title: Change trajectories during home-based services with chronic child welfare cases.
abstract: This study examines how risk factor change patterns vary with case chronicity, and whether risk factor improvement still predicts lower recidivism risk among chronic cases. 2,175 parents in home based child welfare services were surveyed for risk factors at pre-treatment, post-treatment and 6-month follow-up. Mixture modeling of latent difference scores identified change trajectory classes related retrospectively to chronicity and prospectively to recidivism. Five change trajectories were identified: stable low problem, stable high problem, sustained improvement, relapsing, and paradoxical. Chronicity was associated with a decreasing probability of membership in the stable low problem trajectory and increasing probability of membership in the stable high problem and sustained improvement trajectories. Cases with more favorable trajectories recidivated less across levels of chronicity. Findings suggest that chronic cases may improve little, but still retain a stable or increasing chance of sustained improvement associated with lower risk. A cumulative service benefit might be one possible explanation for this observation, and might suggest that repeated intervention efforts are not always wasted on chronic cases. The current episodic and reactive service delivery model in child welfare may be a mismatch with chronic cases where progress is absent or tends to occur cumulatively across service episodes.
authors.affiliation: Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Mark-chaffin@ouhsc.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Chaffin
authors.forename: David
authors.initials: D
authors.lastname: Bard
authors.forename: Debra
authors.initials: D
authors.lastname: Hecht
authors.forename: Jane
authors.initials: J
authors.lastname: Silovsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D002669:Child Welfare; D002675:Child, Preschool; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D004493:Education; D005260:Female; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D055815:Young Adult