Child protection decision making: a factorial analysis using case vignettes.
Stokes, Jacqueline ; Schmidt, Glen
The death of a child due to mistreatment and abuse is tragic and
evokes both private distress and public outcry. A public inquiry into
such a death is a common response, and the inquiry may lead to a major
overhaul of the child protection system responsible for protecting
vulnerable children. The Gove report (1995), which followed the death of
five-year-old Matthew Vaudreuil in British Columbia, Canada, and the
Laming report (2003), which followed the death of Victoria Climbie in
the United Kingdom, are two examples of this process. Reviews of this
nature examine the circumstances of the child's life and death and
pay particular attention to the decisions made by social workers,
supervisors, and managers. Social workers are asked to defend their
procedural practice. A limited amount of attention is paid to the
complexity of information that social workers face in their daily
decision making. Despite the history of numerous reviews conducted from
the perspective of hindsight and the adoption of various technocratic
policies and procedures that occur after such inquiries, child
protection social workers cannot be reduced to automatons who follow
rigidly prescribed blueprints when working with children and families.
Although there is a plethora of literature on child protection practice,
only a minimal amount of research has been devoted to understanding the
decision-making process or how the professional thinks in the context of
everyday practice (Kondrat, 1992; Walmsley, 2004). This research
examines decision making in child protection through the use of case
vignettes.
DECISION-MAKING PROCESS
Decision making in social work, and in particular in child
protection, is difficult, challenging, and fraught with risk and a
degree of uncertainty. Decisions are often made with insufficient,
unreliable, conflicting, or missing information within a stressful and
pressured organizational and political context (Budd, 2005; Gambrill,
2005a; Webb, 2002). Despite this uncertainty, social workers must decide
whether a child is safe, whether a child should be removed from his or
her home, whether to provide additional supports to a family, and how to
engage with a family to facilitate positive change for a child. These
everyday decisions can dramatically affect the lives of children and
their families. Increasingly, child protection practice has turned to
objective or evidence-based knowledge to augment the effectiveness,
accountability, and transparency of these decisions. The development of
risk assessment is a primary example of the application of
research-based knowledge to a practice and procedural tool. Risk items
are included when there is empirical research showing a statistical link
between the items or factors and the circumstances of the case being
assessed (Cash, 2001). These risk assessment tools standardize service
interventions and provide some degree of predictability. In many
jurisdictions the risk assessment tool has become the central
decision-making mechanism in child welfare (DeRoma, Kessler, McDaniel
& Soto, 2006).
However, the practice of applying knowledge to a specific situation
is more than an exercise in technical rationality; it requires social
workers to translate theoretical knowledge into skills and know-how for
practice (Kondrat, 1992; Parton, 2003). In the real world, it requires
what Squires (2005) referred to as
"repetition-with-variation." The art or practice of social
work is to interpret the individual client situation and take actions
that are consistent with the organizational and societal context. This
implicit store of knowledge is sometimes referred to as intuition,
common sense, or tacit knowledge (Zeira & Rosen, 2000). Although
there is some dispute in the literature about the denotative meanings of
these concepts, the literature agrees that there is more to professional
practice than technical know-how. Whereas empirical or scientific
knowledge allows for the application of systemic theory and procedural
rules, secondary forms of experiential knowledge take into account the
professional's store of cultural, personal, and practice knowledge.
It is this personal store of knowledge that becomes internalized and
allows the professional to filter a situation through his or her own
thinking process, to decide which information is relevant, to discover
patterns of meaning, and to value an individual's unique experience
of their everyday world.
It is not surprising that there are differing views among social
workers and experienced practitioners about the process of decision
making (Gambrill, 2005b; Reamer, 1993; Sicoly, 1989). Initial judgments
have been shown to be important in decision making. Gambrill (2005a), in
her work on critical thinking in social work, suggested that "we
have a tendency to believe in initial judgments, even when we are
informed that the knowledge on which we based our judgments was
arbitrarily selected" (p. 19). Furthermore, she contended that
these initial beliefs are resistant to change, even when new evidence is
provided. In a study of reasoning in child protection in Britain, Munro
(1999) developed similar conclusions. She found that most determinations
of risk were based on a limited range of data and subsequently, even
with evidence contrary to the worker's initial case disposition
decision, revision of judgment about cases was slow or nonexistent.
