I have discussed various dimensions of transition as the child protection paradigm shifts away from the traditional model relying on legislative and administrative command and control toward standards focused, best practice driven approaches, informed by generally accepted guiding principles. The transition is nowhere more evident than with how we determine practice effectiveness. In the traditional command and control structure, effectiveness is understood in relatively simplistic terms. There are complex, prescriptive rules and procedures child protection workers are expected to consistently follow. Compliance with this expectation is the primary if not exclusive measure of worker and program effectiveness. This approach is what is typically referred to as Quality Assurance (Q.A.). Perfect performance at the highest level of effectiveness is seen when workers activities comply with all relevant rules and are consistent with all relevant procedures. If you do everything you are expected to do in the ways you are expected to do them, you are doing a good job.
The Q.A. paradigm was largely adapted from production or assembly environments where the goal is to produce uniform products or services. A child and his (or her) situation are first screened to determine general eligibility for child protection services. If determined eligible, the child and his family are then moved (assigned) to an appropriate service area for further processing. The movement from service area to service area continues until the child is moved out of the child protection environment, exiting based on which service area he was in at the time of exit. Even though individual workers may develop some attachments with the child, the childs movement from service area to service area and his eventual exit are primarily determined by eligibility rules for the various service areas and the established procedures for movement and exit.
There has been significant expansion beyond the traditional Q.A. approach to evaluating child protection effectiveness. Over time, it has become increasingly clear reliance on Q.A. is insufficient. Even when there is high rule and procedure compliance, many children are still being harmed and child protections legitimacy is suspect. Simply complying with established rules and procedures finds significant numbers of children no better off than they were before child protection involvement and others clearly less well off. This stark reality has prompted a transition from focus on compliance to focus on outcomes, on what really happens with children and their families.
This new focus starts with safety and expands to include permanence. (At this point, it has not yet expanded to embrace the ongoing success of children.) Are children being kept from harms way and are they living in stable, nurturing families permanently committed to them and their welfare? The answer should be an unqualified Yes. There is a high level of consensus for the correctness of both the question and the desired answer. The point of child protection is to assure safety and permanence for all abused and neglected children.
Child protection is again adopting a strategy from elsewhere. It has incorporated Continuous Quality Improvement (CQI) into its conceptual understanding of practice. In the child protection variant on the strategy, a set of indicators is developed that are thought to be correlates of safety and permanence for children. For example, the frequency of re-maltreatment is understood as a correlate of safety. The lower the rate of re-maltreatment within a population of abused and neglected children, the safer the identified population is as a whole. By implication, agencies and programs showing lower re-maltreatment rates are more effective than those with higher rates. The children with whom they work are safer.
There are various sets of factors thought to be associated with better safety and permanence outcomes for children, although the most widely acknowledged set is the one used for the federal child and family services reviews. With that set as with others, child protection entities are rated using a percent strategy where each entity is given a score on each element in the set. For example, an agencys re-maltreatment rate might be 6%, meaning 6% of children served by the agency experience re-maltreatment within 6 months of the incident prompting initial agency involvement. Other rated elements include events such as movement while in out-of-home care, frequency of contact with families whose children were not removed, and the length of time between initial reports to the agency and the agencys first response.
With CQI, the goal is to improve the percentage of outcomes consistent with the presumed correlate of child safety and permanence. Although this approach does not relate specifically to best practice or how to achieve the desired outcomes, it clearly specifies what are thought to be best outcomes and fairly accurately measures the extent to which those outcomes are being achieved. For this reason, CQI is a major improvement over simple reliance on Q.A. as discussed above.
Although I am not aware of any agencies or programs that have achieved the next level beyond CQI, its nature is evident. Child protection must move beyond CQI to reliance on value based practice and on values that serve as both the prompts for action and the measure of effectiveness. For example, a fundamental value must mandate child protection do no harm. Children must never be worse off for having been served by a child protection agency or program. A childs experiencing re-maltreatment is always an indicator of child protection failure, even if he (or she) is the only child who is re-maltreated. Each child who is not currently safe or in a permanent family where he is accepted and nurtured is the agencys immediate, highest priority; it is a crisis. The value is safety and permanence for each child, each time, immediately. Practice is then evaluated in terms of adherence to the value for every child, every time.
Gary A. Crow, Ph.D. GAC@GaryCrow.net || and visit www.GaryCrow.net.