Response to the Hughes et al. Paper on Differential Response

Potential Misallocation of Resources

Of all the issues raised in this review, we found four to be the most compelling. First, while DR programs vary greatly by jurisdiction, all are designed to provide enhanced services to families identified in various ways as low risk. Although differences in criteria used to define low risk are alone problematic, the idea of providing enhanced services to low-risk families when treatment resources are scarce presents a significant logical and ethical conundrum. Presumably, families assigned to DR are less likely than others to abuse or neglect their children in the future; or, depending which eligibility criteria are used, it is hypothesized that the level of subsequent maltreatment observed in low-risk families will not be as serious as that perpetrated by higher risk cases. To the extent this is true, even if DR programs proved successful, providing enhanced services to low-risk cases may represent a misallocation of resources. If these resources were instead allocated to high-risk families, they may produce even better results, providing greater protection to more vulnerable children.

There is little evidence that providing additional services to low-risk cases reduces future maltreatment. In fact, CRC research indicates that reducing services to low-risk families has no detrimental impact (Wagner & Johnson, 1999). This same research demonstrates that targeting resources to high-risk families can significantly reduce rates of subsequent abuse and neglect.

Some of DR’s focus on low-risk families presumably stems from the belief that, if not provided assistance, these families’ risk levels will increase over time. Prevention is a worthy goal, but there is little evidence to suggest that most low-risk families progress to higher risk levels over time. Unquestionably, some will, but current NCCD research suggests most will not. Though early intervention may prevent some future maltreatment, available research indicates using scarce resources to assist high-risk families has a far greater effect. Knowing this, why would agencies pursue programs that increase resources provided to low-risk families? That is not to say these families do not need services, but there are opportunity costs involved. Unless resources are unlimited, every dollar spent on low-risk families represents a dollar that could assist families at high-risk levels. One could well conclude there is an ethical mandate to establish funding priorities that focus on children most at risk of future maltreatment and that DR programs, by design, do not conform to this mandate.

The Cause and Effect Conundrum

Hughes et al. also cited myriad concerns with DR evaluations completed to date. One issue raised is central to the DR initiative’s fundamental purpose. DR programs are based on the premise that the current approach to child protection is too adversarial—that investigations are threatening and that concentrating on maltreatment allegations makes family engagement and service provision difficult. DR proponents hypothesize that a less adversarial approach concentrating on needs rather than maltreatment allegations will more successfully engage families without negatively affecting child safety.

This is an eminently testable concept. However, many DR programs complicate the issue by adding funding for services and resources—sometimes including basic living needs such as rent and appliances—that are not typically available to families in the traditional response (TR) track. In addition, DR workers often were provided more training and technical assistance than TR staff. This begs the question: if DR proved successful, is the success due to fundamental changes introduced with DR, or simply to increases in services and other resources? One could further argue that a corresponding increase in expectations should accompany increased resources, yet the overall goal for DR programs is simply to keep children as safe as they are in the TR track. It is rare to find evaluations where programs providing more services are expected only to maintain the status quo. Regardless, with these enhancements in place, it would be difficult, if not impossible, to determine precisely what was responsible if and when improvements in outcomes for DR cases were noted.

As Hughes et al. state, if the extra services provided to DR families resulted directly from savings in court costs or other requirements of TR no longer deemed necessary, the enhancements would be attributable directly to the change in strategies, and their inclusion would not be problematic. However, no such claim was made in any evaluation and the additional services were, in some instances, the direct result of funding provided by private foundations. Hence, instead of a level playing field on which the central premise of DR could be evaluated, DR programs were given resources not available to TR programs. Not only would these added services potentially affect outcomes, they would affect results of surveys of client and staff satisfaction as well. Under these circumstances, it would be surprising if families in DR programs—as well as DR staff—did not find DR more responsive to family needs.

It appears the efficacy of the DR strategy has not been established, even for low-risk families. We agree with the Hughes et al. study that claims of DR success go beyond what outcome data legitimately support.

No Clear Definition of Which Cases Should Be Eligible for DR Placement

The various methods used to determine which families are eligible for DR open the door for myriad unintended consequences. In general, DR targets families that are considered low risk. However, low risk is defined in a number of ways, either conflating immediate safety and longer term risk issues; or reflecting the severity of the allegation, the type of allegation (neglect or abuse), the source of the report, and/or case-specific factors, such as the age of the child. Even if valid risk instruments are used to assign cases to DR, there are instances where, in low-risk families, there are immediate and sometimes serious safety issues present. As the Hughes et al. study notes, if workers routinely accept the low-risk rating and concentrate only on building a helping relationship with the family, critical safety concerns could be overlooked:

Inaccurate assessments of children’s safety and risk of further harm not only affect the accuracy of track assignments—they also affect all subsequent case decisions. This is of considerable concern in a dichotomous tracking system such as DR, where everyone expects that families determined to be at “high risk” will be tracked to investigation and “lower risk” families will be tracked to [alternative response]. Therefore, if the information gathered by the screener does not reach the threshold necessary to trigger an investigation, the family may automatically be perceived as “lower risk” and by inference, the children thought to be “safer” than those children referred for investigation. (Hughes et al., 2013, p. 9)

OPEN IN VIEWER

Figure 1.

The relationship of safety and risk in California.

Even greater potential for error occurs when assignments to DR are based on other factors, often used as proxies for risk. As noted earlier, these include the severity or type of allegation, the source of the report, and the age of the child. In such instances, it is not at all clear that cases assigned to DR are indeed low risk. CRC was recently asked to review one state’s policies for assigning cases to DR and found that new referral rates for these families actually exceeded those observed for TR families (18.6% vs. 16.8%). This finding suggests that, if risk is used to guide track assignments, agencies should use valid, research-based tools. Criteria such as those listed above are not equivalent to risk of future maltreatment. Hence, youth assigned to DR could, in some instances, be more vulnerable than those investigated and managed in the traditional fashion.

Finally, the Desire to Help Families Does Not Reduce the Value or Need for Comprehensive Assessments of Safety and Risk

The Hughes et al. study states:

 … the principles that underlie DR programming may prevent a thorough assessment of risk and safety from occurring in alternative tracks. DR’s stated preference that workers focus on family needs rather than incidents of maltreatment would clearly discourage practitioners from having the sometimes difficult conversations with families that are necessary to fully assess risk and to address safety concerns… . . If the specific factors, conditions, and dynamics that elevate risk in a family are not accurately identified and fully understood, it is significantly more difficult to provide relevant services to remediate these conditions to prevent maltreatment recurrences (Rycus & Hughes, 1998). Caseworkers cannot help parents strengthen their protective capacities and reduce risk if the parents do not recognize or understand the safety threats operating in their family and how these are expressed. If workers do not know who was caring for a child when maltreatment occurred, or the circumstances of its occurrence, it is difficult to help families construct and implement safety plans to avoid similar situations in the future. (Hughes et al., 2013, p. 11)

Hughes et al. point out that some DR implementations include standardized, structured assessment tools. Historically, risk assessment has been criticized as being deficits based. As one component in a broader context of family assessment, risk assessment helps workers develop clarity amid the complexity of information available. Approaches that require both structured safety and research-based risk assessments—regardless of track assignment—may more effectively achieve balanced understanding of family situations; greater focus on how parental behavior affects child safety; and increased reliability and validity in decision making regarding the need for ongoing interventions.