Family group decision making: A propensity score analysis to evaluate child and family services at baseline and after 36-months

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Abstract

Family group decision making (FGDM) has been increasingly adopted as a decision making strategy in child welfare agencies, although little research exists on how FGDM facilitates connections to services for children and families. This study utilizes 36 months of nationally-representative data from the National Survey of Child and Adolescent Well-Being (NSCAW) to evaluate the impact of FGDM meetings on children and families' services. Specifically, the study sample consists of 3220 children referred due to child maltreatment who were residing at home during the initial study interview, including 325 children who experienced FGDM meetings during the initial placement or planning assessment. Propensity score matching was used to generate a comparison group of non-FGDM cases, which aimed to mitigate the factors contributing to FGDM selection bias. Analysis using the matched comparison group showed that around the time of the initial case assessment a higher percentages of children who experienced FGDM meetings than those who had not experienced FGDM were connected with some services, specifically parenting services, children's counseling services, and mental health treatment for parents. After 36 months, however, receipt of child and family services was not statistically different between children who experienced FGDM meetings and those who did not.

Introduction

Child welfare agencies are challenged by trying to emphasize more family-centered and community-based approaches to child welfare practice, while ensuring they meet the fundamental goal of protecting children. An emerging family-centered practice in child welfare is family group decision making (FGDM), which promotes sharing the agency's decision-making responsibility with the family and community stakeholders involved with the case. While there are numerous models employing the FGDM approach of involving families, community, and agencies in the decision-making process, this study does not specifically evaluate any particular model, but uses the term FGDM to generally refer to all types of strategies using family-involved decision-making meetings. Central to all FGDM strategies are collaborative meetings that are intended to draw on family and community strengths and allow families, in partnership with child welfare agencies and other professionals, to design individualized plans to protect children who have come to the attention of the child welfare system. Despite the increasing use of FGDM strategies in the United States and internationally, research is needed to evaluate which children tend to experience FGDM meetings and to better understand the impact FGDM may have on outcomes for children and families (Crampton, 2006, Crampton, 2007).

FGDM meetings were first used as a decision-making intervention for child welfare in New Zealand in the late 1980s, as a strategy to resolve child protection cases involving indigenous Maoris, who had an overrepresentation of children in out-of-home care (Levine, 2000). The purpose of FGDM meetings is to empower families and communities, while encouraging shared responsibility to protect children. Since it was first implemented in New Zealand, derivative and complementary FGDM initiatives have been adopted in communities within the United States and throughout the world (Burford and Hudson, 2000, Merkel-Holguin, 1998, Nixon et al., 2005). Increasing interest in FGDM meetings can in part be attributed to several factors, including the growing interest in family-centered and strengths-based practices, changing policies to include families in case planning, and greater endorsement of the belief that protecting children is a shared responsibility among child welfare agencies, communities, and families (Burford, 2000, Merkel-Holguin, 1998, Merkel-Holguin, 2004).

Although this study is using FGDM as an umbrella term for a variety of different models, these models exhibit shared practices and principles that establish the foundation of FGDM. Specifically, FGDM strategies acknowledge and build on strengths of the family and community (Center for the Study of Social Policy, 2002). In addition, all FGDM models utilize decision-making meetings that bring together a broadly defined team of individuals, which includes family members but can also involve community members, service providers, and child welfare agency workers, to discuss and develop a plan for the child and family. These commonly-agreed upon plans may involve strategies to ensure the child's safety, recommend placement options, as well as connect children and caregivers to services. The goal of these meetings is to ensure the child's safety and well being; however, there is a strong emphasis on keeping the child with family or within their community (Levine, 2000). With numerous agency, family, and community members participating in the meeting, FGDM is intended to serve as a useful way to bring more community resources to the problem of child maltreatment (Crampton, 2004). Fundamentally, FGDM strategies establish a process for child welfare agencies to engage and empower families and communities in making decisions for developing a culturally-appropriate protection plan for the child (Center for the Study of Social Policy, 2002).

