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Chapter 1
THE PROBLEM
Introduction
As I embarked on my studies towards becoming a professional social worker I
understood the necessity of being an agent of change. The agent of change that I want to
be is an agent of change in the lives of children. Being an agent of change in the lives of
children is important to me. The primary mission of the social work profession is to
enhance human well-being and help meet the basic human needs of all people, with
particular attention to the needs and empowerment of people who are vulnerable,
oppressed, and living in poverty. Since children are the most vulnerable members of our
society, this is the area where I want to focus. I want to be an agent of change in their
lives and families.
During the second year of my undergraduate studies, I was placed at a local level
twelve children’s home. A level twelve children’s home serves children that have been
removed from home through the court process due to severe neglect and abuse. The
children have been out of home for some time and have significant behavioral disruptive
behaviors that interfere in their ability to live in a home setting. During my time there I
interacted with many children placed there because of behavioral or mental health issues.
After reading their files, I could not help noticing how many times these children were
placed in multiple foster care homes. There was a six year old little girl who had been in
23 different foster or children’s homes since she was removed from her family of origin
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at age four. After being removed from home and changing placements so many times, it
was obvious why these children had behavioral issues. For example, this little girl used
to masturbate in front of the other children and stick pencils inside her vagina.
During my interactions with these children I sensed their need to belong. Many
times they tested me to see if I could handle them or if they could trust me. Others would
open up one day and the next day they would call me every name in the book without any
provocation. By doing this they were testing me to see if I would abandon or giving up on
them. I understood their behavior and frustration every time a family member would not
show up for their visit. They felt abandoned, alone and hopeless.
Now as a student intern in Yolo County Child Protective Services, I see and
experience, first hand that county child welfare agencies are granted extraordinary
powers. They investigate child abuse reports, remove children from their homes without
prior court approval, and determine where and with whom a child in foster care shall live.
They change a child’s placement repeatedly, decide what school that child will attend,
and when, where, and how often that child will visit his or her family. They select the
child’s physician and therapist, and finally, these county agencies dictate what parents
must do in order to regain custody of their children. With these powers come great
responsibilities and I am not sure if child protective agencies are acting responsible
enough to protect abused and maltreated children.
When needy biological parents receive inadequate support services, they are less
able to provide for their children, thereby contributing to the need for child protective
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services. In the absence of intensive support services, permanency planning for many
children means a revolving door; placement in foster care, reunification with the
biological parent (s), and then return to foster care.
According to Reed & Karpilow (2002), seven out of every 10 children in the child
welfare system are in foster care and as of April 1, 2002, 91,951 children were in child
welfare supervised foster care in California. Many children cycle through the foster
system more than once and experience multiple placements. About 20 percent of children
entering foster care each year have been in foster care at least once before. Of the
children who entered foster care in 2000 and remained in care for 12 months, 35 percent
had experienced three or more placements; of those who entered foster care in 1999 and
remained in care for 24 months, 48 percent had experienced three or more placements
(Reed & Karpilow, 2002).
Connell, et. al (2006) explain that children who experience multiple placement
changes are more likely to exhibit attachment difficulties, externalizing and internalizing
behavioral problems. In addition, they argue that placement changes are associated with
disruption in educational settings and decreased academic performance.
Background of the Problem
Foster care is one of the central intervention strategies of contemporary child
welfare practice. Ideally, foster parents care for a maltreated child for a limited period of
time while interventions aimed at family treatment and reunification (family
preservation) or adoption (permanency planning) are implemented. These different
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intervention goals lead to the already traumatized child often spending years in foster
care, sometimes with many foster families. Probably most any child who has already
experienced a number of life traumas and then the loss of their family of origin will only
be further harmed by going through a series of developed and then lost relationships with
foster parents and siblings. For instance, a 4-year-old boy in New York was placed in 37
different homes in two months and another child was placed in 17 homes in 25 days
(Karger & Stoesz, 2006, pg. 402).
Anyone who has practiced or served in the field of social work and child
protection services will understand how such multiple placements can happen. The
typical lack of more permanent placements, in combination with the kinds of multiple
challenges that such maltreated children often have, can present long term and arduous
parenting challenges to the best of foster parents.
Numerous accounts document the often deleterious psychological and health
consequences of frequent changes in placement for foster care children (Holland &
Gorey, 2004). Placement changes are associated with compromised developmental
trajectories and poor adult outcomes. Accounts of such negative consequences have
prompted the public and legislators to call for action. As a result, laws such as the
Adoption and Assistance Child Welfare Act of 1980 and the Adoption Assistance and
Safe Families Act of 1997, were enacted that, among other things, emphasize shorter
lengths of stay and more stable placement for children in foster care.
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Statement of the Research Problem
Team Decision Making (TDM) was implemented with the purpose of reducing
multiple placements of children in the foster care system (Annie E. Casey Foundation,
2001). Yet, not every child in the foster care system has a TDM when changing
placement. The lack of knowledge of TDM by social workers contributes to children
being moved from place to place. Proper planning by service providers and families
would aid in decreasing multiple placements of children involved in the foster care
system. Increasing understanding of social workers regarding TDM would help to
increase their confidence in the proper use of TDM and increase their faith in the
reduction of multiple placements.
Purpose of the Study
The purpose of this study is two-fold. The primary purpose is to find out how
Team Decision Making was implemented to remedy multiple placements in the Child
Welfare System. The secondary purpose is to find out how Team Decision Making is
used and obstacles for implementation. The results of this study will highlight and
measure the process of implementation of such a practice and its utilization. The study
will shed light on how well Team Decision Making is being used and how its
implementation has helped remedy multiple placement of foster children in the child
welfare system. The study will also reveal what Team Decision Making social workers
think about training, use, and satisfaction with Team Decision Making.
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Theoretical Framework
The principles of Systems theory guides this project, in an effort to describe how
Team Decision Making was implemented to remedy multiple placement in the Child
Welfare System, how it is used and obstacles for implementation. Systems theory
continues to be a popular theory for explaining human behavior and social interaction in
the social sciences and particularly in the field of social work because it explains human
behavior as the result of numerous, equitable interactions among people functioning in
common and interrelated systems (Hutchinson, 2003, pg. 50).
System theory has developed around the central idea that systems are made up of
many, interconnected parts. These parts, whether they be “social, cultural, economics,
and political environments” all work together to make up an organized whole
(Hutchinson, 2003, pg. 53). A social system is not exclusive, as all systems are
subsystems of other larger systems and the members of a specific system have
relationships with other systems (Greene, 2005). Social systems are goal-oriented and
purposeful, and work to initiate, maintain, and improve social networks and mutual
support (Greene, 2005; Payne, 2005). This evolution in thinking appreciates the
complexity of systems theory and the capacity for change in one system to create positive
or negative changes within other related systems. A systems perspective has been useful
in social work practice methods because it encourages interventions that are inclusive of
complex systems that continuously change, creating obstacles and barriers for our client
populations.
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In measuring the way team decision making was implemented and used, system
theory will be used to demonstrate how the child welfare system managed to implement
Team Decision Making, (TDM) and how these changes are interrelated in various
systems of change. The level of comfort that TDM social workers have at recognizing
and addressing social issues is important. It identifies their perceptions about the
effectiveness of Team Decision Making.
Systems theory can be applied to the research question by looking at the different
levels of interventions possible to implement a new program. The micro level assesses
the direct ways in which a child’s life would be affected when that child is removed from
their home. Each family is tied to many systems, knowing these systems would be
important when looking for possible barriers to help the family and children overcome
these barriers. These systems could be church, school, and neighborhood among many
others. At a mezzo level of intervention is the surrounding community’s way in helping
the family. Community based organizations have resources to help families and their
children work out the obstacles that impede them from keeping their children at home.
Definition of Terms
Family Group Decision Making: a practice rooted in the belief that families have
a shared history, wisdom, untapped recourses, and an unrivaled commitment to their
children (Merkel-Holguin, 2005). It is a meeting of a child’s extended family and service
providers in cases of child maltreatment.
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Team Decision Making: takes place in child welfare planning, it happens in a
meeting that includes family members, their extended family or other support persons,
foster parents, service providers, other community representatives, and the caseworker to
reach consensus on a decision regarding placement and to make a plan that protects the
children and preserves or reunites the family (Annie E. Casey Foundation, 2002).
Permanency: one of the methods of securing a stable home for a foster child: can
include adoption, legal guardianship, reunification, or placement with a fit and willing
relative (Casey Family Programs, 2006). Adoption happen when an adult or family takes
full legal responsibility for a child as if was their birth child. Legal guardianship is when
a foster parent assumes legal responsibility for a child, but this responsibility is limited
until the child turns 18. Reunification occurs when the child is returned to his/her family
of origin after completion the necessary steps to reunification.
Foster Care: is the care provided to children who are removed from their families,
group homes, or institutions. Such care is supervised by public child welfare agencies for
children in their custody who must live apart from their parents because of child abuse,
neglect, or other special circumstances (Wells & Guo, 1999).
Assumptions
Permanence is essential to the well being of every child in foster care and the
child welfare system. Children deserve a place where they can grow as productive
members of a society and feel proud of themselves. Children need supportive adults in
their lives who love and support them. Social workers know that families need to be
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included in the decision making regarding where their child should be placed. Every
child who enters the Child Welfare System deserves a safe home, nurturing environment,
and childhood without multiple placements.
Justification
This study is important to the field of social work because its supports the fundamental
mission of social work to assist individuals who are marginalized and underrepresented in
society. The social work professions mission to advocate for those affected by controversial
policy issues such as achieving permanence of children in the foster care system, makes this study
relevant to social work. The justification for choosing the topic is to have an understanding
of how Team Decision Making was designed to remedy multiple placements in the child
welfare system. Specifically, the intent of the research study is to get a better
understanding of how a new system, in this case, team decision making is implemented,
its obstacles for implementation and how it is use. Several social workers are employed
in settings where they must organize important information in a child’s life to come to a
team decision making meeting to decide the best placement for that child.
Limitations
This research project was not developed in support of or against Team Decision
Making, rather it was chosen as a means of bringing forth valuable information about
Team Decision Making implementation, limitation and use. Further, the research project
does not study social worker’s actual social work practice out in the field, nor does it
study whether social workers and staff involved in the implementation of Team Decision
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Making have changed in reference to values and attitudes after participating in the
research project.
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Chapter 2
LITERATURE REVIEW
Introduction
The following literature review provides information on different areas of the
Child Welfare System. These areas are explored to gain understanding of the need for the
implementation of Team Decision Making (TDM). There are several policies and
programs that have been implemented in the Child Welfare System that have been
essential to the development of Team Decision Making (TDM).
The literature is divided into three major thematic categories with the intention of
developing a clear perspective about the need for the implementation of Team Decision
Making (TDM) in the Child Welfare System. The following themes will be discussed in
the remainder of this chapter. First, the researcher will provide a brief overview of the
history of the child welfare system and its legislation. Second, foster care in the child
welfare system will be discussed. The third theme is the California Child Welfare
Redesign, which will be discussed because Team Decision Making was implemented as
part of the California Child Welfare System Redesign as one of the four key strategies of
family-to-family. Family-to-family is a variety of strategies for reforming the child
welfare system (Casey E. Foundation, 2009).