Although measuring risk is a predominant focus of a child
protection worker's practice, it is not the only one. Other areas
of attention include kinship care, family collaboration, and family
mediation, For these practices, social workers are required to develop
an interpersonal rapport that facilitates positive change for clients
(Kondrat, 1995).
Much has been written about the necessity of a good, trusting
therapeutic relationship in clinical practice. Building relationships
with non-voluntary clients has not been explored as extensively;
however, practitioners in child welfare regard relationship building as
extremely important (Yatchmenoff, 2005). Kondrat (1995) argues that
"in order to form the relationships necessary for change, the most
essential issue for the practitioner is that of informing his or her
judgment with reliable understanding--understanding of the other, of the
self, and of the emerging relationship" (p. 409).
RESEARCH CONTEXT
Recognition of the rapidity with which social workers have to make
decisions and the reluctance of social workers to modify those judgments
heightens the need to understand decision making from first contact. In
an era of risk management it seems that individual or professional
judgment has been largely ignored. The question arises as to how social
workers in child protection make decisions about children's safety.
Our research on this question was conducted in the province of British
Columbia (BC), Canada. In BC, child welfare protection services are
primarily delivered through the Government of BC's Ministry of
Children and Family Development (MCFD).
METHOD
To examine how social workers make everyday decisions, it is
important to use a research process that replicates as much as possible
the circumstances of daily decision making. The factorial survey method
of research, first developed by Rossi and Nock (1982), is a hybrid
technique that studies people's perceptions, beliefs, judgments,
and decisions associated with complex multidimensional phenomena (Jasso,
2006; Ludwick et al., 2004; Shlay, Tran, Weinraub, & Harmon, 2005).
The factorial survey technique serves to bridge "two research
paradigms by combining elements of experimental designs and probability
sampling, with the inductive, exploratory approach of qualitative
research" (Ganong & Coleman, 2006, p. 455). Although this
method has limited exposure in social work research, Taylor (2006)
argued that "factorial survey has potential as a method for
rigorous study of the impact of client, family, and context factors on
decisions by social work and social care staff" (p. 1187). In the
factorial survey method, the respondents are presented with contrived
hypothetical situations, or vignettes.
The factorial survey method possesses important strengths as a
research design, including internal and external validity and
robustness. Internal validity is high due to the random combination of
factors within vignettes and the random allocation of vignettes to
participants (Ganong & Coleman, 2006; Landsman & Copps Hartley,
2007; Taylor, 2006). External validity is high because the decisions
closely resemble those made in normal work situations. External validity
is also enhanced through consistent wording of the same factors, which
reduces the potential for bias in interpretation of the statements
(Landsman & Copps Hartley, 2007).
The robustness is increased because the vignette is the unit of
analysis rather than the respondent. Because the factors within the
vignette have an orthogonal relationship to one another, each vignette
is considered independent, and this provides the required randomness.
Another advantage of this method is how the sample size is defined.
"In the conventional survey design, the sample size is determined
by the number of participants in the study, and researchers are
interested in variation across subjects and subject groups" (Shlay,
Tran, Weinraub, & Harmon, 2005, p. 403). However, because the
vignette is the unit of analysis, the number of variations on the
vignette forms the sample size. This method maximizes the statistical
power (Landsman & Copps Hartley, 2007, p. 458). Although the
vignette is the unit of analysis, demographics and other factors
relating to the respondent can be considered for their effect on the
decisions (Taylor, 2006).