Although FGDM implementation is growing among many communities, there is a selection bias which contributes to which families experience FGDM meetings. Some families may be disinterested in the FGDM process or some families may not be referred for FGDM meetings due to the characteristics and circumstances surrounding the cases (Crampton, 2006, Crampton, 2007, Merkel-Holguin, 2004). Prior research has begun to identify characteristics of cases that are associated with referrals and involvement in FGDM meetings.

Previous research has tried to address whether cases involving sexual abuse or domestic violence have been diverted from FGDM meetings given the nature of the potential involvement of the abusers, but the findings are mixed (Merkel-Holguin, Nixon, & Burford, 2003). Pennell & Burford (2000) reported that FGDM meetings can be used in sexual abuse or domestic violence cases under certain circumstances. Also, Crampton & Williams (2000) found that the distribution of cases among those receiving and not receiving FGDM meetings is essentially the same for each type of maltreatment. They claim that there are no types of maltreatment that are inappropriate for FGDM meetings and should not be excluded from referrals to FGDM meeting.

In addition, a few studies found that children previously known to child protective services were more likely to experience FGDM meetings. Sundell and Vinnerljung (2004) found that a larger proportion of children who received FGDM meetings, than children who did not receive FGDM meetings, were known to child protection agencies due to earlier investigations. Crampton (2006) also found that families with children who were previously involved with child protective services were more likely to agree to participate in FGDM meetings.

Cases involving substance abuse issues may also benefit from the family involvement of the FGDM process. Research indicates that families with parental substance abuse were more likely to be referred to and participate in FGDM meetings (Crampton, 2006, Crampton and Williams, 2000).

Additionally, the use of FGDM meetings is supported as a culturally competent and community-based approach to help address the problem of racial disproportionality in foster care (Crampton, 1997, Roberts, 2007, Waites et al., 2004). However, research is inconclusive as to whether there are disparities among different racial groups being referred for FGDM meetings. A study by Shore, Wirth, Cahn, Yancey, and Gunderson (2001) found fewer Caucasian families and more Native American families bring referred for FGDM meetings. Another study by Crampton (2006) conducted bivariate analysis and found that African American families were significantly more likely to be referred and approved for FGDM meetings, but when conducting multivariate analysis, the author did not find significant differences among racial groups being referred to or agreeing to participate in FGDM meetings.

Previous research has shown that FGDM meetings are not always available or utilized equally by children and families involved with child welfare services. Access to and involvement in FGDM meetings may be influenced by a variety of reasons, including receiving referrals for meetings and interest by the family to participate in these meetings (Crampton, 2006). Because of various findings showing different likelihoods of cases with certain characteristics to be involved in FGDM meetings, it is critical to account for this selection bias when evaluating FGDM.

Despite the increasing use of FGDM strategies in child welfare, there are relatively few studies that evaluate outcomes associated with the use of FGDM meetings (Crampton, 2007). The studies that have attempted to assess outcomes related to FGDM have demonstrated conflicting results. Several of these studies provide evidence that involvement in FGDM meetings contributes to reductions in subsequent maltreatment, a decrease in future involvement of child protective agencies, better placement stability, and increased placements with relatives (Crampton, 2003, Crampton and Jackson, 2007, Pennell and Burford, 2000, Sundell and Vinnerljung, 2004). However, other studies have shown that involvement in FGDM meetings either did not contribute to significantly different outcomes of subsequent maltreatment and placement stability (Center for Social Service Research, 2004), or FGDM involvement contributed to negative outcomes, such as higher rates of subsequent referrals to child protective agencies and longer out-of-home placements (Sundell & Vinnerljung, 2004).