Brief Child Welfare History & Legislation
In the early history of the United States, child welfare took the form of
orphanages and almshouses that served the poor and orphaned children (Lindsey,
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Shlonsky & McLuckie, 2008). Protective services for children began with one of the
more unusual incidents in American Social Welfare. In 1845, after the much publicized
case of Mary Ellen Wilson, a young child who was abused by her caregivers, New York
City established the country’s first Society for the Prevention of Cruelty to Children
(Brittain & Hunt, 2004, pg. 32). In 1909, President Theodore Roosevelt convened the
White House Conference on the Care of Dependent Children, but the federal government
did not enter the child welfare arena officially until 1912, when it established the
Children’s Bureau (Brittain & Hunt, 2004).
Children had little legal protection from maltreatment until the early 20th century
when addressing child abuse and neglect became a component of the new juvenile court
movement (Jones, 2006). Over the years, the child welfare system has changed and
evolved into a complex system designed to care for maltreated children in family like
settings (Connell, et.al, 2006).
There are key federal laws that impacted the child welfare system. One such lawn
that has had great impact in reporting child abuse and neglect is The Child Abuse
Prevention and Treatment Act (CAPTA) (Brittain & Hunt, 2004). CAPTA began to
shape the current child welfare system by mandating that states establish child abuse
reporting laws, define child abuse and neglect, describe the circumstances and conditions
that obligate mandated reporters to report known or suspected child abuse, determine
when juvenile/family courts can take custody of a child and specify the forms of
maltreatment that are criminally punishable (Reed & Karpillow, 2002).
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The Adoption Assistance and Child Welfare Act of 1980, was intended to reverse
the negative effects of CAPTA by emphasizing preventative services and family
preservation/reunification programs (Brittain & Hunt, 2004, pg. 41). A negative effect of
CAPTA was that it created incentives for states to remove children from their homes and
place them in foster care. In addition, public agencies expended less energy and money
on keeping families intact and allocated their dollars to support out-of-home placement
(Brittain & Hunt, 2004). Reed & Karpillow, 2002 explain that The Adoption Assistance
and Child Welfare Act of 1980 also created a categorical funding stream for out of home
foster care to support the basic goal of protecting children, but established a preference to
maintain and reunify families. This Act requires reasonable efforts to prevent
unnecessary out of home placements, requires consideration of relatives as the placement
of preference, establishes a process to safely reunify children with their families when
possible, and authorizes assistance payments to families who adopt children with special
needs (Reed & Karpillow, 2002). In an effort to respect the cultural heritage of children,
the following laws were implemented.
Multi-Ethnic Placement Act (MEPA), 1994 and Inter-Ethnic Placement
Provisions 1996. MEPA, prohibits delaying or denying the placement of any child on the
basis of race, color, or national origin, and requires that states recruit prospective
adoptive and foster care families that reflect the ethnic and racial diversity of children
needing homes. The Inter-Ethnic Placement Provision amended MEPA and strengthened
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its provisions to ensure that adoption and foster care placements were not delayed or
denied because of race, color, or national origin (Reed & Karpillow, 2002).
The Adoption and Safe Families Act (ASFA), (1997) provided both changes and
clarification to The Adoption Assistance and Child Welfare Act of 1980. The Adoption
and Safe Families Act emphasizes child safety over keeping families together and
provides financial incentives to states to promote permanency planning and adoption
(Brittain & Hunt, 2004, pg. 42). It also identifies additional circumstances for terminating
parental rights, establishes a time-limited federal waiver demonstration project for
selected states to test new service delivery approaches, and requires DHHS to adopt
outcome measures and a way to systematically collect data from states (Reed &
Karpillow, 2002). The data collected from states helps DHHS to measure outcomes of
services provided. However, as is common with large systems such as the child welfare
system, the actual outcomes have failed to meet the projected results.
Child Welfare Challenges
Every state has a system that responds to reports of child abuse and neglect,
investigates these reports, connects some families to services, and places children in
substitute care when necessary to keep a child safe. State and federal laws, framed
largely by the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 and the
Adoption Assistance and Child Welfare Act of 1980 as well as legislative advances
through the 1990’s guide these systems and provide major resources for implementation
(Center for the Study of Social Policy, 2003).
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Child welfare in the United States has a lengthy history of fluctuating between a
priority of child safety and family preservation (Shore, et.al, 2002). Child safety stresses
the state’s responsibility to regulate the child’s care and ensure that it meets adequate
standards of protection; family preservation urges a responsible approach to children and
their caregivers to promote healthy families. While both regulations and responsiveness
are necessary for safeguarding children, neither approach alone is sufficient for an
effective child welfare system (Pennell, 2004).
Policy Makers and advocates have yet to find balance in adequately addressing
both sides of the problem (Shore, et.al, 2002). Child welfare services policy makers and
program managers have not fully assumed responsibility for improving children’s
functioning, at least beyond the implications of increasing their safety and permanency
(Barth & Johnson-Reid, 2000).
Child welfare professionals have always been concerned about the number of
children in out-of-home placement. Jones and Finnegan, (2003) stated that the most
common intervention with problem families in child protection was to remove the child
from the home. While removal is warranted in some situations where the risk is high and
the danger is immediate to the child, the removal in more benign circumstances often has
proved to be detrimental and disruptive to the family. The child welfare system in the
United States has been characterized as problem-oriented (Manalo, 2007). Duncan &
Sholonsky, (2008) explain that in our current child welfare system, prevention is given
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less importance in comparison to investigation and foster care, and that intervention is
reactive rather than proactive.
Merkel-Holguin, (2004) argued that child welfare is plagued by an overburdened
system and limited internal and community-based resources which results in the
standardization and categorical nature of case plans developed to resolve the concerns
that precipitated regulatory action in families’ lives. In addition, as these systems become
overloaded, they are unable to safely return children to their families or to find permanent
homes for them; therefore, children are experiencing much longer stays in temporary
settings (The Annie E. Casey Foundation, 2001).
Foster Care in Child Welfare System
As previously mentioned, many children stay longer than anticipated in the foster
care system. At any given time, there are more than half a million children in the foster
care system (Lindsey & Shlonsky, 2008). The Adoption Assistance and Child Welfare
Act of 1980 has provided the policy framework for public child welfare services, and is
designed to limit the number of children in foster care and, for those who are placed, to
promote their return to their own home or to other families (Wells & Guo, 1999).
Foster care is care provided to children in families, group homes, or institution.
Such care is provided by public child welfare agencies for children in their custody who
must live apart from their parents because of child abuse, neglect, or other special
circumstances. Foster care is essential in child welfare services and it is supposed to be
temporary (Wells & Guo, 1999). The key principle that guides decision making in child
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welfare cases is the best interest of the child. Historically, it has been considered in the
best interest of a child to leave him or her with his or her family of origin. Removal,
however, must occur when the child’s safety is an issue and when it is deemed the least
detrimental alternative (Britner & Mossler, 2002).
A particular challenge in the foster care system is finding stable, appropriate
placement for children. The challenge is greatest for children in foster care for long
periods of time. In 2000, approximately 40,000 children entered the foster care system.
16,004 remained in care for 12 months or longer, many have stayed with relatives and
their placements are generally stable. Of the 8,664 children who have been placed in
traditional foster care placements, the majority have experienced multiple placements
(Little Hoover Commission, 2003).
According to Family-to-Family (2005), older foster children and youth have a
pressing need for permanent placement. Almost half of the 538,801 children in out of
home care at the end of the federal 2000 reporting period were ages 10 to 17 (Casey
Foundation, 2002). California has the largest statewide foster care population in the
country and cares for almost one-fifth of all the children in child welfare supervised outof-home care in the United States (Webster, Barth & Needell, 2000). Children of color
comprise the majority of children in the child welfare system (Reed & Karpilow, 2002).
Overrepresentation of Minorities in the Child Welfare System
Recent national statistics indicate that African American, Native American, and
Hispanic children are overrepresented in the child welfare system (Chibnall et al., 2003).
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African American children represent 15% of the general child population, yet comprise
approximately 42% of the children in the child welfare system. Native American children
constitute approximately 1% of the child population and represent 2% of children in the
Child Welfare System. Hispanic children make up approximately 14% of the national
child population; they comprise 15% of the child welfare system (Hines, Lemon &
Wyatt, 2004).
African American and Native American children represent over half (51%) of the
population of children in out-of-home care longer than four years (Harris & Hackett,
2008). Prior research has shown a difference by race in the percentage of families who
are offered in home services; many of these children are placed in foster care. The
majority of African American children (56%) were placed in foster care, while the
majority of Caucasian children (72%) received services in their home (Harris & Hackett,
2008).
Lu et al., (2004) argue that the child welfare system is not geared to meet the
needs of various minority groups. Studies have shown that families of color receive fewer
and lower quality services. Children of color and their families have less access to
services and their outcomes are poorer (Williams & Christian, 2007). Child Protective
Services places children in foster care instead of offering their families less restrictive
assistance (Roberts, 2003). Lack of resources is a cause for the existence of racial
disproportionality in the child welfare system; there is a need for internal and external
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resources to support families and children, including basic services such as housing and
employment (Chibnal et al., 2003).
According to Curtis and Denby, (2003) children of color are not likely to receive
prevention services. Minority children are at a disadvantage regarding the range and
quality of services provided; the type of agency to which they are referred, the efficiency
with which their cases are handled, the support their families receive, and their eventual
outcomes (Hill, 2003).
Permanency
Many children cycle through the foster care system more than once and
experience multiple placements; about 20 percent of children entering foster care each
year have been in foster care at least once before (Reed & Karpillow, 2002). The
timelines of the Adoption and Safe Families Act (ASFA) require increased attention to
the timing of permanent placement, regardless of the type of placement outcome (Potter
& Klein-Rothschild, 200). ASFA requires states to move towards termination of parental
rights after children have been in care for a set period of time (15 out of the past 22
months), unless there are compelling reasons not to file a petition for termination (Kemp
& Bedonyi, 2000).
According to D’Andrade & Berrick (2006), the Adoption and Safe Families Act
(ASFA) makes use of three primary avenues in its effort to move children to permanency
quickly; first, it decreases from 18 months to 12 months the time allowed for parents to
reunify with their children; second, it provides a number of mechanisms to encourage
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adoption of children; and third, states must make reasonable efforts not only to preserve
and reunify families, but also to find alternative permanent homes for children if
reunification fails.
Timely and sustainable decision making about long term care arrangements for
children in care is crucial to their future protection and well being. In the child protection
field, permanency planning is a process of making long term care arrangements for
children with families that can offer lifetime relationships and a sense of belonging
(Tilbury & Osmond, 2006). Barth (2006), states that during the last eighteen years, the
nation’s child welfare system has been guided by a principle known as “permanency
planning.” The original concept was that a child was deserving of a permanent lifetime
family, through reunification with the biological family or, should that not be safe,
through adoption.
Permanency planning has become too mechanistic and undervalues long-term
care and it fails to sufficiently support a child’s link to his or her heritage (Barth, 1999).
Studies that examine factors related to the child’s experience in the child welfare system
find that children having more placements tend to have lower rates of reunification
(Kortenkamp, Geen and Stagner, 2004). An increasing number of foster care children age
nine and older age out to non-permanent outcomes every year; approximately 20,000
young people age out of foster care without permanent, legal family connections (Annie
E. Casey Foundation, 2005).
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Most foster children are older and have been in care longer. Older children of
color are over-represented in the U.S. child welfare system. Moving children from foster
home to foster home or to other placements is considered a negative outcome (Crampton
& Jackson, 2007). Children who experience multiple placement changes are more likely
to exhibit attachment difficulties, externalizing behavior problems and internalizing
behavior problems (Connell, et.al, 2006). Foster children whose parents used drugs or
who have severe behavior problems are 5 to 9 time more likely to experience multiple
foster placements over longer periods of time (Holland & Gorey, 2004).
