Chaffin, M., Bard, D., Hecht, D., & Silovsky, J. (2011). Change Trajectories During Home-Based Services With Chronic Child Welfare Cases. Child Maltreatment, 16(2), 114-125.
Child welfare is increasingly becoming a system that serves chronic cases which are consistently associated with poor outcomes. However, little is known about problem change during services among chronic cases and whether different change patterns might predict lower or higher risk for recidivism.
The study sample included 2,175 parents who were enrolled in an Oklahoma statewide network of home-based contracted family preservation and support programs. All participants were referred by child welfare due to reports of physical abuse and/or neglect. Parents receiving services due to child sexual abuse were excluded from the study because these cases were felt to present distinct services issues and needs. Data were collected at service entry (baseline), at the end of the program (median time = 205 days from baseline) and again at around 6 months after service exit. The analysis was divided in two parts. In the first section, a set of reliable questionnaires for measuring outcomes was used to determine latent classes of changes trajectories. The resulting classes were then connected to chronicity and recidivism, operationalized as substantiated or indicated reports to statewide child welfare agencies with the parent as the perpetrator. While chronicity refers to reports prior to the program, recidivism was accounted for by future reports starting from baseline and following-up for a mean of approximately three years.
Based on the outcome measures, five latent classes of change trajectories were identified and labelled as Stable Low Problem, Stable High Problem, Sustained Improvement, Relapsing, and Paradoxical. Chronic cases entered services with high problem levels and often showed limited and probably insufficient improvement over the course of services. The odds of being in the Stable Low class decreased and the odds of being in the Stable High class increased as number of prior reports increased. When a Stable High pattern was observed, recidivism was high. However, chronicity also was associated with the encouraging finding of a greater probability, not a lesser probability, of falling into the Sustained Improvement trajectory class. Cases in this trajectory had high problem levels, but they also showed good improvement over the course of services, their improvement was sustained at follow-up, and membership in the trajectory was associated with lower downstream recidivism. This favorable trajectory was noted in 10–20% of all cases. Although reactive episodic service efforts are not necessarily wasted on chronic families, chronic care models ought to be considered as a potentially better fit for this growing segment of the child welfare population.
Two strengths in design and methods are highlighted to underscore the study’s methodological rigor. First, unlike in other intervention studies, data were not collected by the service provider but by independent research assistants. Furthermore, participants completed a computer assisted self-interview and research assistants did not view the responses until the parents asked for assistance. Second, for an intervention study in child welfare with three points of data collection, an overall participation rate of 70% is quite good. To assess possible bias, sample demographics were compared to over 5,000 participants in the same programs from adjoining time with the result that demographics were comparable. A major limitation is the fact that outcome was solely assessed by parents. Future studies should aim at also including the child’s view.