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Hasbro Children's Foundation Pro


									    Early Multidisciplinary
    Assessment Pilot Project

    Kathleen Coulborn Faller, Ph.D.,
        University of Michigan

               University of Michigan   1
• 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

                     University of Michigan                   2
        Why Conduct Early
• (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
• 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
             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
•   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
•   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
• 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%
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
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
• 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
                 University of Michigan      14

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