Permanency plans must be timely, culturally appropriate and collaboratively
determined in order to achieve optimum outcomes for children and families. A permanent
placement is more than a long-term placement; it is a placement that meets a child’s
social, emotional and physical needs (Tilbury & Osmond, 2006). One program designed
to achieve permanency is Kinship Care.
Kinship Care as an Alternative to Foster Care
Federal laws requires the child welfare agency to first try to place children
removed from their home with a relative before turning to placement in a stranger’s home
or a shelter (Reed & Karpilow, 2002). McGowan & Walsh (2000) explain that a dramatic
increase in kinship care occurred in the 1980s following the U.S. Supreme Court decision
in Miller v. Youakim (1979) that children living in relatives’ home were entitled to the
same level of foster care payments as children living with non-kin.
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The Casey Foundation (2006) describes kinship care as the full time care,
nurturing, teaching, and protection of children by relatives (through blood, adoption, or
marriage) tribe or clan members or by godparents, stepparents, or any adult who the
child, youth, or family recognizes as having a significant bond with them. More than 2.5
million children are being raised by grandparents and other relatives (Casey Family
Programs, 2008).
Kinship care offers several benefits including greater familiarity between the
caregiver and the child, potentially less traumatic placements, more visitation and contact
with birth parents, and fewer placement changes (Goldman & Salus, 2003). A significant
percentage of children in the United States grow up in the care of family members who
are not their parents: historically, the type of care has been provided on an informal basis
outside the formal state child welfare system (Herring, 2003).
In addition, Herring (2003) revealed that kinship foster care placements
predominantly involve certain types of biological relatives; for example, 40 to over 50%
of children are placed with grandparents or other relatives. The foster care caseload in
California has largely been immersed by relative caregivers, who have always been a
primary, if informal, source of care for children whose parents are absent (Reed &
Karpilow, 2002).
California Child Welfare Redesign
According to the National Center for Youth Law (2006) California has 58
separate child welfare agencies and it is one of 13 states in which counties, rather than a
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single state agency, administer child welfare services. The state Department of Social
Services (DSS) is empowered to set policy and supervise county programs, however, it is
county social services agencies or departments that are primarily responsible for
screening and investigating reports of child abuse, providing services to preserve and
reunite families, determining placements, monitoring the care and safety of children in
foster care, and providing adoption services (National Center for Youth Law, 2006).
More than 100,000 children were victims of abuse or neglect in California in 2004
and during the same period, nearly 39,000 children were removed from their homes and
placed in foster care, an average of 100 children per day (D’Andrade & Duerr Berrick,
2006). A report prepared by the National Center for Youth Law (2006) of a review of the
California child welfare system, found that California failed to meet all six federal
standards. The federal standards are reductions in: 1) recurrence of abuse or neglect, 2)
incidence of child abuse and/or neglect in foster care, 3) foster care re-entries, 4)
instability of foster care placements, 5) length of time to reunification, and 6) length of
time to adoption.
Recognizing the failures of California’s child welfare system, Governor Gray
Davis signed AB 636 into law in 2001, authored by Assembly Member Darrell Steinberg.
AB 636 mandated that the California Health and Human Services Agencies convene a
workgroup to develop measurable performance outcomes consistent with federal child
and family review measures (National Center for Youth Law, 2006).
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The California Legislature enacted the Child Welfare System Outcomes and
Accountability Act (AB 636) to improve outcomes for children in the child welfare
system, while holding county and state agencies accountable for the outcome achieved
(The Result Group, 2008). AB 636 was enacted to replace the state’s process driven
county compliance review system with a new system that focuses on results (U.C.
Berkeley CWS/CMS Reports, 2003).
AB 636, Child Welfare Improvement & Accountability Act of 2001 was enacted
to improve outcomes for children in the Child Welfare System and to provide the legal
framework for measuring and monitoring each county’s performance in ensuring the
safety, permanence and well-being of children (Department of Health and Human
Services, 2003). The Child Welfare Services Redesign project was designed to improve
the efficiency and results of existing state-funded child abuse intervention and prevention
services (Prevent Child Abuse California, 2004).
AB 636 was designed to assess performance and support improvement in
California’s child welfare system in the following areas: safety, permanency and stability,
family relationships and community connections and well being (The Results Group,
2008). According to the Results Group (2008), the California Department of Social
services launched an Eleven-County Pilot Project that focused on three strategies
targeting outcomes in the California Child Welfare System Outcomes and Accountability
System. The three strategies are as follows: Standardized Safety Assessment, Differential
Response and Permanency and Youth Transition.
25
Differential Response, Family Group Decision Making and Team Decision
Making are important components of the California Redesign. These
programs/components are described below.
Differential Response
Differential Response is an approach in California that allows child protective
services to respond differently to accepted reports of child abuse and neglect, based on
such factors as the type and severity of the alleged maltreatment, the number of previous
reports, the age of the child, and the willingness of the parents to participate in services
(American Humane, 2008). Differential Response creates more options for responding to
families in need of help; child welfare services and service organizations work together to
identify families in need and offer them services (The Results Group, 2008).
According to Conley (2007), Differential Response is a fairly new approach to
child welfare in which Child Protective Services agencies sort families by risk levels and
offer services to those deemed at lower to moderate risk, who under traditional child
welfare services would often received nothing. In addition, Conley (2007), stated that the
Differential Response approach is characterized by voluntary provision, greater respect
for families, and increased community involvement. Friend, Shlonsky, & Lambert
(2008), explain that there are four key components of Differential Response: 1) a
customized approach to families, 2) the engagement of community based agencies as
partners in child protection, 3) enhancement of the role of informal and natural helper
26
mentors, and 4) the development of a team approach interacting with the family on a
voluntary basis.
In addition, Differential Response creates more options for responding to families
that need help; child welfare services and a diverse range of service organizations work
together to identify families in need and offer them services, whether or not abuse or
neglect is substantiated (The Results Group, 2008). According to Child Welfare
Information Gateway (2008), the introduction of Differential Response has been driven
by the desire to: be more flexible in responding to child abuse and neglect reports,
recognize that an adversarial focus is neither needed nor helpful in all cases, understand
better the family issues that lie beneath maltreatment reports, and engage parents more
effectively to use services that address their specific needs.
Proponents of Differential Response see in it the potential to reduce the
adversarial nature of the relationship between the agency and parents with child welfare
problems (Lindsey & Shlonsky, 2008). Studies have shown that through Differential
Response child safety is preserved and that families and staff prefer the differential
response model to traditional child welfare services (Conley, 2007). Another strategy that
has been used in the United States since 1990 to work with families is family group
decision making, which is explained in detail below.
Family Group Decision Making
Family Group Decision Making (FGDM) was first introduced to child welfare in
the United States in the early 1990’s. The Family Group Decision Making model was
27
adapted from New Zealand, where this approach was legislated in 1989 to address child
welfare and youth justice (Pennell & Burford, 2000). FGDM is a child welfare decisionmaking process in which efforts are made to bring all parties with an interest in the wellbeing of the child together to discuss the concerns that bring the child to the attention of
protective services, the strengths in the family system and changes necessary to keep the
child safe (Berzin, Thomas, & Cohen, 2007).
Family Group Decision Making is characterized as a practice which is familycentered, family strengths-oriented, and culturally based (Jones & Finnegan, 2003). It
recognizes that families have the most important information about themselves to make
well-informed decisions and that individuals can find security and a sense of belonging
within their families. It emphasizes that, first and foremost, families have the
responsibility to not only care for, but also to provide a sense of identity for their children
(Crampton, 2007).
The focus of FGDM is a plan for protecting and caring for a child developed
through a meeting of the child’s extended family in case of child abuse and neglect.
FGDM is a rapidly growing practice around the world. For example, the number of
communities in the United States trying FGMD grew from five in 1995 to more than one
hundred by 2000; in the same way, in England and Wales four pilot programs began in
1994 and now fifty five local authorities or nongovernmental groups have FGDM
programs in those countries (Crampton & Jackson, 2007). In addition, FGDM focuses on
the future safety and well-being of the children involved. The extended family partners
28
with the system professionals in order to develop a plan to achieve this. The family
members receive significantly more information than usual from the state about their
case, including the actions of the social worker, the official concern about the abuse or
neglect, and any other pertinent facts about resources and constraints that could affect
decision making (Crampton, 2007).
The American Humane Association (2008), describes the FGDM process as
follows: (1) an independent (i.e. non-case carrying) coordinator is responsible for
convening the family group meeting with the agency personnel, (2) the child protection
agency personnel recognize the family group as their key decision making partner, and
time and resources are available to convene this group, (3) family groups have the
opportunity to meet on their own, without the statutory authorities and other non-family
members present, to work through the information they have been given and to formulate
their responses and plans, (4) when agency concerns are adequately addressed, preference
is given to the family group’s plan over any other possible plan, and (5) referring
agencies support the family group by providing the services and resources necessary to
implement the agreed upon plans (The American Humane Association, 2008).
According to Walton, Roby, Frandsen, and Davidson (2003), FGDM includes
four main phases: referral, preparation, family meeting, and implementation of the plan.
In the referral phase, the child welfare worker or other professional conducts an
investigation and refers the case to a facilitator for an FGDM. During the preparation
phase, the facilitator establishes a date for the conference and invites family members and
29
professionals involved in the case, such as the caseworker, guardian, school counselor or
therapist. The family meeting provides opportunity for the family to deliberate in private;
the family has the first opportunity to sort through the issues and develop solution-based
plans and recommendations without the involvement of professionals. During the
implementation of the plan everyone is brought together to reach an agreement on the
plans developed by the family (Connolly, 2006)
According to Jones & Finnegan, (2003), FGDM results in: 1) fewer children,
particularly minority children, living in out-of-home care, 2) reductions in family
violence, 3) reduction in dependency on social services, 4) increased family
empowerment, 5) increased social work cooperation and understanding of extended
families, 6) increased use of kinship care and resources to ensure family continuity and
support for family reunification and permanency, 7) increased empathy, 8) decreases in
child abuse, and 9) decreases in blame toward victims in the extended family network.
Crampton, (2007), states that family members come to FGDM meetings when
they are given an opportunity; they participate appropriately and develop plans that are
child centered. Both family members and child welfare professionals believe these
meetings improve child protection work; and children placed through meetings are more
likely to be placed with members of their extended families. Through FGDM families are
brought together and empowered to make decisions that will best serve their needs and
the needs of their children. FGDM seeks to bring together multiple family members and
encourage them to help each other solve problems (Berzin, 2006).
30
Family Group Decision Making conferences offer a democratic context that
challenges years of paternalistic practice in which professionals have assessed problems,
used clinical tools to determine levels of risk or harm, and developed corrective actions
plans with little consideration for or interest in the families’ opinions (Merkel-Holguin,
2004). According to the American Humane Association (2003), FGDM is a practice that
respectfully invites and offers families to come together as the best people to make short
and long term decisions for its members. Despite the best intention to serve families
using FGDM, Team Decision Making meetings are now held for all placement-related
decisions and for all families served by the public child welfare agency.
