Structured Decision Making (SDM)
About This Program
Target Population: Families referred to and assessed by child protective service (CPS) agencies
For parents/caregivers of children ages: 0 – 17
SDM is a comprehensive case management system for Child Protective Services (CPS). CPS workers employ objective assessment procedures at major case decision points from intake to reunification to improve child welfare decision-making. SDM targets agency services to children and families at high risk of maltreatment and helps ensure that service plans reflect the strengths and needs of families. When effectively implemented, it increases the consistency and validity of case decisions, reduces subsequent child maltreatment, and expedites permanency. The assessments from the model also provide data that help agency managers monitor, plan, and evaluate service delivery operations.
The primary goals of Structured Decision Making (SDM) are:
- Reduce subsequent maltreatment
- Reduce time to permanency
The essential components of Structured Decision Making (SDM) include:
- The primary goal of the SDM case management system in CPS is to reduce the subsequent maltreatment of children in families where an abuse or neglect incident has occurred.
- The underlying logic is that the best way to accomplish this goal is to accurately identify families at high risk for maltreatment, prioritize them for agency service intervention, and then effectively deliver services appropriate to their needs.
- The following SDM assessments were designed to help workers make decisions necessary to accomplish these tasks. Use of the assessments can also help bring a greater degree of consistency, objectivity, and validity to case decisions. The model includes the following components:
- Safety Assessment: This helps workers identify the immediate protective service interventions (including child removal) required, if any, during a CPS investigation or case.
- Research-Based Risk Assessment: This estimates the likelihood of future abuse and/or neglect and informs the decision to provide services and how often a worker should have contact with a family.
- Objective Strengths and Needs Assessment: This helps workers identify and prioritize the specific service interventions needed to construct an effective treatment plan.
- Periodic Reassessments of Safety, Risk, and Needs: These measure progress and help workers update the treatment plan and review readiness for case closure.
- Reunification Assessment: This informs workers' decision to reunify the child with his/her family or to change the permanency-planning goal.
- Service Levels (e.g., low, moderate, high, and intensive) Based on Results of the Risk Assessment: These guide the minimum contact standards a worker makes with the family. This practice ensures that staff time and attention are concentrated on those families at the highest levels of risk and need.
- Efforts to Support Equity: These include multicultural participation and awareness of multicultural lens in customizing items and definitions in the development phase; testing for equity in risk validation studies in the research phase; and continuous quality improvement to evaluate consistent application of items across cultures, supervision/coaching to increase awareness of application of items across cultures, and use of aggregate data cross-tabulated by race/ethnicity to examine patterns and use of findings to focus efforts to increase equity in the post-implementation practice and evaluation phase.
Structured Decision Making (SDM) directly provides services to parents/caregivers and addresses the following:
- Child involved in the Child Welfare system
The number of face-to-face contacts between a family and the caseworker varies based on the risk level obtained from completing the risk assessment. The number of contacts increases with an increase of the family risk level. The goal of differential contact standards is to target limited resources to those families most at risk of maltreating their children in the future. For example, a very high-risk family will have four face-to-face contacts (at least two with the case manager) per month, while a moderate risk family will have two face-to-face contacts (at least one with the case manager) per month.
Caseworkers employ assessments throughout the life of a CPS case, from intake to closure from foster care or in-home services.
This program is typically conducted in a(n):
- Community Agency
This program does not include a homework component.
Resources Needed to Run Program
The typical resources for implementing the program are:
Usually existing agency resources can be used. A management information systems component is strongly recommended.
Education and Training
Prerequisite/Minimum Provider Qualifications
Minimum qualifications for workers using the case management system are determined by the CPS agency.
Education and Training Resources
There is a manual that describes how to implement this program , and there is training available for this program.
- Philip Decter
phone: (800) 306-6223
Training is obtained:
Training is typically provided onsite, as either a training-for-trainers or direct training of workers and supervisors.
Number of days/hours:
2 to 4 days
There are pre-implementation materials to measure organizational or provider readiness for Structured Decision Making (SDM) as listed below:
An organization is helped to fully understand the implications and process for adopting SDM. This includes, but is not limited to:
- Understanding the objectives the organization wishes to achieve
- Assisting in developing a logic model for the project
- Reviewing the elements (i.e., implementation drivers) needed for success
- Contributing to an informed decision on whether the organization is ready, and if not, what would help to prepare PowerPoint presentations are used in conversations with jurisdictions who are considering SDM, and throughout implementation to explain and continuously revisit implementation drivers.
Formal Support for Implementation
There is formal support available for implementation of Structured Decision Making (SDM) as listed below:
The program offers assistance to a jurisdiction interested in implementing SDM from pre-implementation through sustainability. Assistance with the following implementation related-issues can be provided:
- Change management
- Policy and procedure integration
- Implementation planning
- Helping to build organizational culture and climate that supports learning
- Developing internal capacity for training and coaching
- Data collection
- Automation consultation
- Quality improvement
There are fidelity measures for Structured Decision Making (SDM) as listed below:
Specific fidelity measures fall into these groups:
- Completion rates
- Accuracy of completion
- Alignment of actions taken with actions recommended
Please note that SDM is typically taught within a family-centered, strengths-based, and safety-focused practice framework. Fidelity of these practice skills should also be evaluated, though this is not specifically part of SDM.