The development of the vignette is critical to the factorial survey
method. The vignette is designed to tell a logical story that simulates
real-life practice; therefore, the independent variables within the
vignette are important. In this research, consideration was given to all
of the dimensions currently identified in the BC Risk Assessment Model
as potential independent variables. The factors included as independent
variables were those that either dominate the literature or are present
in a substantial number of children or families that are investigated by
child protection agencies. Eight factors were chosen as independent
variables in decision making: (1) harm to child, (2) income, (3)
housing, (4) culture, (5) parental substance use, (6) family violence,
(7) resources and support, and (8) cooperation. A vignette framework was
then developed to include these factors.
Vignette Framework
Vignettes were structured using the following basic format:
The following situation has been presented at
a team meeting: Susan, age 7 is--harm to
child--. Susan lives with her mother and
father who--income--. They are living
in--housing--. Susan and both her
parents are--race--. The parents
--substance use--, and Susan reports that
--family violence--. The prior contact
record shows that the family--resources
and supports--. The parents have
--cooperation--.
Each of the independent variables, referred to as dimensions, is
broken into levels. For example, harm to child had four levels: (1)
neglect, (2) physical harm, (3) emotional harm, and (4) sexual abuse.
Income also had four levels: (1) no known income, (2) income assistance,
(3) one minimum wage, and (4) two jobs. With the exception of culture
(which had two levels: aboriginal and Caucasian), all other dimensions
had four levels. A computer-generated survey tool was developed that
would allow for the random assignment of levels for each dimension,
thereby ensuring that any non-orthogonality of the independent variables
was due to random error only. To ensure the realism of the vignettes,
three expert consultants with experience in child protection decision
making reviewed the vignette construction and the list of dimensions and
levels for content validity and clarity. Changes were made to the
vignette to ensure that the vignettes had internal believability. With
seven dimensions that have four levels and one dimension that has two
levels, 32,798 possible vignettes exist in this study.
Sample Vignette
The following populated vignette represents an example that a
respondent might receive.
The following situation has been presented at
a team meeting: Susan, age 7 has been attending
school with no lunch, without breakfast
and often seems tired and lethargic; she has
few clothes and no winter coat and is often
cold. Susan lives with her mother and father
who are relying on one minimum wage job.
They are living in a house that is poorly maintained
with numerous broken windows, open
electrical outlets, and evidence of animal
waste inside the house. Susan, and both her
parents, are Aboriginal people. The parents
are known to have a serious problem with
drug abuse, and Susan reports that she has
seen her father hit and shove her mother. The
prior contact record shows that the family has
little consistent, or reliable, support from
friends or family members. The parents have
had ambivalence about change and often miss
appointments but have some follow through
to services offered.
Responding to the Vignettes
Four questions about four dependent variables were developed.
Questions one and two dealt with the objective and technical aspects of
the risk assessment tool, whereas questions three and four related to
the relationship development factors important to the contextual
understanding of the client's situation.
Question 1 asked, "On a scale of risk, what is your initial
impression of the level of risk?" Respondents were asked to circle
one number on a five-point scale on which 1 = no risk and 5 = extreme
risk.
Question 2 asked, "Based on the information you have so far,
what is likely to be your placement decision throughout the
investigation process?" Respondents were given five possible
answers and asked to choose one:
(1) Close file, no further service required.
(2) Provide a referral to a community service provider.
(3) Provide intensive family support services with MCFD case
management.
(4) Arrange an informal placement with a family support network
(e.g. kith and kin in which MCFD does not have temporary custody).
(5) Develop a formal in-care arrangement (e.g. family foster care,
or a group home in which MCFD has temporary or flail custody).
Question 3 asked, "In this situation, how important is it that
you visit the family home in determining the degree of risk and
placement decision?" Respondents were asked to circle one number on
a five-point scale on which 1 = not very important and 5 = extremely
important.
Question 4 asked, "How many hours would you plan to spend
getting to know the parent(s) over the next four weeks?"
Respondents were asked to write any number of hours into a box.
Sampling
A request to participate in the survey was sent via e-mail to all
social workers in the BC MCFD. The social workers who agreed to
participate were provided with up to three unique vignettes. Most
participants responded to all three vignettes, but some addressed only
one or two. In total, 118 respondents responded to 327 unique vignettes.
