Predicting outcomes of children in residential treatment: A comparison of a decision support algorithm and a multidisciplinary team decision model

Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study

“…This study, like most observational, longitudinal outcome studies, is methodologically limited by the lack of a control group or consideration of covariates that might explain “change.” Foremost, regression to the mean, as highlighted in our earlier study (Chor et al 2012), could explain the most robust findings that were consistent with our hypothesis, specifically the significant results for under-placing children in foster care, specialized foster care, and group home relative to children in concordant residential treatment. To safeguard against this phenomenon, comparisons between concordant and discordant decisions were made within the same level of care recommended by the CANS Algorithm (see Table 1).…”

“…The CANS Algorithm uses select CANS items, specific rating thresholds, and Boolean logic to standardize different placement criteria for foster care, specialized foster care, group home, and residential treatment (see Appendix). For example, to qualify for residential treatment, a child must show higher ratings (i.e., “2” or “3”) on risk behavior items, than to meet the criteria for specialized foster care, which are less stringent (Chor et al 2012; Lyons and Abraham 2001). The CANS Algorithm accounts for variability in child profiles.…”

“…Consistent with goals to reduce restrictive placements as well as increase placement stability, there is a growing interest in improving placement decision-making to continuously improve children’s experiences in out-of-home care (Barber and Delfabbro 2003; Blakey et al 2012; Chor et al 2012; James et al 2004; Leathers 2006; Rubin et al 2007). Two major decision models have been applied to placement decision-making in child welfare: the multidisciplinary team model and the decision support algorithm (Chor 2013).…”

“…An initial study examined 466 children placed in residential treatment. Where the placement in residential treatment was concordant with the CANS Algorithm, there was greater improvement in children’s life functioning, emotional, behavioral needs, and risk behaviors (Chor et al 2012). Children whose placement in residential care was not supported by the CANS Algorithm, however, showed less or no improvement, suggesting that less restrictive, community-based settings would be more appropriate.…”

Therapeutic residential care in Spain. Population treated and therapeutic coverage

“…A last aspect that should be clearly defined is the profile of the population that is treated in these centres. It seems that the lack of clear criteria, as well as the limited use of rigorous detection instruments to refer cases to TRC facilities, is fairly widespread (Chor, McClelland, Weiner, Jordan, & Lyons, ; Pecora & English, ; Whittaker et al, ). This is a serious problem because, as the profile of the population to be treated is not defined, it is practically impossible to clearly define the components that determine the success of the intervention because of the mix of different profiles.…”