Team Decision Making
A Team Decision Making (TDM) meeting is held when there are safety concerns
in a child’s home that might require the child to be placed into out-of-home care. The
meetings are held for children in foster care who require a placement change due to a
child’s permanency goal changing or children being returned home. Crampton & Narajan
(2005), state that in Team Decision Making, every participant as a group is convened for
the specific purpose of making an immediate placement related decision and the process
is used for each decision faced by the public agency in its daily work. The public agency
shares but does not delegate its responsibility to make critical decisions.
Team Decision Making (TDM) is a core strategy of the family-to-family child
welfare reform initiative, which was sponsored by the Annie E. Casey Foundation, as an
initiative that has been implemented in approximately 60 sites across 17 states. Crea et
31
al. (2008) describe six key elements of Team Decision Making: (1) a TDM meeting,
including birth parents and youth, is held for all decisions involving child removal,
change of placement, and reunification and other permanency planning, (2) the TDM
meeting is held before the child’s move occurs, or in cases of imminent risk, by the next
working day, and always before the initial court hearing in cases of removal, (3)
neighborhood-based community representatives are invited by the public agency to
participate in all TDM meetings, especially those regarding possible removal, (4) the
meeting is led by a skilled, immediately accessible, internal facilitator, who is not a casecarrying social worker or line supervisor, (5) information about each meeting, including
participants, location, and recommendations, is collected and ultimately linked to data on
child and family outcomes, in order to ensure continuing self evaluation of the TDM
process and its effectiveness, and (6) each TDM meeting resulting in a child’s removal
serves as a springboard for the planning or “icebreaker” family team meeting, ideally to
be held in conjunction with the first family visit, so that the birth-foster parents
relationship can be initiated.
The Annie E. Casey Foundation, (2002) explains that the goals of team decision
making are to improve the agency’s decision making process to encourage the support
and “buy-in” of the family, extended family, and the community to the agency’s decision;
and to develop specific, individualized, and appropriate interventions for children and
families. Instead of being excluded from the process, the family, private service
32
providers, and community representatives can participate in a discussion and partnership
designed to keep the community’s children safe.
There are various benefits of Team Decision Making; caseworkers, families,
foster families, private agencies, and the community all benefit when team decision
making is implemented because instead of having to make difficult decisions on their
own, caseworkers concerned about a child’s safety routinely have access to more
experienced and knowledgeable fellow staff and family members that can help them
solve the problem. Another benefit of team decision making is that when families and
extended families are part of the decision making process, they are more likely to
participate in services to keep their family together or to complete tasks in order to have
their children safely returned home (Annie E. Casey Foundation, 2002). The following
section will explore the differences between FGDM and TDM.
FGDM vs TDM
Crampton, (2004) states that both models, FGDM and TDM, focus on a plan for
the care and protection of a child that is developed through a meeting of child welfare
professionals and the child’s extended family in case of child abuse or neglect.
According to Crampton & Natarajan, (2005) Team Decision Making and Family Group
Decision Making differ in various ways; for example, the purpose of TDM is to make an
immediate decision regarding child’s placement, including providing services and
support. On the other hand, FGDM’s purpose is to develop a plan for the care and
protection of a child. Another manner in which TDM and FGDM differ is in the decision
33
making. In TDM public agencies share but do not delegate their responsibility to make
critical placement decisions. In FGDM the family develops a plan on their own, but
agency staff can veto plans they believe are not safe (Crampton & Narajan, 2005). In
addition Crampton & Narajan (2005) explain that in many models of FGDM, key
decisions are made during private family time when the facilitator and other professional
staff have left the room and the family members are developing plans on their own. On
the other hand, Crampton & Narajan (2005) make clear that TDM places a greater
emphasis on facilitation skills and these skills are described as the ability to focus on:
family strengths, develop cooperative interventions, find common ground among diverse
participants, help present risks without making the family feel defensive, and keep family
meeting participants focused on tasks.
Gaps in Research
Although FGDM and TDM are increasingly used to intervene in child abuse and
neglect cases, the field does not know enough about their structural variations,
implementation process or effectiveness (Crampton, 2004). These interventions in child
protection are rapidly growing; these services are being widely praised as effective and
widely adopted without a shred of scientifically reputable evidence that these
interventions actually work (Crampton, 2004). In addition, Crampton, (2004) explains
that in a preliminary analysis of Team Decision Making in Cuyahoga, County, Ohio
suggests that children are more likely to be placed with relatives rather than in foster care
when relatives attended the meetings.
34
As far as outcome there is very limited information regarding TDM because it is
fairly new and there is not much research conducted on this topic. There is much more
information and research about FGDM (Crampton, 2004; Crampton & Narajan, 2005;
Crampton, 2007) and very limited on TDM. Wilfire, (2002) expressed that in order to
measure the impact of TDM on outcomes for children, an agency must be able to link
specific TDM meetings and decisions to individual children and families, to achieve this,
an agency should record the unique child and family ID numbers in each TDM record.
This study will fill a gap in the literature in the areas of TDM implementation,
usage, and social workers satisfaction with the program, but there are many aspects of
TDM which have yet to be studied. Future research needs to examine aspects of TDM
which encourage TDM reporting data to show its effectiveness, conduct TDM meetings
for all children who enter the foster care system and respond to the needs of all children
and families involved in the foster care system. Hardly any studies have evaluated TDM
and there is no strong empirical evidence proving the TDM decreases the amount of
placement changes of children in the foster care system.
Summary
This literature review of the implementation, use and effectiveness of Team
Decision Making (TDM) discussed the definition of TDM and the different programs that
led to its implementation. The results of the literature review revealed several important
programs supporting the need for team decision making. These programs and/or themes
include the child welfare system history, child welfare challenges, foster care in the child
35
welfare system, overrepresentation of minorities in the child welfare system, permanency
planning, kinship care, California child welfare redesign, differential response, and
family group decision making. These themes are important to mention because provided
a background for the need to implement Team Decision Making.
For example, Crampton, (2004) states that both models, FGDM and TDM, focus
on a plan for the care and protection of a child that is developed through a meeting of
child welfare professionals and the child’s extended family in case of child abuse or
neglect. Additionally, studies have shown that through Differential Response child safety
is preserved and that families and staff prefer the differential response model to
traditional child welfare services (Conley, 2007).
Permanency planning has become too mechanistic and undervalues long-term
care and it fails to sufficiently support a child’s link to his or her heritage (Barth, 1999).
Studies that examine factors related to the child’s experience in the child welfare system
find that children having more placements tend to have lower rates of reunification
(Kortenkamp, Geen and Stagner, 2004).
Team Decision Making is a one part of the Annie E. Casey Foundation’s Family
to Family initiative which also includes strategies to recruit and support resource families
and community partnerships as well as self evaluation procedures for determining how
well the entire reform effort is working. Specifically, in a Team Decision Making
meetings, participants come together to make the best and least restrictive placement for
36
the child to reduce the amount of placement changes that that child endures while that
child is in the foster care system.
Evidence of Team Decision Making effectiveness is scarce, but a similar
program, FGDM, is not. A Michigan study included outcome analysis referrals received
from 1996 to 1998. During this time, the FGDM received 257 referrals, 96 of which
proceeded with a family meeting. Children placed through FGDM were less likely to
have additional contact with CPS; they moved less between temporary homes; they were
less likely to be placed in an institutional setting and were more likely to remain placed
with their extended family members in a legal guardianship (Crampton, 2007).
Many children cycle through the foster care system more than once and
experience multiple placements; about 20 percent of children entering foster care each
year have been in foster care at least once before (Reed & Karpillow, 2002). Timely and
sustainable decision making about long term care arrangements for children in care is
crucial to their future protection and well being. A permanent placement is more than a
long-term placement; it is a placement that meets a child’s social, emotional and physical
needs (Tilbury & Osmond, 2006).
The need for solutions about finding permanent placements for children in foster
care is evident from the number of children that enter the system. With the rising
demands of child welfare, workers need to consider new options, including strategies that
promote a collaborative effort of family, community and government. While Team
Decision Making main’s goal is to reduce unnecessary multiple placement, more research
37
needs to be done. Only with more information on outcomes of TDM will it show if TDM
is a success or not.
38
Chapter 3
METHODOLOGY
Research Design
The purpose of this study is to find out how Team Decision Making (TDM) was
implemented and how it is used to reduce multiple placements of children in the foster
care system. The research design employed for this project is a one-group post test-only
design. A one group post test-only design is cross sectional and does not require second
data collection efforts. The measure or questionnaire that was given to Team Decision
Making social workers and staff was intended to measure their knowledge and use of
Team Decision Making. This exploratory research project surveyed professional social
workers and staff to obtain their perceptions of the implementation of Team Decision
Making (TDM). The social workers and the staff that were involved in the
implementation of Team Decision Making were also requested to share their own
perceptions and opinions about their training, usage and validity of Team Decision
Making. The questions were written in a way that required social workers and staff to
think about the implementation and use of Team Decision Making, which is an activity
this is routine to their daily professional duties. The purpose of this study is to find out
how TDM was implemented and how it is used to reduce multiple placements of children
in the foster care system.
39
Population
The subjects who participated in this research project are social workers and other
staff who are part of the Team Decision Making (TDM) team from the Department of
Health and Human Services located in Sacramento County. The source of subjects was
limited to those professionals who designed, implemented and used Team Decision
Making. The social work staff that was part of the implementation of TDM was chosen
due to the researcher’s accessibility to upper management in order to obtain authorization
to conduct this research.
Sampling Plan
The choice of a snowball sampling method for this research project was based on
the type of research design selected and the sampling method that was most compatible to
it. The sample was selected using non-probability criteria which included forty
respondents who worked in the field of social work. The sample was accessed by
contacting professionals the researcher knew through association of student and guess
speaker contact at California State University, Sacramento. The survey subjects are
professional social workers and Team Decision Making staff who were currently
employed with Sacramento County Child Welfare Services. The sample size was limited
to forty social workers and staff located at the Department of Health and Social Services
office on Del Paso Blvd, in Sacramento, California.
40
Measurement Tool
The instrument used for gathering the data was developed for this project by the
researcher (please refer to Appendix A). A survey format was the most appropriate for
this project. The questionnaire was developed by this researcher based on literature
review and informal discussions with both professional social workers and second year
Master degree students at California State University, Sacramento.
The instrument used for this project is a qualitative questionnaire which consists
of a combination of twenty six carefully constructed open-ended and closed-ended
questions. The collected data may be beneficial in better understanding of the
implementation and use of Team Decision Making. The questionnaire also gathered
participant’s demographics regarding gender, education, assigned unit, current position,
and number of years worked in child welfare services. Some of the themes assessed
through the questionnaire include: purpose, training, benefits and success of Team
Decision Making in the child welfare system.
Data Collection Procedures
First, the researcher created a survey to use as a tool for gathering data. In order to
establish participant confidentiality, the survey contained no personal identifying
information. The survey distribution was conducted in two phases. The initial phase
consisted of distributing a copy of the questionnaire with consent to participate form
attached as a cover sheet in Team Decision Making meetings. The second phase was
employed two weeks later, which consisted of this researcher performing face-to-face
41
requests for participation. This researcher visited staff cubicles and verbally explained the
purpose of the survey, the appropriate time needed to complete the questionnaire and the
need for a consent form. Also, participants were informed that their responses would be
confidential. All completed surveys regardless of distribution were submitted by
participants to a designated box especially designed for confidentiality which was located
at one supervisor’s desk at the Department of Health & Human Services located at 925
Del Paso Blvd, Sacramento, CA 95815.
