title: Patterns of out-of-home placement decision-making in child welfare.
abstract: Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state's child welfare system by comparing two models of placement decision-making: a multidisciplinary team decision-making model and a clinically based decision support algorithm. Based on records of 7816 placement decisions representing 6096 children over a 4-year period, hierarchical log-linear modeling characterized concordance or agreement, and discordance or disagreement when comparing the two models and accounting for age-appropriate placement options. Children aged below 16 had an overall concordance rate of 55.7%, most apparent in the least restrictive (20.4%) and the most restrictive placement (18.4%). Older youth showed greater discordant distributions (62.9%). Log-linear analysis confirmed the overall robustness of concordance (odd ratios [ORs] range: 2.9-442.0), though discordance was most evident from small deviations from the decision support algorithm, such as one-level under-placement in group home (OR=5.3) and one-level over-placement in residential treatment center (OR=4.8). Concordance should be further explored using child-level clinical and placement stability outcomes. Discordance might be explained by dynamic factors such as availability of placements, caregiver preferences, or policy changes and could be justified by positive child-level outcomes. Empirical placement decision-making is critical to a child's journey in child welfare and should be continuously improved to effect positive child welfare outcomes.
authors.affiliation: Mental Health Services and Policy Program, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Suite 1200, Chicago, IL 60611, USA.
authors.forename: Ka Ho Brian
authors.initials: KH
authors.lastname: Chor
authors.forename: Gary M
authors.initials: GM
authors.lastname: McClelland
authors.forename: Dana A
authors.initials: DA
authors.lastname: Weiner
authors.forename: Neil
authors.initials: N
authors.lastname: Jordan
authors.forename: John S
authors.initials: JS
authors.lastname: Lyons
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D005581:Foster Home Care; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: Child welfare; Decision support algorithm; Log-linear modeling; Out-of-home placements; Team decision-making