Because the unit of analysis is the vignette, the sample size (n) is
327. The participants included 95 women (80.5 percent) and 23 men (19,5
percent). Thirty percent of all participants were between the ages of 35
and 44, and all held a minimum of a bachelor's degree in either
social work or child and youth care. Almost 70 percent of the
participants had six or more years experience in child protection; 88
percent of all participants had received specialized training in child
abuse, and 94 percent of all participants had received training in risk
assessment.
Analysis and Findings
Multiple regression was the primary statistical method used to
measure the relationship between each factor and the decision made.
Analysis of variance was used to establish statistical reliability.
Taylor (2006) suggested that by using multiple regression "it is
possible to infer a causal explanation (that is, that the factors
actually cause the change in the decision, rather than merely being
associated with it by 'accident') because the factors in the
vignette are virtually independent" (p. 1196).
The initial analysis provided the frequency, mean, median, and
standard deviation (SD) of the responses on each of the dependent
variables. The median response for all vignettes in terms of risk was 4
(on a five-point scale in which 1 = no risk and 5 = extreme risk) (SD =
0.77). For the service provision decision, the median response was to
provide intensive family support services (SD = 0.90). The median
response for visit importance was 4 (on a five-point scale in which 0 =
not very important and 5 = extremely important) (SD = 0.78). For the
number of contact hours, the median response was 7.25 hours (SD = 4.91).
For all six possible combinations of dependent variables, there was a
positive correlation. That is, a higher risk evaluation positively
correlated with a more intensive intervention, higher importance placed
on a home visit, and an increase in the number of hours to be spent with
the family. The highest positive correlation was for the interaction
between risk level and service provision ([R.sup.2] = .45, r = .673).
For the other five comparisons, there was a positive but weak
correlation.
A multiple regression analysis was used to examine the effect of
the independent variables on the assessment of risk, the service
provision, the visit importance, and the amount of contact hours (see
Table 1). Using the conventional probability level of .05, the
independent variables that had at least one level with a statistically
reliable effect on the decision of risk from the vignette were harm to
child, housing, substance use, spousal violence, and cooperation. The
independent variables of harm to child and housing had at least one
level that had a statistically reliable effect on the decision to
provide service. The factors housing and substance use had an impact on
visit importance, and only harm to child had a statistically reliable
effect on the number of contact hours. No factor had a statistically
reliable effect on all decisions. Income, culture, and resources and
support did not have a statistically reliable effect on any decision.
Although the vignette is the unit of analysis and not the
respondent, in factorial survey design the factors about the respondents
are treated as independent variables. Respondents were asked questions
pertaining to ten independent variables: gender, age, job satisfaction,
type of degree qualification, the amount of child protection experience,
the amount of experience in the community, delegation, whether they
practiced in an urban or rural location, satisfaction with supervision,
and the specific role they played in protection work (for example,
intake, resource, family service) (see Table 2). Only degree and
supervision satisfaction had a statistically reliable effect on the
decision about risk level. Degree, child protection experience, and
community experience had at least one level that had a statistically
reliable effect on service provision. Gender, age, job satisfaction,
degree, and current social work role had at least one level that had a
signficant effect on visit importance. The number of contact hours
decision was affected at statistically reliable rates on eight of the 10
variables; the only variables that showed no statistically reliable
effect were job satisfaction and supervision satisfaction. Of the
independent variables associated with the respondent, all had at least
one level that had a statistically significant effect on at least one
dependent variable. Degree was the only variable that had a
statistically reliable effect on all four of the dependent variables.
DISCUSSION
Decision making in child protection work is complex, and workers
are influenced by factors from multiple sources. Our research does not
demonstrate a clear causal relationship between the decisions made and
the source of knowledge on which those decisions rest. However, it does
appear that social workers are more likely to use technocratic,
evidence-based knowledge derived from the case situation when making
decisions about risk level or service provision. This contrasts with
decisions that are related to developing a relationship with the client.
