April 2022

Summary

This report presents the findings of a rapid review of the body of work focussing on the quality of decision making and risk assessment for children referred to statutory children’s social care (CSC) services.

The review highlights the fact that the definitions of quality and effectiveness are not well articulated in policy or practice, nor are they always clearly operationalised in research, particularly in the UK.  Five categories of definition, as well as five predominant factors that play a role in decision making were identified in the report.

The evidence presented confirms that decision making in this field is a highly skilled activity, requiring organisations to support and develop professional expertise. The international evidence also highlights the importance of equity as a marker of quality in decision making, which aligns with recent research into child welfare inequalities in the UK. 

Objectives

The aim of the review was to contribute to the knowledge base on how to improve the quality of decision making and risk assessment for children referred to statutory CSC services. The aim was to answer the following research questions:

1. How are quality and effectiveness understood and operationalised in studies of decision-making in children’s social care?
2. What factors affect the quality and effectiveness of decision-making?

How we went about it

A keyword search was carried out on five electronic databases (Scopus, Cochrane, PubMed, PsychINFO, Web of Science). The database search was supplemented by a manual search of other reviews and key websites. Two stages of screening, first of titles/abstracts and second of full text articles, were undertaken in specialist software for collaborative reviews using a decision-making flowchart to help standardise responses.

For the final sample of included full texts, the quality of research including potential sources of bias was appraised. A pro-forma was used to extract data from each study and an adapted Framework method was used to guide the analysis and synthesis of findings. Preliminary themes and definitions of quality were discussed by the review team and summarised in table format. Finally, quantitative and qualitative material were brought together and reported using a narrative approach.

Key findings

Defining quality and effectiveness

Overall, five categories of definition were identified in the reviewed work:

• Accuracy refers to the extent to which decisions are corroborated by other knowledge obtained by CSC services about the child and their circumstances.
• Consistency refers to the extent to which different professionals make a similar decision about a particular set of circumstances.
• Outcomes refers to the consequences of a decision in terms of children’s health and wellbeing at follow-up in research.
• Practice refers to the professional conduct of judgment and decision-making, particularly in real-life settings.
• Equity refers to the expectation that children from different socio-demographic groups should have similar decisions made about them by child welfare professionals.

Factors affecting decision making

These factors were broken down in terms of the decision threshold and the contextual domain:

• Intake/response to referrals – referral decisions were found to be influenced primarily by case characteristics combined with organisational and external factors that might affect what action was taken at a particular level of assessed risk. Inconsistent agency responses were identified in relation to weekend referrals, team caseloads and referrals with insufficient information. Volume of demand, involvement of managers, and expertise of practitioners also had a bearing on the quality of practice and consistency of thresholds.
• Substantiation of maltreatment – substantiation decisions were influenced primarily by case characteristics. Inaccurate substantiation decisions were linked to limited knowledge and information, as well as resource issues. 
• Risk and needs assessment – good practice in risk assessment was linked to expertise in analytical skills such as hypothesis testing and argumentation, the ability of managers to probe workers’ judgements, practitioners’ confidence in expressing their views, as well as recognition of the impact of emotions and the power dynamics in interprofessional networks.
• Admission to care – decisions to admit children to care were primarily influenced by the risk assessment but also by child characteristics and family income. Inconsistent DM could result from the multiple perspectives of professionals, while thresholds for placing children were not always aligned with the results of parenting assessments. Caseloads and institutional support for DM affected rates of admissions, as did the prevailing organisational and practice culture and workers’ prior hypotheses and value position.
• Reunification from care – the quality of reunification decisions was affected by confirmation bias, poor record-keeping, and a tendency to downgrade referrals from family members. More timely reunifications could be supported by great involvement of parents in decisions.

Implications / Next steps

This review emphasises the need to establish clear definitions of quality and effectiveness and to gather appropriate data to monitor associations and trade-offs between them. Drawing on the principles of partnership and co-production of services, the report also argues that the extent to which children and families are directly involved in decision making should be a key indicator of quality. 

Greater appreciation of the distinction between risk predictions and threshold decision is also crucial for both research and policy, and has implications not only for efforts to improve decision making but also for the wider issue of structural change and innovation in CSC.