Variability in the implementation of Team Decisionmaking (TDM): Scope and compliance with the Family to Family practice model

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Abstract

Team Decisionmaking (TDM) is a method of making child welfare placement decisions that draws from the perspectives of family members, community representatives and agency staff members to determine the best placement options for children. This article compares three communities which had different experiences in their implementation of TDM. During the time of this study, the first experienced uneven TDM implementation due to changes in leadership; the second had enthusiastic implementation due to strong agency support; and the third had mature implementation because of a long history of TDM use. The three communities are compared in terms of qualitative analysis of interviews with key informants and quantitative analysis of TDM statistics and foster care placement trends. The study highlights the value of examining implementation from multiple perspectives to better understand what leads to effective implementation.

Introduction

In contemporary human services research, outcome evaluations of a program or intervention should begin with an implementation or process study to ensure that the program is being implemented in accordance with its design (Gilliam et al., 2000, Wind and Brooks, 2002). The purpose of this study is to measure the extent to which Team Decisionmaking (TDM), an innovative approach to child welfare decision-making, is being implemented in accordance with its design across three sites. Implementation analyses are important for a number of reasons. Findings can be used for ongoing program refinement and to provide information to funding sources regarding how resources are being used. Implementation studies can also document successful strategies for future replication and demonstrate program activities to the public before outcomes are achieved (Substance Abuse and Mental Health Services Administration [SAMHSA], 2000). Shortcomings in implementation make it impossible to determine an intervention's intrinsic effectiveness. While full implementation should lead to the intended goals of a program, program staff and researchers need to monitor agency practice to ensure that implementation is executed in close alignment with the practice model before they evaluate program effectiveness (Gilliam et al., 2000, Usher et al., 1999).

A variety of reasons exist for a policy or program's failure to follow its intended guidelines. A recent study of concurrent planning implementation in California combined quantitative data extracted from case files of children who entered out-of-home care before and after concurrent planning implementation with qualitative data from interviews and focus groups with child welfare professionals who worked with the children (D'Andrade, Frame, & Berrick, 2006). This study found wide support among agency workers for simultaneously planning for reunification or other permanency options. Yet, despite this support, implementation of concurrent planning was thwarted by several impeding factors, such as conflicting priorities for workers, confusion for children, and emotionally overwhelming challenges for birth families under strict timelines. Moreover, by law, California counties had wide discretion in how to implement concurrent planning, such that implementation differed greatly across counties in emphasis and intensity.

Successful implementation may also be hindered by fiscal and administrative limitations. A study of Shared Family Care demonstrated that despite some positive outcomes for the agency and community, the lack of agency administrative infrastructure leads to such inconsistencies in treatment and service structure chaos that county workers became reluctant to refer clients to the program (Simmel & Price, 2002). Such challenges are not uncommon, though agencies vary in their responses. For example, when the Commonwealth of Kentucky implemented a multidisciplinary assessment center for children entering foster care, the demand for services threatened to exceed agencies' capacity to cope effectively. Agencies responded by a variety of strategies, such as securing additional funding, developing a priority response system, and educating and developing important linkages among stakeholders. The success of the program was directly related to the degree of financial and political support it enjoyed at the state level (Sprang, Clark, Kaak, & Brenzel, 2004).

The findings of implementation literature across a wide range of fields suggest that implementation is most successful when it targets multiple levels. That is, implementation strategies must take into consideration both micro- and macro-level barriers, as well as particular strengths within a site to aid successful implementation (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). These multilevel considerations also apply to the field of child welfare. In presenting a conceptual framework for child welfare reform,Usher, Gibbs, & Wildfire (1995) identified these key concerns:

...Any given program or service is but one component of the system each community develops – deliberately or not – to respond to the needs of its families and children. Therefore, in evaluating changes in specific family and children's services and assessing their impact as part of a systemic reform effort that transcends individual programs and services, we must understand the policy, programmatic, and organizational context within which such services fit (p. 893).

Section snippets

Implementing Team Decisionmaking

Team Decisionmaking (TDM) is a core strategy of the Family to Family child welfare reform initiative, sponsored by the Annie E. Casey Foundation, an initiative that has been implemented in approximately 60 sites across 17 states. Team Decisionmaking includes six key elements:

  • 1.

    A TDM meeting, including birth parents and youth, is held for all decisions involving child removal, change of placement, and reunification/other permanency plan.

  • 2.

    The TDM meeting is held before the child's move occurs, or in

Research questions

The research questions in this study focus on (1) the broader commitment of agencies to rolling out TDM to achieve patterns of usage that conform to the Family to Family practice model; and (2) the level of support expressed by senior administrators as well as evidence of the allocation of sufficient resources and support from frontline staff.

Initial placements

An examination of the pattern of first entries into foster care highlights markedly different patterns across sites (see Table 2 and Fig. 1). The most striking pattern is evident in Agency C, the site having the most experience with TDM. While data are not available for FY 2000, Agency C witnessed 2407 entries to foster care in 2001. These entries dropped by 17.4% to 1988 entries in 2002, and this pattern continued into 2005, whose 891 entries represent only 37.0% of the overall volume

Presence of adequate resources

One of the biggest challenges to effective TDM implementation is a problem perhaps endemic to many social work practice settings: an overall lack of resources related to budget constraints that limit the number of staff members an agency can hire. In this respect, Agency C is at a more advanced stage of development than the other agencies, with 18 facilitators (see Table 1). Agency B has 4 facilitators with plans of adding 2 more. Agency A appears to be the agency most under strain with only 3

Support from caseworkers and supervisors

In general, interviewees expressed their belief that caseworkers and supervisors supported TDM practice. This level of support, however, appears to be the result of a gradual process of accepting practice changes that challenge traditional approaches to child welfare casework and supervision. In contrast to upper-level administrators, who have consistently expressed their support for TDM meetings and mandated their usage, staff members closer to the frontline appear to be slower to accept the

Discussion

The aggregate quantitative data presented in this study provide some preliminary evidence that not only is TDM being implemented on a wide scale, but that this implementation may be associated with changes in placement patterns for children over time. Of course, caution must be used in interpreting these findings, as causality between TDM and these placement dynamics is impossible to establish with these limited data.

One of the most interesting findings is the rapid decrease of initial entries

Conclusion

This article describes an implementation and process evaluation using both quantitative and qualitative methods. While the absence of an experimental design precludes any conclusions about whether TDM implementation can change foster care services, these results do suggest that when the leadership of an agency promotes TDM and allocates sufficient resources to implement TDM, over time placement patterns tend to follow the desired outcomes of TDM. Fewer children enter care and more are placed in

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The research described in this article was funded by the Annie E. Casey Foundation. We thank them for their support but acknowledge that the findings and conclusions presented in this article are those of the authors alone, and do not necessarily reflect the opinions of the Foundation.

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