Variables about the social workers themselves affect factors such as
time spent with the family and the importance of a home visit.
Although the debate about whether social work is a science or an
art is a long-standing one, this research indicates that despite the
emphasis on the quantitative and procedural mechanism of the risk
assessment tool, some social work decisions are affected by the social
worker's own experiences and who he or she is as a person. This is
consistent with the findings of Parada, Barnoff, and Coleman (2007),
who, in their ethnographic study on social work decision making in
Ontario, concluded that there is an interaction between the structured
system of standardized procedures and the use of intuition that was
likely grounded in the social workers' internalized knowledge.
Similarly, Blom, Nygren, Nyman, and Scheid (2007) found that child
protection workers used multiple forms of knowledge.
In BC, Judge Gove (1995) recommended that the Risk Assessment Tool
be used but argued that no formal risk assessment system can replace
good social worker judgment (Callahan & Swift, 2007). However, an
unintended consequence of the focus on the so-called objectivity and
proceduralization of a device, such as the risk assessment tool, has
been a neglect of the development of further understanding of how
professional judgment and personal subjectivity affect the
decision-making process. Current practices have devalued the importance
of the skills it takes to develop and sustain an effective relationship
in child protection. Our research found that child protection workers
are more likely to pay attention to objective facts about a case
situation when making decisions about risk and service provision, but
more subjective factors are likely to affect decisions about home visits
and contact hours.
This is an important point, as it shows a shift away from
investigative work to work that emphasizes family support. Researchers
such as Yatchmenoff (2005), who identified how positive client
engagement is a beneficial component of child welfare, and Lee and Ayon
(2004), who argued that the nature of the client relationship is a
primary prerequisite for effective assessment and intervention in child
welfare, have highlighted the positive effect of a good helping
relationship with involuntary and sometimes resistant clients.
Furthermore, Lee and Ayon (2004) found a significant correlation between
a good worker-client relationship and improvements in children's
physical care, discipline, emotional care, and parental coping. The
necessity of a good helping relationship has been further argued by
Platt (2008), who concluded that in the current context of increasing
proceduralization in statutory social work changing the structures and
techniques may be helpful, "but the roles of skilled workers are at
least equally important" (p. 314). Our research indicates that when
the importance of home visits and the amount of client contact are
considered critical to the development of the relationship, the
characteristics of the social worker are paramount in decision making.
This indicates that more attention should be paid to relationship
building skills that continue past the formal academic environment into
the practice setting. Although schools of social work provide
foundational relationship building skills in their curriculums, more
advanced in-house instruction and training should be provided in order
to make certain that these skills remain viable and integrated into
practice.
The role of relationship development seems to he critical to client
change in child protection, but it requires more than technical
instrumentality; social workers must make effective use of self to
exercise professional judgment. In contemporary society professional
judgment has been relegated to a secondary form of knowledge widely
perceived as being untrustworthy. In complex situations in which there
is no simple agreed-on solution, workers need to be encouraged by their
supervisors to reflect on the complexities of the case. This kind of
reflective practice involves talking and sharing on both rational and
affective levels (Ruch, 2002) and requires time for social workers to
describe and interpret their experiences, ideas, thoughts, and feelings.
This can occur in self-reflective ways through internal dialogue,
dialogue with oneself through writing or audio recording, or through
dialogue with colleagues and supervisors. This iterative process of
questioning and reflecting leads to a conscious and more objective use
of self (Mandell, 2007).
Child protection work is complex, and the environment in which it
occurs can be challenging. Mistakes and tragedies become the subjects of
intense media scrutiny, which leads to political pressure to change
procedures and social work practice. Social workers may be vilified in
the media, and the credibility of the profession is hurt. When changes m
practice are implemented in reaction to public scrutiny and media and
political pressure, the resulting swings or shifts can be dramatic. In
the case of BC, the media attention and the subsequent Gove Inquiry
surrounding the death of Mathew Vaudreuil saw the child protection
system shift its emphasis from significant use of family support
services involving professional judgment to a primary focus on
technocratic risk assessment. Neither of these approaches is inherently
good or bad, and perhaps the best child welfare practice uses both in a
balanced and thoughtful manner.
