Abstract
After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed.
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Acknowledgments
This study was funded by the Illinois Department of Children and Family Services (IDCFS). The authors would like to give special thanks to the Child and Youth Investment Teams (CAYIT), especially Teddy Savas and Lee Annes, for their invaluable insight and input.
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Appendix: Child and Adolescent Needs and Strengths (CANS) Algorithm—placement criteria for residential treatment, group home, specialized foster care, and foster care
Appendix: Child and Adolescent Needs and Strengths (CANS) Algorithm—placement criteria for residential treatment, group home, specialized foster care, and foster care
4. Residential treatment center (RTC) criteria
4.1 At least two or more ‘3’ among the following needs
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Adjustment to trauma | 14 | 14 |
Psychosis | 46 | 48 |
Attention deficit/impulse | 47 | 49 |
Depression | 48 | 50 |
Anxiety | 49 | 51 |
Oppositional behavior | 50 | 52 |
Conduct | 51 | 53 |
Substance use | 52 | 54 |
Attachment | 53 | 55 |
Eating disturbance | 54 | 56 |
Affect dysregulation | 55 | 57 |
Behavioral regression | 56 | 58 |
Somatization | 57 | 59 |
Anger control | 58 | 60 |
4.2 Three or more ‘2’ among the following needs
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Adjustment to trauma | 14 | 14 |
Psychosis | 46 | 48 |
Attention deficit/impulse | 47 | 49 |
Depression | 48 | 50 |
Anxiety | 49 | 51 |
Oppositional Behavior | 50 | 52 |
Conduct | 51 | 53 |
Substance use | 52 | 54 |
Attachment | 53 | 55 |
Eating disturbance | 54 | 56 |
Affect dysregulation | 55 | 57 |
Behavioral regression | 56 | 58 |
Somatization | 57 | 59 |
Anger control | 58 | 60 |
4.3 A rating of ‘2’ or ‘3’ on Developmental (32-intellectual/developmental) (CANS 2.0–34).
4.4 At least one ‘3’ among the following risk behaviors.
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Delinquency | 65 | 67 |
Fire setting | 67 | 69 |
4.5 Three or more ‘2’ among the following risk behaviors.
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Runaway | 64 | 66 |
Delinquency | 65 | 67 |
Judgment | 66 | 68 |
Fire setting | 67 | 69 |
Social behavior | 68 | 70 |
Sexually reactive behavior | 69 | 71 |
Referral to a Residential Treatment Center is indicated by a CANS that satisfies the following criteria matching rules:
Rule 1: (4.1 = TRUE OR 4.2 = TRUE OR 4.3 = TRUE) AND (4.4 = TRUE OR 4.5 = TRUE)
Rule 2: Consider a specialty program if
CANS 1.0 | CANS 2.0 |
|---|---|
4.3 OR (CANS 63 (Sexual Aggression) OR CANS 36 (Medical) OR CANS 37 (Physical) OR CANS 65 (Delinquency) = 2 or 3) | 4.3 OR (CANS 65 (Sexual Aggression) OR CANS 37 (Medical) OR CANS 38 (Physical) OR CANS 67 (Delinquency) = 2 or 3) |
3. Group home/treatment group home (GRH/IGH) criteria
A. Child is less than 12 years old.
3a.0 Child is less than 12 years old.
3a.1 At least one or more ‘3’ or two or more ‘2’ among the following needs.
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Adjustment to Trauma | 14 | 14 |
Psychosis | 46 | 48 |
Attention deficit/impulse | 47 | 49 |
Depression | 48 | 50 |
Anxiety | 49 | 51 |
Oppositional behavior | 50 | 52 |
Conduct | 51 | 53 |
Substance use | 52 | 54 |
Attachment | 53 | 55 |
Eating disturbance | 54 | 56 |
Affect dysregulation | 55 | 57 |
Behavioral regression | 56 | 58 |
Anger control | 58 | 60 |
3a.2 A rating of at least ‘2’ on Developmental (32—Developmental/Intellectual)
(CANS 2.0–34)
3a.3 One ‘3’ among the following risk behaviors
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Delinquency | 65 | 67 |
Fire setting | 67 | 69 |
3a.4 Two or more ‘2’ among the following risk behaviors
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Runaway | 64 | 66 |
Delinquency | 65 | 67 |
Fire setting | 67 | 68 |
Group Home Referral rule:
Rule A1: 3a.0 AND (3a.1 OR 3a.2) AND (3a.3 OR 3a.4)
Rule A2: Consider specialty program if
CANS 1.0 | CANS 2.0 |
|---|---|
3a.2 OR (CANS 63 (Sexual Aggression) OR CANS 36 (Medical) OR CANS 37 (Physical) OR CANS 65 (Delinquency) = 2 or 3) | 3a.2 OR (CANS 65 (Sexual Aggression) OR CANS 37 (Medical) OR CANS 38 (Physical) OR CANS 67 (Delinquency) = 2 or 3) |
B. Child is 12 through 14 years old
3b.0 Child’s age is 12 through 14 years
3b.1 At least one or more ‘3’ or two or more ‘2’ among the following needs
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Adjustment to trauma | 14 | 14 |