Protection of Human Subjects
California State University, Sacramento procedures for protection of human
subjects were adhered to as described in the application reviewed by the Division of
Social Work Committee for the Protection of Human Subjects. This application
explained the research procedures intended and the possible impact on subjects. This
researcher obtained approval from the committee, which deemed the research procedure
to be of “No Risk” to human subjects. The approval number is 08-09-038. Each
questionnaire whether distributed in the staff meeting or personally was accompanied by
a consent to participate form.
The form outlined the voluntary consent to participate, approximate time needed
for completion of the survey, and the purpose of the research project. The consent form
also mentioned that each participant had the right to withdraw from participation at any
time and that their participation was voluntary. Confidentiality was ensured by asking
participants to refrain from including any identifying information on the questionnaire
42
(i.e., name, birth date, student i.d.). Furthermore, the consent form expressed possible
benefits of the research project and provided this researcher’s and her advisor’s e-mail
addresses and phone numbers in case any participant had questions or concerns.
Data Analysis
Upon the conclusion of data collection, the researcher will use a mixed method
approach in the data analysis process which includes using a quantitative type of analysis
through SPSS 15.0. The tool for this project was a survey made up of 28 questions. The
survey began by asking for demographic information from the participants such as
gender, age, ethnicity, level of education and current position. It then probed for
information regarding definitions of team decision making.
The open-ended questions will be analyzed according to themes. The researcher
will analyzed the answers gathered from the survey, grouped according to specific and/or
emerging themes, and framed conclusions from the data. The collected data may be
beneficial in better understanding of the implementation and use of Team Decision
Making.
Summary
This exploratory research project surveyed professional TDM social workers and
staff to obtain their perceptions of the implementation and use of Team Decision Making
in general and their knowledge, training, and use of Team Decision Making in the child
welfare system. The design was an exploratory study and the unit of analysis was the
individual. The participants were 40 professionals working in the field of social work.
43
The instrument used consisted of a survey made up of twenty three open and closed
ended questions. Respondents reported demographic information such as gender, age,
level of education and current position. The participants were informed of procedures to
ensure confidentiality and the possibility of minimal risk involved in participating in the
study. The analysis of the data included placement of the data into categories that
identified emerging themes. Conclusions were framed from the analysis of the data.
Results of the data collected on the implementation and use of Team Decision Making
are presented in chapter four.
44
Chapter 4
FINDINGS
Introduction
This study explored the implementation, use and effectiveness of Team Decision
Making in Sacramento County through self-administered questionnaires. Participants
included facilitators, supervisors, schedulers and team members who worked with Team
Decision Making between June 2008 and July 2009. The participants were employees of
Sacramento County Children Protective Services and members of the Team Decision
Making group located in Sacramento, California. Specifically, the questionnaires
gathered information regarding social work professionals’ characteristics and attitudes
toward the implementation, use and effectiveness of Team Decision Making. Data from
the self-administered questionnaires were analyzed by this researcher by looking at
patterns and themes within the participants’ responses. The enclosed findings will give a
detailed account of the demographics of the participants, training, use and efficacy of
Team Decision Making. In addition participants will express their experiences using this
tool as well as their opinion of it. A total of 40 questionnaires were distributed, and 23
were returned. Returned questionnaires represented 58 percent. All returned
questionnaires were analyzed by this researcher and the outcome of this analysis is listed
below.
45
Organization of the Data
The data will be displayed by first reviewing the demographic composition of the
research participants, which are members of the Team Decision Making unit. Followed
by participants’ opinions about TDM and, finally with the participants’ responses to the
qualitative questions included in the questionnaire. The data gathered and themes
discovered from each question on the survey will be presented separately. The
demographic information gathered through self-administered questionnaires will be
displayed using tables. The qualitative data collected through self-administered
questionnaires will be explored through narrative format. For each question this
researcher will detail the number of subjects who answered.
Questionnaire
Gender. The sample consisted of 23 social workers and other staff who work for
the Department of Health and Human Services, Team Decision Making Unit in
Sacramento County. All 23 participants completed the gender portion of the self
administered questionnaire. The participants were asked to choose their gender from two
choices, male and female. Nineteen, (82.6 percent) identified as female while the
remaining four, 17.4 percent, identify as male (See Table 4.1).
46
Gender
Frequency
Male
Percent
Cumulative
Percent
Valid Percent
4
17.4
17.4
17.4
Female
19
82.6
82.6
100.0
Total
23
100.0
100.0
Table 4.1. Gender
Race/ethnicity. All 23 participants completed the race/ethnicity portion of the
questionnaire. There were five different responses. Eleven, (47.8 percent), identified as
White. Three, (13 percent), identified as African American. Three, (13 percent),
identified as Asian American. Two, (8.6 percent), identified as Hispanic and four, (17.4
percent) identified as other, (See Table 4.2).
Ethnicity
Frequency
White
Percent
Valid Percent
Cumulative
Percent
11
47.8
47.8
47.8
African am
3
13.0
13.0
60.9
Asian am
3
13.0
13.0
73.9
Hispanic
2
8.7
8.7
82.6
Other
4
17.4
17.4
100.0
Total
23
100.0
100.0
Table 4.2 Ethnicity of Respondents
47
Age. Twenty two of the participants completed the age portion of the
questionnaire. Age was asked in ten year increments or ranges. One participant, (4.3
percent), was between the age of 20-29 years. Eleven, (47.8 percent), were between the
ages 30-39 years. Seven, (30.4 percent), were between the ages 40-50 years. Three, (13
percent), were over fifty years. (See Table 4.3).
Age
Frequency
Percent
Valid Percent
Cumulative
Percent
20-29
1
4.3
4.5
4.5
30-39
11
47.8
50.0
54.5
40-50
7
30.4
31.8
86.4
over 50
3
13.0
13.6
100.0
22
95.7
100.0
1
4.3
23
100.0
Total
Missing
Total
Table 4.3 Age of Respondents
Level of Education. All 23 participants completed the highest level of education
portion of the questionnaire. One, (4.3 percent), had a bachelor degree. Sixteen, (69.6
percent), had a master degree. Six, (26.1 percent), selected other (See Table 4.4).
48
Education
Frequency
BS
Percent
Cumulative
Percent
Valid Percent
1
4.3
4.3
4.3
MSW
16
69.6
69.6
73.9
Other
6
26.1
26.1
100.0
Total
23
100.0
100.0
Table 4.4 Level of Education
Title. All participants completed the title portion of the questionnaire. Eight, (34.8
percent), were TDM facilitators. Two, (8.7 percent), were Social Service Workers (SSW)
at the master level. Six, (26.7 percent), were Social Service Workers (SSW) at bachelor
level. Seven, (30.4 percent), were “other”. Among those were schedulers and supervisors
(See Table 4.5).
Title
Frequency
Percent
Valid Percent
Cumulative
Percent
TDM
Facilitator
8
34.8
34.8
34.8
SSW MSW
2
8.7
8.7
43.5
SSW BS
6
26.1
26.1
69.6
Other
7
30.4
30.4
100.0
Total
23
100.0
100.0
Table 4.5 Title
49
Years Working in the Child Welfare System. All 23 participants completed the
years working in CWS portion of the questionnaire. There was a broad range of years of
working in the Child Welfare System. The minimum was one year while the maximum
was twenty-two years. The mean of the participants working in the Child Welfare System
was 8.6, the mode was 4 and the median was 7 and 8. (See Table 4.6).
Years Working in CWS
Frequency
Percent
Valid Percent
Cumulative
Percent
1
1
4.3
4.3
4.3
1.5
1
4.3
4.3
8.7
4
2
8.7
8.7
17.4
4.5
1
4.3
4.3
21.7
5
3
13.0
13.0
34.8
6
1
4.3
4.3
39.1
7
2
8.7
8.7
47.8
8
4
17.4
17.4
65.2
11
1
4.3
4.3
69.6
12
3
13.0
13.0
82.6
15
1
4.3
4.3
87.0
20
2
8.7
8.7
95.7
22
1
4.3
4.3
100.0
23
100.0
100.0
Total
Table 4.6. Years Working in CWS
50
Level of Involvement with TDM. Twenty two of the participants provided data for
the level of involvement in TDM portion of the questionnaire. Two, (8.7 percent), were
involved in planning and implementation. Six, (26.1 percent), were facilitators and social
service workers. Eight, (34.8 percent), chose other (See Table 4.7).
Level of Involvement in TDM
Frequency
Percent Valid Percent
Cumulative
Percent
Planning &
Implementation
2
8.7
9.1
9.1
Facilitator
6
26.1
27.3
36.4
Social Service Worker
6
26.1
27.3
63.6
Other
8
34.8
36.4
100.0
Total
22
95.7
100.0
1
4.3
23
100.0
Missing
Total
Table 4.7. Level of Involvement in TDM
Comfort Level Using TDM. Participants were asked to estimate their comfort level
using TDM. A Likert Scale of 1 to 5 was used to aid participants in their estimation: 1=
“not at all comfortable”, 2= “not very comfortable”, 3= “somewhat comfortable”, 4=
“very comfortable”, 5=”Excellent comfortable”. Twenty-two of the participants
completed the comfort level using TDM portion of the questionnaire. Twenty-one, 91.3
percent, estimated that their comfort level using TDM was excellent. One, 4.3 percent,
was very comfortable using TDM (See Table 4.8).
51
Comfort Level Using TDM
Frequency
Very
Missing
Total
Percent
Valid Percent
Cumulative
Percent
1
4.3
4.5
4.5
Excellent
21
91.3
95.5
100.0
Total
22
95.7
100.0
1
4.3
23
100.0
Table 4.8. Comfort Level Using TDM
TDM Benefit for Child and or Family. Participants were asked if they consider
TDM meetings to be beneficial for the child and or family. A Likert Scale of 1 to 4 was
used to aid participants in their responses: 1= “disagree”, 2= “somewhat agree”, 3=
“agree”, 4= “strongly agree”. Twenty-two of the participants completed this portion of
the questionnaire. Twenty, (87 percent), strongly agreed that TDM meetings were
beneficial for the child and or family. Two, (8.7 percent), agreed that TDM meeting were
beneficial for the child and or family (See Table 4.9).
52
TDM Benefit for Child or Family
Frequency
Agree
Percent
Valid Percent
Cumulative
Percent
2
8.7
9.1
9.1
Strongly agree
20
87.0
90.9
100.0
Total
22
95.7
100.0
1
4.3
23
100.0
Missing
Total
Table 4.9. TDM Benefit to Child or Family
Opinion of TDM Success. Participants were asked to express their opinion in
regards to the success of TDM. A Likert Scale of 1 to 4 was used to aid participants in
their opinion: 1= “disagree”, 2= “somewhat agree”, 3= “agree”, 4= “strongly agree”. All
participants provided data for this portion of the questionnaire. Sixteen, (69.6 percent),
had high opinions about the success of TDM. Seven, (30.4 percent), agreed with the
opinion that TDM was a success (See Table 4.10).
