Commentary on the Report of the APSAC Task Force on Evidence-Based Service Planning Guidelines for Child Welfare

Abstract

‘‘Evidence-based service planning’’ (EBSP) is a phrase new to me. Yet the concept is consistent with the work of Stein, Gambrill, and Wiltse (1984) that the role of the child welfare professional is timely decision making, at least as much as it is treatment provision, and that referral should be made to programs with evidence of effectiveness. In 1984, these child welfare scholars could only point to the importance of using research to guide decision making but had little more to go on because there were no organized bodies of research on screening or interventions for child welfare–involved families. Now, as this innovative and important report (Berliner, Fitzgerald, Dorsey, Chaffin, Ondersma & Wilson, this issue) describes, we have many more resources to use to ensure that our clients are referred to the most fitting interventions and achieve the best possible outcome. This report is intended for the use of child welfare service (CWS) professionals and others who are involved with children and families, especially mental health professionals, court personnel, attorneys, and Child Advocacy Centers. The most elemental formulation in this important report is that principles of evidence-based interventions should also be principles of EBSP (also known as case management). In particular, EBSP is of shorter term, focused (not necessarily comprehensive), skills based, and shaped by the periodic measurement of outcomes. Likely to be the most controversial assertion of this report is the proposition that a focused and parsimonious plan is the key to an EBSP rather than the traditional standard of comprehensive service. One piece of this rationale is that some improvements in the main priority problems, for example, a reduction in the sense of having out-of-control children, will cascade to other areas (e.g., a reduction in depression). The argument for stepped care is certainly appealing and straightforward: that the minimally intrusive and demanding form of intervention is provided first and only moves to more intensive interventions, if necessary, in time. Yet, there is little mention of the alternative hypothesis that even if one area improves the gains may be short-lived if other areas are not addressed. Surely, we do know that some relief from the problems of parenting can reduce depression (DeGarmo, Patterson, & Forgatch, 2014), but it is also the case that if depression is more endogenous and a result of more ingrained biopsychosocial influences, it may not abate, even with improved parenting. Families with unstable housing may also have significant problems continuing with the progress made during evidence-based interventions. We have much work to do to understand the issues that are the most pivotal for a family’s lasting success. The child welfare professional and family must also be mindful of the tight CWS timelines that require a relatively quick case resolution. If the stepped approach does not address more serious underlying mental health problems of the child or parent at the same time that they address parenting, the overall impact may not unfold in time and the service period may end before there is an optimal outcome. Although there is certainly a reason to think that most problems specifically related to child abuse and neglect are parenting problems, and not adult behavioral health problems, there seems to be less than overwhelming evidence that these problems are really better addressed sequentially rather than concurrently. We do have evidence that CWS-involved families are often overwhelmed by the demands on them to get therapeutic services and are often not consulted about what is feasible (Estefan, Coulter, WandeWeerd, Arrmstrong, & Gorski, 2012). This American Professional Society on the Abuse of Children (APSAC) report is rightfully critical of such approaches. Estefan, Coulter, WandeWeerd, Arrmstrong, and Gorski (2012) report that the 21 clients they studied were referred to 61 services, and 7 indicated that they also needed to maintain a stable income and housing. In addition, eight parents were expected to enroll their children in therapeutic services or have engagement with a guardian ad litem. On average, each family was being directed to about four services. That sounds unfocused, but the