Psychosis | 46 | 48 |
Attention deficit/impulse | 47 | 49 |
Depression | 48 | 50 |
Anxiety | 49 | 51 |
Oppositional behavior | 50 | 52 |
Conduct | 51 | 53 |
Substance use | 52 | 54 |
Attachment | 53 | 55 |
Eating disturbance | 54 | 56 |
Affect dysregulation | 55 | 57 |
Behavioral Regression | 56 | 58 |
Somatization | 57 | 59 |
Anger control | 58 | 60 |
3b.2 A rating of ‘2’ or ‘3’ on Developmental (32 - Developmental/Intellectual)
3b.3 One ‘3’ among the following risk behaviors
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Delinquency | 65 | 67 |
Fire Setting | 67 | 69 |
Sexually reactive behavior | 69 | 71 |
3b.4. Two or more ‘2’ among the following risk behaviors
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Runaway | 64 | 66 |
Delinquency | 65 | 67 |
Fire Setting | 67 | 69 |
Sexually reactive behavior | 69 | 71 |
3b.5 A rating of ‘3’ on at least two or more of the following:
CANS Subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
School attendance | 41 | 43 |
Judgment | 66 | 68 |
Social behavior | 68 | 70 |
Group Home Referral rule:
Rule B1: 3b.0 AND (3b.1 OR 3b.2) AND (3b.3 OR 3b.4 OR 3b.5)
Rule B2: Consider specialty program if
CANS 1.0 | CANS 2.0 |
|---|---|
3b.2 OR (CANS 63 (Sexual Aggression) OR CANS 36 (Medical) OR CANS 37 (Physical) OR CANS 65 (Delinquency) = 2 or 3) | 3b.2 OR (CANS 65 (Sexual Aggression) OR CANS 37 (Medical) OR CANS 38 (Physical) OR CANS 67 (Delinquency) = 2 or 3) |
C. Child is aged 15 or above
3c.0 Youth’s age is 15 or above
3c.1. Attachment (CANS 53) (CANS 2.0: 55) is rated as a ‘2’ or ‘3’
3c.2 Meets criteria for Specialized Foster Care (FHS)
3c.3 Parenting Role (CANS 86 (CANS 2.0: 89) rated a ‘2’ or ‘3’
Group Home Referral rule:
Rule C1: 3c.0 AND ((criteria for section B above) OR (3c.1 AND 3c.2) OR 3c.3)
Rule C2: Consider specialty program if
CANS 1.0 | CANS 2.0 |
|---|---|
3c.2 OR 3c.3 OR (CANS 63 (Sexual Aggression) OR CANS 36 (Medical) OR CANS 37 (Physical) OR CANS 65 (Delinquency) = 2 or 3) | 3c.2 OR 3c.3 OR (CANS 65 (Sexual Aggression) OR CANS 37 (Medical) OR CANS 38 (Physical) OR CANS 67 (Delinquency) = 2 or 3) |
2. Specialized foster care (FHS) Criteria
2.1 A rating of ‘2’ or ‘3’ on one of the following.
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Medical | 36 | 37 |
Physical | 37 | 38 |
Somatization | 57 | 59 |
2.2 At least one ‘2’ or ‘3’ on one of the following
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Adjustment to trauma | 14 | 14 |
Psychosis | 46 | 48 |
Attention deficit/impulse | 47 | 49 |
Depression | 48 | 50 |
Anxiety | 49 | 51 |
Oppositional behavior | 50 | 52 |
Conduct | 51 | 53 |
Substance use | 52 | 54 |
Attachment | 53 | 55 |
Eating disturbance | 54 | 56 |
Affect dysregulation | 55 | 57 |
behavioral regression | 56 | 58 |
Anger control | 58 | 60 |
2.3 A rating of ‘3’ on at least one of the following:
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Intellectual/developmental | 32 | 34 |
Motor | 70 | 72 |
Sensory | 71 | 73 |
Communication | 72 | 74 |
Failure to thrive | 73 | 75 |
Regulatory problems | 74 | REMOVED |
Substance exposure | 78 | 79 |
Independent Living Skills | 84 | 87 |
2.4 A rating of ‘3’ on at least one of the following.
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
School behavior | 39 | 41 |
Social behavior | 68 | 70 |
Sexually reactive Behavior | 69 | 71 |
2.5 A rating of ‘2’ or ‘3’ on at least one of the following.
CANS subject | CANS 1.0 question # | CANS 2.0 question # |
|---|---|---|
Suicide risk | 59 | 61 |
Self mutilation | 60 | 62 |
Other self harm | 61 | 63 |
Danger to others | 62 | 64 |
Sexual aggression | 63 | 65 |
Runaway | 64 | 66 |
Delinquency | 65 | 67 |
Fire setting | 67 | 69 |
Specialized Foster Care referral rule:
2.1—Medically complex
OR.
2.2 and (2.3 OR 2.4 OR 2.5)—Mental Health
1. FOSTER HOME (FHB/FHP) Criteria
The only rule for recommended placement into FHB or FHP is that if Child and Youth Central Information System indicates this as the current placement type, and no other part of the algorithm suggests another Level of Care, then we use the Child and Youth Central Information System placement type.
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Chor, K.H.B., McClelland, G.M., Weiner, D.A. et al. Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study. Adm Policy Ment Health 42, 70–86 (2015). https://doi.org/10.1007/s10488-014-0545-5
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DOI: https://doi.org/10.1007/s10488-014-0545-5