Opinion of TDM Success
Frequency
Agree
Percent
Valid Percent
Cumulative
Percent
7
30.4
30.4
30.4
Strongly agree
16
69.6
69.6
100.0
Total
23
100.0
100.0
Table 4.10 Opinion of TDM Success
53
Rate TDM Success. Participants were asked to rate the success of TDM A Likert
Scale of 1 to 4 was used to aid participants in their opinion: 1= “disagree”, 2= “somewhat
agree”, 3= “agree”, 4= “strongly agree”. All participants provided data for this portion of
the questionnaire. Twelve, (52.2) percent, rated the success of TDM as very high. Eight,
(34.8 percent), rated the success of TDM to be high and three, (13.0) percent, rated the
success of TDM to be average (See Table 4.11).
Rate TDM Success
Frequency
Very high
Percent
Valid Percent
Cumulative
Percent
12
52.2
52.2
52.2
High
8
34.8
34.8
87.0
Average
3
13.0
13.0
100.0
23
100.0
100.0
Total
Table 4.11 Rate TDM Success
Qualitative Data
Participants were asked thirteen open-ended questions to gather information about
their individual experience and knowledge related to TDM. Listed below are the
qualitative questions included in the questionnaire and a summary of their responses by
emergent themes.
What was your role in the implementation of TDM. Some of the roles described
were: scheduler, which are the personnel in charge of scheduling TDM for case-carrying
54
social workers. Trainers, which are in charge of training case-carrying social workers;
TDM facilitators, which are social workers who facilitate the team decision meetings
along with members of the community and parents. Others were supervisors and clerical
staff.
Who made the decision to implement TDM? Many of the participants expressed
different opinions about this question, such as “CPS management as a method of
reducing caseloads and placement changes for foster youth”, “The County partnered with
the Annie Casey Organization as part of the Family to Family Initiative’. One theme that
emerged from this question was the necessity to address multiple placement changes of
children in the foster care system. Another theme was the necessity to create stability for
children in the foster care system.
How was TDM roll out in Sacramento? Twenty of the participants answered this
section of the questionnaire. Sixteen of the participants stated that TDM was first focused
in Family Reunification (FR) then moved to Permanency Services (PS), Family
Maintenance/Informal Supervision and Court Services. Two participants did not know
how TDM was roll out and two participants expressed that it started in “Court Programs”
In addition, one participant expressed that “Social Workers were very slow to respond
and finally management made it mandatory.” Another participant expressed that “TDM
was heavily resisted by many social workers within CPS”
What is your experience using TDM? All participants answered this section of
the questionnaire. All participants expressed to have had a very positive experience using
55
TDM. Some of the words used by participants were: “good”, “great”, “very positive”,
“very useful tool”, “has good outcomes.” One participant expressed: “My experience has
been excellent! I have been the social worker on the other side requesting a TDM and my
colleagues are effective in sorting out the issues.” Another participant expressed: “ I am
very pleased with the practice of bridging the gap between birth parents, resources,
families, children and community partners. I know it is the best practice in the best
interest of the families we work with.”
Please define TDM in your own words: All participants completed this section of
the questionnaire. Some of the themes that emerged from this question were: best
practices, about placement issues, everyone coming together, a way to bridge agency
responsibility with family participation. One participant expressed: “I found them to be a
powerful tool for families and staff, as well as community partners. It provides a forum
for discussion and an opportunity to have straight talk with families about the concerns
and the strengths.” Another participant expressed: “TDM is a meeting to make the best
possible placement decision with input from multiple people involved with the child.”
Another participant responded: “TDM is a group decision process that tries to be
inclusive, engaging of families and strength-based, while still maintaining safety of
children as we make decisions about placements.”
How long was your training in TDM? Twenty participants completed this section
of the questionnaire. Of those twenty, ten received 5 days training or 40 hours. Two
56
received two days training and seven received no training at all. Three did not respond to
this question.
Do you think you received adequate training to use TDM? All participants
completed this section of the questionnaire. Some of their responses were as follows
“Yes, the facilitator training was one of the best and thorough trainings I have had’, ‘Not
training in specific but learning through participation in the implementation process and
Family to Family Conferences”. ‘I believe the training helped me to be able to facilitate
TDM meetings and everything I learned was applied on the job.” Three participants
answered “no.”
What is the purpose of TDM? All 23 participants completed this section of the
questionnaire. From all of the participants’ answers three themes were identified. The
first theme was to avoid unnecessary multiple placement changes. The second theme was
to discuss placement issues. The third theme was to include the community and family in
the decision making.
Do you use TDM for every family on your case load? Twenty two participants
completed this portion of the questionnaire. Nineteen participants answered no to this
question. Two participants answered yes. One participant did not answer this question.
One participant responded “we used it only when necessary.”
How many times have you used TDM with your families on your case load?
Eighteen participants completed this section of the questionnaire. Five participants did
not answer this question. Eleven participants responded that they never use TDM. The
57
responses of the remaining seven participants varied. Six participants had used TDM
between four and fifteen times. One participant answered “a lot.”
How long it does usually takes to contact everyone for the meeting? Nine
participants did not answer this question. From the fourteen who did answer this question
three themes or categories were identified. The first theme was that it depends if the
correct information is given to schedulers. The second theme was that it depends on all
participants’ availability. The third theme was it takes from two to five days.
How long does the TDM meeting usually last? One participant did not answer this
question. Twenty two participants completed this section of the questionnaire. The
responses of the twenty two participants made up three categories. Fifteen participants
responded that the meeting lasts one and half hours. Five participants responded that the
meeting lasts two hours. One participant responded that the meeting lasts three hours.
What is your personal opinion of the efficacy of TDM? One participant did not
answer this question. From the twenty two participants who did answer this question six
themes or categories were identified. The first theme was that TDM is very efficient. The
second theme was that TDM was effective in getting children and families’ needs met.
The third theme was that TDM should be used as a tool for identifying best placements
for children. The fourth theme was that all parties are allowed to voice their opinions.
The fifth theme was that TDM is a valuable tool for use in all programs.
What difficulties (if any) have you experienced using TDM? All participants
completed this portion of the questionnaire. The following three themes emerged from
58
their answers. The first theme was, not hearing back from participants on a timely
manner. The second theme was, getting all parties to meet at the same time. The third
theme was, that social workers do not want to include others in the decision making
process, while also being resistant to change.
In your view, who are the key participants in TDMs? All participants completed
this section of the questionnaire. All participants listed the following individuals as key
participants in TDM: Social workers, foster parents, biological parents, teachers,
therapists, children (if older than 10), community partners, involved service providers,
relatives, counselors and facilitators.
What do you think are the County’s goals in implementing TDM? All twenty three
participants completed this portion of the questionnaire. The responses of the
participants made up three themes. The first theme was to reduce unnecessary placement
changes that children endure while in the foster care system and improve outcomes. The
second theme was to create safe and stable placements for children. The third theme was
to have every child facing a placement change to be part of a TDM and to improve
placement stability.
Please state your additional comments. Ten participants did not answer this
question. From the thirteen participants who did answer this question, six themes or
categories were identified. The first theme was that TDM is successful for those that are
scheduled, but TDM is not being used for every placement change. The second theme
was TDM can be more successful if more education is given to social workers about
59
TDM. The third theme was that TDM would be more successful if the message from
management was supportive and engaging. The fourth theme was that if social workers
with negative attitudes about TDM, used TDM properly, more people would see the
benefit of it and that it works. The fifth theme was that it could be very successful if
TDM is held before placement changes occur, not after.
Summary
This chapter presented the findings of a research project that included data
collected by survey of social workers from the Team Decision Making Unit in
Sacramento County. A majority of the participants described their gender as female
(nineteen), identified as White (eleven), were between the ages of 30-39 years (eleven),
and had a master’s degree (sixteen). Most of the participants were TDM facilitators
(eight). The majority of the participants have been working with the child welfare system
for more than four years, with one participant having had been working with the child
welfare system for 22 years (see Table 4.6). The majority of the participants estimated
their comfort level using TDM to be excellent (twenty-one), strongly agreed that TDM is
beneficial to the family (twenty), had strong opinions that TDM is a success (sixteen),
and rated TDM success to be very high (twelve).
Quantitative data presented was obtained from closed-ended questions utilizing a
Likert scale. Four questions asked participants to select the best answer reflective of their
experience from a list of choices. Ten open-ended questions provide some qualitative
data that will be further explored in chapter five.
60
Some of the most significant quantitative findings indicate that TDM was heavily
resisted by social workers within CPS. Participants who used TDM expressed having
very positive experience using TDM. The findings indicated that TDM facilitators
receive longer trainings than case carrying social workers. One significant finding was
that TDM is not being used for every placement change of children in the foster care
system. The majority of the participants expressed that TDM is a success. Another
significant finding is that most participants believed that TDM works in reducing the
number of placement changes for children in the foster care system when a TDM occurs
before placement.
This exploratory project evaluated the implementation, use and effectiveness of
Team Decision Making in Sacramento County through a review of literature and thematic
analysis of data collected through self administered questionnaires. Findings indicate that
Team Decision Making lessens unnecessary placement changes of children in the foster
care system. Team Decision Making helps make the best and least restrictive placement
and brings all impacted people together to make the best decision for the child or
children. The implications and conclusions of this research study determined from the
main themes present in the data collected through self-administered questionnaires will
be explored further in chapter 5.
61
Chapter 5
CONCLUSIONS AND RECOMMENDATIONS
Introduction
This research project explored the implementation, use and effectiveness of Team
Decision Making in Sacramento County through self-administered questionnaires.
Participants included 23 facilitators, supervisors, schedulers and team members who
worked with the Team Decision Making team between June 2008 and July 2009. The
participants were employees of Sacramento County Children Protective Services and
members of the Team Decision Making unit located in Sacramento, California.
Specifically, the questionnaires gathered information regarding social worker
professionals’ characteristics and attitudes toward the implementation, use and
effectiveness of Team Decision Making. Data from the self-administered questionnaires
were analyzed by this researcher by looking at patterns and themes within the
participants’ responses. The research findings gave an account of the demographics of the
Team Decision Making unit, participants’ knowledge and opinion about the efficacy of
TDM. The goal of this research study was to gain information about how TDM was
implemented in Sacramento County; social workers’ training and knowledge, its use, and
how effective it is in reducing placement changes of children in the foster care system.
Discussion
A particular challenge in the foster care system is finding stable, appropriate
placement for children. The challenge is greatest for children in foster care for long
62
periods of time. In 2000, approximately 40,000 children entered the foster care system.
Sixteen thousand-four children remained in care for 12 months or longer, many have
stayed with relatives and their placements are generally stable. Of the 8,664 children who
have been placed in traditional foster care placements, the majority have experienced
multiple placements (Little Hoover Commission, 2003).
Child welfare professionals have always been concerned about the number of
children in out-of-home placement. Jones and Finnegan, (2003) stated that the most
common intervention with problem families in child protection was to remove the child
from the home. This chapter will discuss the findings reported in chapter four, organized
by the significant findings from the questionnaire.
Participants were asked if they considered TDM meetings to be beneficial for the
child and/or family. Twenty of twenty-three participants strongly agreed that TDM
meetings are beneficial for the child and his/her family. This is a very significant finding
because it shows that TDM is a great instrument to minimize the number of placement
changes of children in the foster care system. Participants were asked to express their
opinion in regards to the success of TDM. Sixteen, (70 percent), of the participants
strongly agree and seven, (30 percent) agree that that TDM is a success. This finding is
significant because if social workers believe that TDM is a success, they more likely
utilize TDM in every one of their cases.