Implementation Guides or Manuals
There are implementation guides or manuals for Structured Decision Making (SDM) as listed below:
The implementation plan is customized for each site. Using the implementation drivers, combined with steps needed to customize the jurisdiction's SDM assessments and policies, a plan is customized to identify actions needed throughout pre-implementation, implementation and sustainability phases.
Research on How to Implement the Program
Research has not been conducted on how to implement Structured Decision Making (SDM).
Relevant Published, Peer-Reviewed Research
This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.
Johnson, K., & Wagner, D. (2005). Evaluation of Michigan's foster care case management system. Research on Social Work Practice, 15(5), 372-380.
Type of Study:
Nonrandomized comparison group matched by county
Number of Participants: 1,722
- Age — 0-18 years
- Race/Ethnicity — SDM: 79.5% White, 19.1% African American, and 5% Other/Unknown; Comparison: 49.1% White, 43.9% African American, and 7% Other/Unknown
- Gender — Not specified
- Status — Participants were children in foster care at the beginning of the intervention.
Summary: (To include comparison groups, outcomes, measures, notable limitations)
Counties implementing Structured Decision Making (SDM) were matched with counties using standard case management on demographics including race, percentage receiving public assistance, percentage below poverty line, and percentage in rural areas. They were also matched on administrative characteristics such as foster care caseload, ratio of cases per foster care worker, and percentage of cases managed under private agencies. Researchers assessed the permanency status of children at 15 months after placement. Permanency was defined as reunification with a parent, placement with another family member, adoption, or ability to be adopted due to termination of parental rights or other permanent arrangement (e.g., independent living, guardian placement). Analysis showed a significantly higher percentage of permanent placements for the counties using SDM than for the comparison group. This difference held when controlling for age, ethnicity, and initial type of placement. A greater number of comparison group children re-entered foster care than those in the counties using SDM (10.7% versus 7.9%), although this difference was not statistically significant.
Length of postintervention follow-up: 15 months.
Johnson, W. L. (2011). The validity and utility of the California Family Risk Assessment under practice conditions in the field: A prospective study. Child Abuse & Neglect, 35(1), 18-28.
Type of Study:
Number of Participants: 7,685 child abuse/neglect reports
- Age — Not specified
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were social workers in child welfare systems.
Location/Institution: Los Angeles, Humboldt, Orange, San Luis Obispo, and Sutter counties in California
Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study presents the analysis of the validity and implementation of a child maltreatment actuarial risk assessment model, the California Family Risk Assessment (CFRA; now called Structured Decision Making (SDM)). The following study addressed the following: (1) Is there evidence of the validity of the CFRA under field operating conditions? (2) Do actuarial risk assessment results influence child welfare workers’ service delivery decisions? (3) How frequently are CFRA risk scores overridden by child welfare workers? (4) Is there any difference in the predictive validity of CFRA risk assessments and clinical risk assessments by child welfare workers? The study analyzes reports originating in 5 California counties followed prospectively for 2 years to identify further substantiated child abuse/neglect. Measures of model calibration and discrimination were used to assess CFRA validity and compare its accuracy with the accuracy of clinical predictions made by child welfare workers. Results indicate imperfect but better-than-chance predictive validity was found for the CFRA on a range of measures. For 114 cases, where both CFRA risk assessments and child welfare worker clinical risk assessments were available, the CFRA exhibited evidence of imperfect but better-than-chance predictive validity, while child welfare worker risk assessments were found to be invalid. Child welfare workers overrode CFRA risk assessments in only 114 of 7,685 cases and provided in-home services in statistically significantly larger proportions of higher versus lower risk cases, consistent with heavy reliance on the CFRA. Limitations include the absence of blinding to previous risk assessments and a lack of population descriptive data.
Length of postintervention follow-up: None.
D’Andrade, A., Austin, M. J., & Benton, A. (2008). Risk and Safety Assessment in Child Welfare: Instrument Comparisons. Journal of Evidence-Based Social Work, 5(102), 31-56.
Shlonsky, A., & Wagner, D. (2005). The next step: Integrating actuarial risk assessment and clinical judgment into an evidence-based practice framework in CPS case management? Children and Youth Services Review, 27, 409-427.
Wiebush, R., Freitag, R., & Baird, C. (2001). Preventing delinquency through improved child protection services. OJJDP Juvenile Justice Bulletin. Washington, D.C: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.
- Philip Decter
- Agency/Affiliation: Children's Research Center
- Website: www.nccdglobal.org/assessment/structured-decision-making-sdm-model
- Email: PDecter@nccdglobal.org
- Phone: (800) 306-6223
- Fax: (608) 831-6446
Date Research Evidence Last Reviewed by CEBC: November 2017
Date Program Content Last Reviewed by Program Staff: October 2017
Date Program Originally Loaded onto CEBC: June 2008