A few studies have attempted to assess outcomes of FGDM meetings in regard to whether these meetings facilitate connections to services for children and families. Given the intent of FGDM is to bring families together with child welfare agency staff as well as community service providers, FGDM meetings should improve families' access to needed services. Studies have shown that FGDM plans frequently include recommendations linking them to resources, which include both services from agencies as well as family-provided supports (Merkel-Holguin et al., 2003). In their study of FGDM in the eastern Canadian provinces of Newfoundland and Labrador, Pennell and Burford (2000) found FGDM plans usually included counseling, addiction treatment, in-home supports, child care, transportation, material assistance, or recreational services that were provided by both agency and family members. Furthermore, a three-year comparative study by Sundell and Vinnerljung (2004) found that children who experienced FGDM meetings received more services on average than children in the comparison group. They also found that services in general were received by a greater percentage of children who experienced FGDM meetings than those who did not experience FGDM meetings. Additionally, they found that children with FGDM meetings received services for longer periods of time. With regard to types of services, they did not, however, find significant differences in receiving in-home services or parent support services.

Although there are a few studies that have contributed to the FGDM literature regarding child and family outcomes, there are several serious limitations to previous FGDM studies (Berzin, 2006, Crampton, 2007). Most prior studies evaluating FGDM outcomes were conducted in site-specific geographic locations with small sample sizes, contributing to the need for research using larger samples and samples that are more nationally-representative. Also, most studies lack the ability to follow FGDM meeting participants over time, therefore limiting their ability to have follow-up data to assess outcomes after several years. Furthermore, it is difficult to establish valid and reliable comparison groups of children and families who do not receive FGDM. By simply selecting cases that do not experience FGDM, researchers may be creating a comparison group that embodies the selection bias caused by differences in referrals and participation in FGDM meetings, potentially confounding the study results by detecting differences due to the characteristics of the groups rather than the experience of FGDM meetings. In addition, attempting to control for selection bias by including covariate factors in multivariate analysis is not a sufficient, robust method to address selection bias (Guo, Barth, & Gibbons, 2006).

To overcome some of the limitations of prior studies, this study utilizes a large nationally-representative child welfare dataset that obtains information regarding children and families' experiences over 36-months. The sample contains 325 cases where FGDM meetings were used as part of the initial assessment process. In addition, the large sample size allows the use of statistically-matched comparison groups to evaluate difference between those who experienced FGDM meetings and those that did not. Specifically, this study seeks to evaluate whether there are significant differences between children and caregivers who did and did not experience FGDM meetings in regard to: (1) services being provided, arranged, or referred at baseline and (2) services received by 36-months.

Section snippets

NSCAW data

Data for this study comes from the National Survey of Child and Adolescent Well-Being (NSCAW), which is the first national longitudinal study to gather data about the characteristics, needs, experiences, and outcomes of children and families involved with the child welfare system. The study was authorized under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 and administered under the guidance of the Children's Bureau of the Administration for Children and

Results

To understand differences among children and families that experienced FGDM meetings versus those that did not experience FGDM meetings, bivariate analysis of case characteristics was conducted. Table 1 depicts the results of bivariate analysis of characteristics among the entire study sample, as well as chi-square bivariate tests comparing case characteristics between those who experienced FGDM meetings and those who did not. Of the overall NSCAW sample of children who were in-home at

Discussion

By applying propensity score matching to control for selection bias and utilizing data from a nationally-representative, longitudinal sample of children, this study provides a unique and valuable contribution to the existing research on the impact of FGDM meetings. Bivariate analysis of the original sample of in-home children at baseline shows that children who experienced FGDM meetings had significantly higher percentage of cases reporting moderate or severe maltreatment, domestic violence,

Acknowledgments

This document includes data from the National Survey on Child and Adolescent Well-Being, which was developed under contract with the Administration on Children, Youth, and Families, U.S. Department of Health and Human Services (ACYF/DHHS). The data have been provided by the National Data Archive on Child Abuse and Neglect. The information and opinions expressed herein reflect solely the position of the author(s). Nothing herein should be construed to indicate the support or endorsement of its

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