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Early Multidisciplinary Assessment Pilot Project http://www.ssw.umich.edu/earlyassessment/ Kathleen Coulborn Faller, Ph.D., A.C.S.W. University of Michigan University of Michigan 1 Auspices • Supported by: • Conducted by: – Hasbro Children’s – Family Assessment Foundation— Clinic—started in intervention 1985 component – Child Protection – University of Team—started in Michigan Office of 1971 the Vice-President for Research—evaluation component University of Michigan 2 Why Conduct Early Assessments? • (We were tired of being called the Terminators) • Patterns in child protection reports. – Since 1994, over 3 million children per year reported to Child Protective Services (CPS). – 2004 5.5 million children reported. – About 2/3 are screened in for investigation. – About 25% are substantiated by . – About 1/3 of cases are repeatedly referred. University of Michigan 3 Why Conduct Early Assessments? • By the time there is decisive intervention by the child welfare system, children are often quite damaged and families cannot be salvaged. • Arguably, it is less costly in financial terms if there is earlier assessment and intervention. • Early multidisciplinary assessments resonate with Child & Family Services Review findings—Agency risk and safety assessments in 22 of 35 states did not capture underlying problems. University of Michigan 4 Target Population for Early Multidisciplinary Assessments • Families with at least one child 7 or younger (Hasbro Children’s Foundation) • First time substantiated CPS cases • Serious cases—because assessments are intrusive for families and labor intensive for staff – Court intervention required – CPS cooperation required University of Michigan 5 Outcomes related to child safety, permanency, & well-being • Safety= – Fewer re-reports, – Fewer terminations of parental rights • Permanency= – With one or both parents – Permanent placement • Well-being= – Child Behavior Checklist -CBCL – Child Sexual Behavior Inventory-CSBI – Trauma Symptom Checklist for Young Children- University of Michigan 6 TSC-YC Research Design • Pilot was conducted in 2 counties with manageable social problems & some resources • Target population—50 children • Comparison cases—50 children from families matched on type of maltreatment, family composition, race, time of report. • Outcomes from: – MIS system—safety & permanency – Worker of record—worker satisfaction; implementation of recommendations – Caretakers of children—child wellbeing University of Michigan 7 Intervention • Review all background information. • Interview all parties: children, caretakers. • Children receive at least 2 interviews. • Medical exams on all children 7 & under & older children as indicated. • Psychological testing/consultation when indicated. • Parent-child interactions when indicated. • Psychiatric consultation when indicated. • Medical consultation & medical specialties. University of Michigan 8 Intervention, continued. • Substance abuse, domestic violence, criminal history assessed. • Educational consultation when indicated. • Collateral contacts when indicated. • Consultation meeting to address questions and make additional recommendations. • Feedback given to the family. • Follow-up consultation available to referring worker/agency. • Court testimony when needed. University of Michigan 9 Placement Status at Follow-up (1 year after assessment completed) Own Relative Foster Adoption Total home care Early N=37 N=5 N=3 N=4 N=49 assessme 75.5% 10.2% 6.1% 8.4% nt Compari N=16 N=10 N=11 N=9 N=46 -son 34.8% 21.7% 23.9% 19.6% Total N=53 N=15 N=14 N=13 N=95 Chi square(3, N=95)=16.4; p<.001 University of Michigan 10 Permanency (proxy) Permanent Impermane Total nt Early N=46 N=3 N=49 assessment 93.9% 6.1% Compari- N=35 N=11 N=46 son 76.1% 23.9% Total N=81 N=14 N=95 Chi square(1, N=95)=6; p<.01 University of Michigan 11 Other system findings • Case open at follow-up. – Early assessment=33% Comparison=33% • Court involvement at follow-up. – Early assessment=33% Comparison=33% • Termination of parental rights. – Early assessment=30.1% Comparison=52.1% – Chi square(1,N=91)=4.5; p=.035 • Re-reports to Child Protective Services – Early assessment=44% Comparison=68.8% University of Michigan 12 Sobering findings • Project took 4 years instead of 2 to implement. • It took over a year for workers to view Early Assessments as a benefit to them. • Worker turnover impeded our ability to collect follow-up data on case outcomes. • Lack of a social welfare safety-net impeded implementation of the recommendations. • Lack of a social welfare safety-net was instrumental in re-referral. University of Michigan 13 Conclusions • Early Assessments hold promise for serious reports to CPS. • Need to replicate findings. • Early Assessment must be seen as genuinely useful by the public child welfare workers. • Without a welfare safety-net, poor families will continue to be reported to CPS. University of Michigan 14
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