Our research indicates that despite pressures to adopt a technical,
rational approach to decision making, social workers are holding on to
the humanistic and artistic components of social work practice. They are
using self and their experiential knowledge to make decisions about
developing client relationships while paying attention to empirical
research linked to evidence within case situations to make decisions
about risk and safety.
POINTS & VIEWPOINTS
If you would like to make a substantive response to the premises,
studies, and intellectual positions in an article you read in Social
Work, this is your forum! This column seeks to stimulate dialogue that
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doi: 10.1093/sw/swr007
Original manuscript received February 19, 2010
Final revision received August 5, 2010
Accepted August 17, 2010
Advance Access Publication June 4, 2012
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Jacqueline Stokes, EdD, RSW, is dean, School of Academic Foundation
and Academic Services, College of New Caledonia, Prince George, Canada.
Glen Schmidt, PhD, RCSW, is associate professor, School of Social Work,
University of Northern British Columbia, Prince George, Canada. Address
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Table 1: Risk Assessment (n = 327)
Risk Level
Variable df [chi square] P
Harm to child 3 104.98 <.0001
Income 3 0.96 .8100
Housing 3 7.84 .0494
Culture 1 0.55 .4569
Substance use 3 15.89 .0012
Spousal violence 3 11.62 .0088
Resources and support 3 5.25 .1546
Cooperation 3 13.86 .0035
Service Visit
Provision Importance
Variable [chi square] P [chi square] P
Harm to child 102.79 <.0001 4.08 .2529
Income 1.01 .7996 2.46 .4823
Housing 15.31 .0016 11.81 .0081
Culture 1.22 .2690 1.52 .2173
Substance use 1.57 .1347 10.33 .0167
Spousal violence 3.16 .3679 0.40 .94505
Resources and support 0.47 .9256 4.37 .2241
Cooperation 7.60 .0550 3.75 .2903
Contact
Hours
Variable F P
Harm to child 4.63 3
Income 0.94 .4234
Housing 2.10 .1011
Culture 0.04 .8405
Substance use 2.00 .1147
Spousal violence 0.85 .4657
Resources and support 0.37 .7763
Cooperation 1.55 .2019
Table 2: Respondent and Organizational Variables (n =118)
Risk Level
Variable df [chi square] P
Gender 1 3.29 .697
Age group 3 2.28 .5171
Job satisfaction 3 2.10 .5510
Degree 4 11.29 .0235
Protection experience 4 8.96 .0621
Community experience 5 7.26 .2024
Delegation experience 1 0.08 .7772
Practice in urban location 2 0.88 .6430
Supervision satisfaction 6 15.99 .0138
Current social work role 1 5.40 .7138
Service Visit
Provision Importance
Variable [chi square] P [chi square]
Gender 0.74 .3892 6.55
Age group 4.87 .1815 8.26
Job satisfaction 3.21 .3602 24.29
Degree 17.31 .0017 20.69
Protection experience 17.52 .0015 4.61
Community experience 9.90 .0780 6.40
Delegation experience 0.16 .6882 1.61
Practice in urban location 3.52 .1716 1.40
Supervision satisfaction 10.30 .1125 6.17
Current social work role 7.91 .4426 74.79
Visit
Importance Contact Hours
Variable P F P
Gender .0105 3.96 .0475
Age group .0409 9.06 <.0001
Job satisfaction <.0001 1.93 .125
Degree .0004 7.76 <.0001
Protection experience .3294 0.73 .5719
Community experience .2691 3.61 .0035
Delegation experience .2039 6.59 .0108
Practice in urban location .4965 12.64 <.0001
Supervision satisfaction .4042 1.85 .0906
Current social work role .0017 2.08 .383