcomes for children and families vary widely. In the past decade, more than 20 states have been sued as a result of their inability to ensure the safety, permanency, and well-being of the children and families in their care.

Taxpayers and policymakers are demanding that social service programs be cost-conscious and results- or outcomes-based. They are calling for system reform. Because some experts suggest that using a managed care model in child welfare would help reach that goal -- by promoting structured decision making, the delivery of appropriate services, and cost-containment -- many states and counties are considering it. Others, however, wonder if managed care principles can be applied in the child welfare arena without compromising children’s safety.

There are many significant differences between the child welfare and the medical or behavioral health systems in which managed care principles are widely applied. In healthcare, there are research-based links among symptoms, diagnoses, treatments, and outcomes, and practitioners can develop clinical protocols that connect types and lengths of treatments to diagnoses. In child welfare, however, this is not so easily accomplished. The needs of children and families served by the child welfare system are complex, and they differ from those of individuals with well-defined medical illnesses. The chronic and multi-layered nature of child maltreatment may cause severe emotional, social, and behavioral problems that cannot be resolved with short-term treatments.

Child welfare practitioners and policy makers must continue to pursue system reform. They must determine which outcomes are most critical for children and families, learn how to measure them, and decide whether a managed care model will help achieve those outcomes. To that end, Casey Family Programs and the Annie E. Casey Foundation have invested funds in this important effort -- the Casey Outcomes and Decision Making Project -- to develop management and practice tools to guide child welfare staff in providing needs-based, outcomes-focused services.

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