The author expected that more participants were involved in the implementation
of TDM, but they were not. Only two participants were involved in the implementation.
63
According to one of the participant who was involved in the implementation, in 2004,
Sacramento County became a Family to Family county, embracing the philosophy and
the strategies. In the first stage of implementation, a group was convened and began
looking at data to determine where TDM could have the most impact for children and
families. The process started by utilizing volunteers in Family Reunification to test TDM
and provide feedback. The process was monitored and utilized the feedback of the
volunteers to get others interested. The first focus was Family Reunification, and then
moved to Permanency Services, Family Maintenance/Informal Supervision and Court
Services. TDM became mandatory in those programs in March 2008. Currently the
county is moving forward with implementing TDM at the front end (Emergency
Response) utilizing a similar process. The author expected the participants to reflect a
greater knowledge about the implementation phase of TDM.
Participants were asked to express the difficulties they had experienced using
TDM. Four themes emerged from their answers. The first theme was not hearing back
from participants in a timely manner. Time is of essence when scheduling a meeting. The
second theme was getting all parties to meet at the same time. It is difficult to get people
to adjust their schedule to be present in these meetings. The third theme was that social
workers did not want to include others in the decision making process. Social workers
need time to adjust to the new procedure. The fourth theme was the resistance to change
from some social workers and supervisors about TDM. One participant expressed: “As a
facilitator, I find the most difficult part is the resistance and negativity from other social
64
workers and supervisors who should be utilizing TDM as its best practice.” Another
participant expressed: “I think TDM is successful for every meeting outcome, but we (in
Sacramento County) are not using a TDM for every placement change.”
The findings also suggested that even though a TDM is mandatory for every
placement change, TDM is not being used for every placement change. It seems that the
lack of education given to social workers about TDM has a negative effect on its use. In
addition, managers and supervisors are not being supportive of Team Decision Making
therefore; social workers are not using TDM as mandated.
Implications for Further Research
Research on Team Decision Making is new. There are not many studies on TDM
because the process is fairly new and there are very limited references available.
Therefore, there is not much research conducted on this topic. Wilfire (2002) expressed
that in order to measure the impact of TDM on outcomes for children, an agency must be
able to link specific TDM meetings and decisions to individual children and families, to
achieve this, an agency should record the unique child and family ID numbers in each
TDM record.
There is selective training for TDM facilitators and not for carrying case social
workers. Since TDM is not being used for every placement change as mandated, the
problem may be exposure. In addition, social workers are being resistant to TDM.
Resistance and non use of TDM may be due to the lack of training and exposure; future
65
studies should include specific training for social workers about TDM before use and
after to compare changes about their perceptions of TDM.
This research study had several limitations including a non-random, convenient
sampling of social workers from one agency and a small sample size of 23 participants.
Future studies should include participants from multiple sites and random sampling
procedures so that results can be generalized. Future studies surveying social workers’
use and efficacy of TDM may provide additional information about this tool.
Additionally, more studies with larger sample sizes from different units are needed to
expand upon this study demonstrating that Team Decision Making meetings are needed
to minimize multiple placement changes of children of the foster care system.
This research study would have been more informative had it included additional
subjects to complete questionnaires. The study could have benefited from including more
participants that were part of the implementation phase of TDM, in addition to collecting
specific data recorded by the county about the children who have had a TDM before
placement to see its impact. The sample could have also included members of the
different units that are mandated to use TDM, such as Family Reunification, Permanency
Services, Family Maintenance, and Court Services. These units would have provided a
greater picture of how TDM is used within Child Protective Services. Had the sample
included these units the research may have provided a better understanding of how TDM
has being used. The study provided data from the TDM unit, but the other units mandated
to use TDM were not represented. Had the research study focused on all units using
66
TDM, there would have been a better indication of how it has been used and its
effectiveness.
Future research should include interviews with case carrying social workers.
These social workers are the ones in charge of calling a TDM meeting every time a child
is going to be moved from one place to another. In addition, the study should have
included participants in TDM meetings. The data collected from these meetings would
have been beneficial to the research because it would have included the insight of the
participants as well as the dynamics of these meetings. In addition, parents, foster
parents, service providers, teachers, and social workers should have been included in the
research to get their perception about TDM as a means to minimize placement changes. It
would have given a truer picture of what they themselves feel is important in regard to
placement and TDM.
Implications for Social Work
As social workers it is important to be aware and understand the best way to
handle children that have been in the foster care system for long periods of time.
Education and experience teaches social workers to be change agents and to advocate for
those who are underserved. Timely and sustainable decision making about long term care
arrangements for children in care is crucial to their future protection and well being.
As indicated in Chapter One, Connell, et. al (2006) explain that children who
experience multiple placement changes are more likely to exhibit attachment difficulties,
and externalizing and internalizing behavioral problems. In addition, they argue that
67
placement changes are associated with disruption in educational settings and decreased
academic performance.
Social workers know that families need to be included in the decision making
regarding where their child should be placed. Every child who enters the Child Welfare
System deserves a safe home, nurturing environment, and childhood without multiple
placements. Several social workers are employed in settings where they must organize
important information in a child’s life to come to a Team Decision Making meeting to
decide the best placement for that child.
The knowledge gained from this research adds to the knowledge social workers
should have about the benefits of using Team Decision Making for every child that enters
into the foster care system in California. The findings from this research suggest that
social workers need to be more familiarized with TDM. TDM facilitators receive five
days training on how to conduct successful meetings but, case carrying social workers do
not receive training. TDM facilitators receive training to develop specific skills. These
skills include: ability to use family strengths, ability to develop cooperative interventions,
ability to find common ground among diverse participants, ability to help present risks
without making the family feel defensive, and the ability to keep family meeting
participants focused on tasks.
More information about TDM should be given to all social workers who work in
the child welfare system. One way to increase awareness about TDM is to include all
case carrying social workers in trainings and ensure they are informed about the
68
effectiveness of TDM. This researcher has no doubt; we as social work professionals can
help make a positive difference regarding TDM once we all become better informed.
Implications for Social Work Policy
Placement changes are associated with compromised developmental trajectories
and poor adult outcomes (Crampton & Jackson, 2007). Accounts of such negative
consequences have prompted the public and legislators to call for action (MerkelHolguin, 2004). The most important standard that underlines TDM is to reduce
unnecessary multiple placement changes of children who enter the foster care system.
When a child does not receive a TDM before change of placement, he/she will have the
risk of being moved several times unnecessarily. TDM’s main goal is about making the
best and least restrictive placement for the child; the same policy that guides the foster
care system. When all people impacted are brought together to do this, a better decision is
made.
A TDM meeting looks first at family members as a best placement for that child.
Without a TDM meeting the children have the potential of being moved and not being
placed with family members. In addition, during TDM meetings everyone that is part of
the child’s life is there to make the best placement decision for that child. If the first
placement does not work, there is a plan B to move the child with another family
member.
Achieving permanence of children in the foster care system is essential for every
child. Since the social work profession’s mission is to advocate for those affected by
69
controversial policy issues such as achieving permanence of children in the foster care
system, the implication of TDM in the foster care system is essential to reaching the goal
of permanency.
This policy requires that every child who enters the foster care system have a
TDM before placement change. Findings of this research study suggested that this
requirement is not being fulfilled. Not every child gets a TDM before placement and
some children have a TDM after placement occurs. A strict enforcement of this policy is
required so every child that enters the foster care system has a TDM before change of
placement. In addition every social worker should receive training or seminars to gain
ample knowledge of the goals of TDM and its effectiveness. Knowledge and education
would help social workers to buy in to the program. The County should have disciplinary
actions against those social workers who still, after training and education, do not use
TDM as mandated.
Initially, TDM process started by utilizing volunteers in Family Reunification to
test and provide feedback; the process was monitored and utilized the feedback of the
volunteers to get others interested. Children in family reunification may have already
been moved from place to place too many times. Psychological damage may have
occurred in these children. After careful consideration, the program should have had
started first in Emergency Response and not utilized volunteers, but the whole unit as a
starting point of the new policy.
70
Conclusion
This chapter included a discussion of the significant findings from this research
project. The findings of this study constitute an important preliminary step to revealing
the need for more heightened awareness of TDM. Future studies should concentrate on
connecting with more TDM units from different sites. It is recommended that the
instrument used in this research study should be refined or new instruments should be
developed to obtain sufficient validity and reliability in data. This researcher feels that it
is crucial that TDM is implemented in every county in California.
This researcher hopes that a future review of the social work literature will reveal
an increased interest in the subject with more studies conducted to reveal how TDM is
functioning in decreasing the amount of times a child is moved from place to place while
in the foster care system. The need for solutions about finding permanent placements for
children in foster care is evident from the number of children that enter the foster care
system. While Team Decision Making’s main goal is to reduce unnecessary multiple
placements, more research needs to be done. Studies surveying families that have
children in the foster care system and have had a TDM before placement change may
provide additional information about the difficulties, benefits and efficacy of TDM as a
best program to decrease multiple changes of children who enter the foster care system.
71
APPENDICES
72
APPENDIX A
Informed Consent
73
Informed Consent
You are being asked to participate in a research study conducted by Lucy De La
Cruz, MSW II student at CSUS in partial fulfillment of the requirements for a Master’
Degree in Social Work. The purpose of this study is to reveal how Team Decision
Making (TDM) was implemented to address multiple placements in the Child Welfare
System, how it is used and obstacles for its implementation. The results of this study will
reveal what has been the change process in Sacramento County with the implementation
of TDM.
If you choose to participate in this study, you will be asked to complete a
questionnaire that includes questions about your involvement with TDM and your
impressions about the process. You will also be asked for demographic information, such
as your level of education and experience. Completing the questionnaire will take
approximately 15 minutes.
The researcher believes that there is no risk to you by participating in this research
project. Your participation is completely voluntary. You may choose not to participate or
end your participation at anytime without any negative consequences. Participating or not
participating will not affect your current or future employment with DHHS. You may
also choose to end your participation at any time.
You may not benefit directly from participating in this research project. However,
the results of this study may be helpful in understanding system change in the child
welfare system.
Confidentiality will be maintained to the extent possible. Your signed consent
form will be separated from your questionnaire. Your name will not be on the
questionnaire so that even the researcher will not know which questionnaire you
completed. All research data will be kept in a locked cabined that is only accessed by the
researcher. No papers or publications that result from this research will contain any
individually identifying information. All research data will be destroyed by July, 2009.
Complete confidentiality cannot be guarantee because the federal DHHS may review
research records to ensure the protection of research subjects.
The information obtained on the completed questionnaires will be recorded and
analyzed using SPSS and open-ended questions will be analyzed according to themes.
The results will then become incorporated into this student’s thesis project. If you have
any questions regarding this research, you may contact the researcher personally via
telephone at (916) 847-5979 or via e-mail at lucydlc@wavecable.com and/or her thesis
advisor, Dr. Teiahsha Bankhead either by phone at (916) 278-7177 or e-mail at:
bankhead@csus.edu.
74
By signing this consent form you agree to participate in this research study. I have
received my own copy of this form.
