By David Thompson
The efficacy of Family Assessment Response (differential response) in Minnesota is being questioned after the maltreatment death of a young child who had been the subject of an Investigative Response and several Family Assessment Responses. The death was particularly tragic since multiple other reports did not receive a formal response.
Given this context it is important to re-examine the purpose of the Family Assessment Response, clearly understand the intervention protocol itself and assess its impact.
The forensic focus of the Investigative Response was developed over fifty years ago to address battered children and other severe forms of maltreatment. In the intervening years, many other categories of child maltreatment were added to the responsibility of Child Protection including educational neglect, lack of food, clothing, shelter, supervision, medical care as well as emotional neglect and prenatal exposure to drugs. Over 78 percent of child maltreatment reports nationally are for neglect, according to the 2012 National Child Abuse and Neglect Data System (NCANDS).
The development of the Family Assessment Response in Minnesota grew out of dissatisfaction with the capacity of the Investigative Response to effectively address neglect and abuse issues driven by the lack of resources and services. Family safety and well-being could be better enhanced if families were quickly engaged and provided with services addressing their child maltreatment risk factors. Setting aside the fault-finding process diffused the families’ adversarial perception of Child Protection while the intervention still required an assessment of safety and risk and a disposition concerning the need for protective services or family support services.
The 2012 NCANDS report found that only 17.7 percent of child maltreatment reports were substantiated across the country.
Unintentionally, a child protection investigation often places additional stress on families already struggling with multiple stressors. Given the low substantiation rate, there is clearly an opportunity to work with families in a less adversarial environment. The service orientation of Family Assessment also provides an opportunity to invest in preventive services for families that were previously closed after an unsubstantiated report of child maltreatment.
The Family Assessment protocol in Minnesota parallels that of the Investigative Response absent the requirement for a substantiation decision. In addition, all reports alleging substantial child endangerment (severe abuse, abandonment, shaken baby, failure to thrive, etc.) must be initiated as Investigations.
Both protocols employ the Structured Decision Making (SDM) Safety and Risk Assessment tools. Family Assessment also conducts a Family Strength and Needs Assessment during the initial assessment. Both responses come to a conclusion about the need for protective services based on unresolved safety issues and/or high risk of maltreatment status. In addition, the Family Assessment may also make a disposition about the voluntary need for family support services when safety and risk are not in question.
In 2012 protective services dispositions were made in 16 percent of the Family Assessments in Minnesota, and voluntary family support services were opened in an additional 14 percent of Family Assessments. Both protocols allow switching between responses during the assessment or investigation based on new information. Family Assessments are not voluntary. In either the Family Assessment or Investigative protocols, a Juvenile Court petition for oversight is to be considered by the county attorney if families fail to cooperate with the initial assessment/investigation or a subsequent protective services plan.
In 2013, 7 percent of Family Assessments had a Juvenile Court filing within six months of the initial case opening.
The Institute of Applied Research studies of Family Assessment in both Minnesota and Ohio, involving random clinical trials, found that families were engaged quicker without sacrificing safety. Similar results were found in an earlier study in Missouri. More services were provided in Family Assessments and, while costing more initially, cost less over time due to higher needs of returning families in the Investigative track. Families also expressed greater satisfaction with the intervention.
These results continued over the multiple years of follow-up. Child maltreatment fatalities in Minnesota are a third of the national average and child maltreatment recurrence rates remain well within the federal standards, according to the 2012 NCANDS study.
Since the end of the pilot study and state-wide application in 2004, the percentage of reports assigned to Family Assessment has grown from approximately 40 percent to 70 percent.
Also during this time, the percentage of families in the high-risk category served by Family Assessment has grown to just over 25 percent. Approximately 50 percent of Investigations are in the high-risk category.
It is important to note that high risk does not equate to severity. Severity is indicated by the report category of substantial child endangerment. Risk projects the likelihood of any type of maltreatment. The higher the risk classification, the greater the likelihood that families in that class will experience subsequent child maltreatment of any type. The Minnesota Department of Human Services is analyzing risk data to see if there are characteristics of high-risk families (age of child, type of maltreatment, mandated or voluntary reporter, etc.) that suggest better outcomes by assignment in either track.
Some form of differential response exists in almost half of the states. With this growth there is a need for standardization of the intervention protocol, ongoing outcome accountability and funding support. Leadership concerning national standards should occur at the federal level.
The child welfare field should also be interested in reviewing the Investigative Response, which has a more standardized protocol nationally but widely varying outcomes for substantiation rates, service provision and maltreatment recurrence.
For both response tracks, child protection worker training and meaningful supervisory guidance is necessary to assure that protocols are being followed. Failures in both tracks may be more the result of failing to follow the intervention protocol than a failure of the protocol itself.
As a Minnesota Department of Human Services Child Protection manager, David Thompson was responsible for early intervention and child protection Investigative and Family Assessment Responses. He also consulted nationally concerning differential response and taught social work at the Universities of St. Thomas and St. Catherine, and currently chairs a non-profit organization, Give Us Wings, that builds infrastructure in rural Uganda and Kenya.