___________________________
Participant’s Name
___________________________
Participant’s Signature
___________________
Date
75
BILL OF RIGHTS FOR EXPERIMENTAL SUBJECTS
1. To be told what the study is trying to find out.
2. To be told what will happen to you and whether any of the procedures, drugs, or
devices are different from what would be used in standard practice.
3. To be told about the frequent and/or the important risks, side effects, or discomforts
of the things that will happen to you for research purposes.
4. To be told if you can expect any benefit from participating and, if so, what the benefit
might be.
5. To be told of other choices you have and how they may be better or worse than being
in the study.
6. To be allowed to ask any questions concerning the study, both before agreeing to be
involved and during the course of the study.
7. To be told what sort of medical treatment is available if any complications arise.
8. To refuse to participate at all, or to change your mind about participating after the
study has started. This decision will not affect your right to receive the care you
would receive if you were not in the study.
9. To receive a copy of the signed and dated consent form.
10. To be free of pressure when considering whether you wish to agree to be in the study.
76
APPENDIX B
Self-Administered Questionnaire
77
Questionnaire
1. What is your Gender?
Female
Male
2. What is your Ethnicity/ Racial Identification?
White/Caucasian
Native American
African American
Asian American
Hispanic/Latino
Other
3. What is your age?
20-29
30-39
40-50
Over 50
4. What is your level of Education?
 BS
 MSW
 Ph.D.
 Other _______
5. What is your title?
 TDM Facilitator
 Social Service Worker MSW Level
 Social Service Worker BS  Other _______
6. How many years have you been working in the Child Welfare System? _____
7. Indicate your level of involvement with TDM (check all that apply)
 TDM Planning & Implementation
 TDM Facilitator
 Social Service Worker
 Other
8. What was your role in the implementation/use of TDM?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
9. Who made the decision to implement TDM and Why?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
78
10. How was TDM roll out in Sacramento?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
11. What is your experience using TDM?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12. Please define TDM in your own words
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
13. How long was your training in TDM?
a) Number of hours ____
b) Number of days ______
14. Do you think you received adequate training to use TDM? Yes or No, Why or
why not?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
15. What is the purpose of TDM?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
16. On a scale of 1 to 5, (1 is lowest and 5 the highest) How comfortable do you feel
using TDM? _____. 1- Not at all, 2- Not very, 3- Somewhat, 4- Very, 5- Excellent
79
17. Do you use TDM for every family on your case load? Why or why not?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
18. How many times have you used TDM with families on your case load?
19. How long does it usually take to contact everyone for the meeting?
_____ Number of days
_____ Number of hours
20. How long does the meeting usually last? _____ Hours
______ Minutes
21. What is your personal opinion about the efficacy of TDM?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
22. What difficulties (if any) have you experienced using TDM?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
23. Do you consider the TDM meeting to be beneficial for the child and/or family?
Please Select:
1- Disagree, 2- Somewhat Agree, 3- Agree, 4- Strongly Agree
24. In your view, who are the key participants in TDMs? List in order of priority.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
25. What do you think are the County’s goals in implementing TDM?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
80
26. In your opinion, do you think that TDM is a success?
Please Select:
1- Disagree, 2- Somewhat Agree, 3- Agree, 4- Strongly Agree
27. Please rate the success of TDM
 Very High
High
 Average
Poor
28. Please state your additional comments
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
81
REFERENCES
Adams, P., & Chandler, S. (2004, March). Responsive Regulation in Child Welfare:
Systematic Challenges to Mainstreaming the Family Group Conference. Journal
of Sociology & Social Welfare, 31(1), 93-116. Retrieved October 10, 2008, from
Academic Search Premier Database.
American Humane Association, (2008). Family Group Decision Making in Child
Welfare, Purpose, Values, and Processes. Retrieved October 25, 2008, from
www.americahumane.org/fdgm
Annie E. Casey Foundation, (2001). Family to Family Tools for Rebuilding Foster Care
Implementing the Values and Strategies of Family to Family.
Barth, R.P. (1999). After Safety, what is the goal of Child welfare Services: Permanency
Family Continuity or Social Benefit? International Journal of Social Welfare, 8(4)
244-252. Retrieved October 10, 2008 from www.csa.com.
Barth, R. P. (2002). Family Group Conferencing: New Directions in CommunityCentered Child and Family Practice (Book)." Journal of Sociology & Social
Welfare 29(3), 199-201. Retrieved October 20, 2008 from Academic Search
Premier
Barth, R.,P. & Johnson-Reid, M. (2000). Outcomes After Child Welfare Services:
Implications for the Design of Performance Measures. Children and Youth
Services Review 22(9) 763-787. Retrieved October 22, 2008 from Academic
Search Premier Database.
82
Berzin, S., Thomas, K., & Cohen, E. (2007, December). Assessing Model Fidelity in
Two Family Group Decision-Making Programs: Is This Child Welfare
Intervention Being Implemented as Intended? Journal of Social Service Research,
34(2), 55-71. Retrieved October 20, 2008, from Academic Search Premier
Database.
Berzin, S. (2006). Using sibling data to understand impact of family group decisionmaking on child outcomes. Children & Youth Services Review, 28, (12), 14491458. Retrieved October 10, 2008 from Academic Search Premier Database.
Britner, P. A., & Mossler, D. G. (2002). Professionals' decision-making about out-ofHome placements following instances of child abuse. Child Abuse and Neglect,
26(4), 317-332. Retrieved October 23 from www.csa.com
Crampton, D., & Jackson, W. (2007, May). Family Group Decision Making and
Disproportionality in Foster Care: A Case Study. Child Welfare, 86(3), 51-69.
Retrieved October 20, 2008, from Academic Search Premier Database.
Crampton, D. (2004) Family Involvement Intervention in Child Protection: Learning
from Contextual Integrated Strategies. Journal of Sociology & Social Welfare
31(1), 175-198. Retrieved October 22, 2008. From Academic Search Premier
Database.
Crampton, D. (2007). Research Review: Family group decision-making; a promising
practice in need of more programme theory and research. Child & Family Social
Work. 12 (2), 2002-2009.
83
Crampton, D., & Natarajan, A. (2005, January). Connections Between Group Work and
Family Meetings in Child Welfare Practice: What Can We Learn from Each
Other? Socia Work with Groups, 28(1), 65-79. Retrieved October 20, 2008,
From Academic Search Premier Database.
Crea, T. M., et al., (2008) Implementation fidelity of Team Decisionmaking, Children
and Youth Services Review. Retrieved October 17, 2008 from Academic Search
Premier Database
Crea, T., Crampton, D., Abramson-Madden, A., & Usher, C. (2008, November).
Variability in the implementation of Team Decisionmaking (TDM): Scope and
compliance with the Family to Family practice model. Children & Youth Services
Review, 30(11), 1221-1232. Retrieved October 20, 2008, from Academic Search
Premier Database.
Connolly, M. (2006, September). Up Front and Personal: Confronting Dynamics in the
Family Group Conference. Family Process, 45(3), 345-357. Retrieved October
20, 2008, from Academic Search Premier Database.
Frame, L., Berrick, J., & Coakley, J. (2006, November). Essential elements of
implementing a system of concurrent planning. Child & Family Social Work,
11(4), 357-367. Retrieved October 20, 2008, from Academic Search Premier
Database.
Holland, S., & O’Neill, S. (2006). We had to be there to make sure it was what we
84
wanted. Childhood, 13(1), 91-111. Retrieved October 10, 2008 from Academic
Search Premier .Database
Jones, L., & Finnegan, D. (2003, December). Family Unity Meetings: Decision Making
and Placement Outcomes. Journal of Family Social Work, 7(4), 23-44. Retrieved
October 20, 2008, from Academic Search Premier Database.
Kalafat, J., Illback, R., & Sanders, D. (2007) The Relationship between implementation
Fidelity and educational outcomes in a school-based family support program:
Development of a model for evaluating multidimensional full-service programs.
Evaluation and Program Planning, 30(2), 136-148. Retrieved October 10, 2008,
from Academic Search Premier Database.
Karski, R., & Barth, R. (2000, June). Models of State Budget Allocation in Child Welfare
Services. Administration in Social Work, 24(2), 45-66. Retrieved October 20,
2008, from Academic Search Premier Database.
Kemp, S., & Bodonyi, J. (2000). Infants Who Stay in Foster Care: Child Characteristics
and Permanency Outcome of Legally Free Children First Placed as Infants. Child
& FamilySocial Work, 5(2), 95-106. Retrieved October 18, 2008, from Academic
Search Premier Database .
Kemp, S., & Bodonyi, J. (2002). Beyond Termination: Length of Stay and Predictors of
Permanency for Legally Free Children. Child Welfare, 81(1), 58-86 Retrieved
October 20, 2008, from Academic Search Premier Database.
Manalo, V. (2008). Understanding practice principles and service delivery: The
85
Implementation of a Communtiy-based Family Support Program. Children and
Youth,30(8), 926-941. Retrieved October 20, 2008, from Academic Search
Premier Database.
Mitchell, L., Barth, R., Green, R., Wall, A., Biemer, P., Berrick, J., et al. (2005, January).
Child Welfare Reform in the United States: Findings from a Local Agency
Survey. Child Welfare, 84(1), 5-24. Retrieved October 20, 2008, from Academic
Search Premier Database.
Merkel-Holguin, L. (2004, March). Sharing Power with the People: Family Group
Conferencing as a Democratic Experiment. Journal of Sociology & Social
Welfare, 31(1), 155-173.Retrieved October 20, 2008, from Academic Search
Premier Database.
Pennell, J. (2004, March).Family Group Conferencing in Child Welfare: Responsive and
Regulatory Interfaces. Journal of Sociology & Social Welfare, 31(1), 177-135.
Retrieved October 20, 2008, from Academic Search Premier Database.
Pennell, J., & Burford, G. (2000, March). Family Group Decision Making: Protecting
Children and Women. Child Welfare, 79(2), 131-158. Retrieved October 20,
2008, from Academic Search Premier Database.
Potter, C., & Klein-Rothschild, S. (2002). Getting Home on Time: Predicting Timely
Permanency for Young Children. Child Welfare, 81(2), 123-150. Retrieved
October 18, 2008, from Academic Search Premier Database.
Rubin, D., Alessandrini, E., Feudtner, C., Mandell, D., Localio, A., & Hadley, T. (2004,
86
May). Placement Stability and Mental Health Costs for Children in Foster Care.
Pediatrics, 113(5), 1336-1341. Retrieved October 20, 2008, from Academic
Search Premier Database.
Tilbury, C., & Osmond, J., (2006). Permanency Planning in Foster Care: A Research
Review and Guidelines for Practitioners. Australian Social Work, 59(3), 265-280,
Retrieved October 17, 2008, from Academic Search Premier Database.
Walton, E., Roby, J. Frandsen, A., & Davidson, R. (2003, December). Strengthening AtRisk Families by Involving the Extended Family. Journal of Family Social Work,
7(4), 1-22. Retrieved October 10, 2008 from Academic Search Premier Database
Webster, D., Barth, R., & Needell, B. (2000, September). Placement Stability for
children in Out-of-Home Care: A Longitudinal Analysis. Child Welfare, 79(5),
614-632. Retrieved October 20, 2008, from Academic Search Premier Database.
Wells, K., & Guo, S. (1999). Reunification and Reentry of Foster Children. Children and
Youth Services Review, 21(4), 273-294. Retrieved October 10, 2008 from
www.csa.com