All Unhappy Families: Standardization and Child Welfare Decision-Making.

In the past 15 years, actuarial-based risk assessments designed to make child welfare decision-making more objective have proliferated. However, we know little about how actuarial-based decision-making plays out on the ground. Drawing on qualitative interviews with 66 Child Protective Service (CPS) workers in 2 states, this dissertation extends existing scholarship on actuarial-based risk assessments to foreground how CPS workers and child welfare agencies make meaning of decision-making in a structured environment. In three separate but related empirical papers, I investigate the intended and unintended consequences of using actuarial-based risk assessments to frame decision-making at the level of the organization, the individual, and the risk assessment itself. In the first article, I find that individual workers conceptualize and complete the risk assessment in varied ways. The amount of discretion that workers reported having was often associated with their social status characteristics, suggesting that issues of social power and privilege remained at play in a context intended to constrain their impact. The second article examines differences between a tight vs. loose implementation of the same standardized procedure, highlighting the ways in which distinct approaches to implementation changed the meaning of the intervention itself. In the third article, I look at how one risk assessment is structured. I find that an unintended focus on preventing one type of error in judgment de-emphasizes preventing others, sometimes with a devastating impact for families. Breaking away from rigid dichotomies that pit clinical and actuarial decision-making as mutually exclusive methods, I propose an integrative model that capitalizes on the strengths of both clinical and standardized processes. I argue that it is critical to understand and recognize how subjective assessments are already incorporated into processes for using standardized decision-making tools. The solution is not to find new ways to exclude caseworkers’ judgment but to offer a place for it alongside other approaches to improving case decision-making. I propose creating an integrated clinical and standardized decision-making model as well as revising current risk assessments to reflect a relational and dynamic assessment of case factors.PhDSocial Work and SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111625/1/bosk_1.pd

Teachers’ Perceptions of Childcare and Preschool Expulsion

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142342/1/chso12228_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142342/2/chso12228.pd

Standardizing Biases: Selection Devices and the Quantification of Race

Racial inequality persists despite major advances in formal, legal racial equality. Scholars and policymakers argue that implicit bias and other forms of “new prejudice” combined with subjective organizational decision-making practices perpetuate racial inequality. The standardization of decision-making offers a potential solution, promising to eliminate the subjectivity that allows implicit bias to creep into consequential decisions. Drawing on research in science studies and law and society, we argue that standardization must be understood as a heterogeneous practice capable of producing very different outcomes depending on the details of the standard and the organizational infrastructure surrounding its use. We compare “selection devices” – simple quantified tools for making allocation decisions – in undergraduate admissions and child welfare to highlight the complex relationships between race and standardization. In particular, we suggest that actuarial standardization practices, including those adopted with the intention of reducing racial inequality, tend to reinforce an unequal status quo by reconfiguring mutable social structures into immutable individual risk factors, while non-actuarial practices lack the mechanical objectivity needed to stave off challenges of racial bias

An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives

Mental health professionals are frequently presented with situations in which they must assess the risk that a client will cause harm to themselves or others. Troublingly, however, predictions of risk are remarkably inaccurate even when made by those who are highly skilled and highly trained. Consequently, many jurisdictions have moved to impose standardized decision-making tools aimed at improving outcomes. Using a decision-making ecology framework, this conceptual paper presents research on professional decision-making in situations of risk, using qualitative, survey, and experimental designs conducted in three countries. Results reveal that while risk assessment tools focus on client factors that contribute to the risk of harm to self or others, the nature of professional decision-making is far more complex. That is, the manner in which professionals interpret and describe features of the client and their situation, is influenced by the worker’s own personal and professional experiences, and the organizational and societal context in which they are located. Although part of the rationale of standardized approaches is to reduce complexity, our collective work demonstrates that the power of personal and social processes to shape decision-making often overwhelm the intention to simplify and standardize. Implications for policy and practice are discussed

All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth.

PURPOSE: Research consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth. METHODS: Data were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up. RESULTS: At baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups. CONCLUSIONS: Harsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings

A Relational Workforce Capacity Approach to Trauma-Informed Care Implementation: Staff Rejection Sensitivity as a Potential Barrier to Organizational Attachment

This study explores the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among mental health agencies transitioning to Trauma-Informed Care (TIC), which is currently outside the focus of most research. Specifically, this study examines: (1) whether staff rejection sensitivity predicts organizational attachment; (2) whether staff turnover intentions account for the association between rejection sensitivity and organizational attachment; and (3) whether those associations hold once taking into account staff demographic factors (gender, race and ethnicity, education, and income)? Around 180 frontline workers in three Northeastern U.S. mental health agencies responded to surveys collected between 2016 and 2019 using the organizational attachment, rejection sensitivity and turnover intention measures, and their previous TIC training experience. Rejection sensitivity was significantly associated with organizational attachment (β = −0.39, p p < 0.05), accounting for 22% of its variance. This study concludes that TIC transitioning mental health agencies’ staff with a higher rejection sensitivity are more likely to express lower organizational attachment and higher intent-to-turnover

Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains

Exploring perceptions of genetic risk and the transmission of substance use disorders

Abstract Background Substance use disorders (SUDs) have been consistently shown to exhibit moderate intergenerational continuity (1–3). While much research has examined genetic and social influences on addiction, less attention has been paid to clients’ and lay persons’ perceptions of genetic influences on the heritability of SUD (4) and implications for treatment. Methods For this qualitative study, twenty-six structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving inpatient SUD treatment. These interviews were thematically analyzed for themes related to maternal perceptions around intergenerational transmission of substance use behaviours. Results Findings show that over half of the mothers in this sample were preoccupied with their children’s risk factors for addictions. Among this group, 29% spontaneously expressed concerns about their children’s genetic risk for addiction, 54% shared worries about their children’s propensity for addiction without mentioning the word gene or genetic. Additionally, 37% had challenges in even discussing their children’s future when prompted. These concerns mapped onto internal working models of attachment in unexpected ways, with parents who were coded with balanced working models being more likely to discuss intergenerational risk factors and parents with disengaged working models displaying difficulties in discussing their child’s future. Conclusion This research suggests that the dominant discourse around the brain-disease model of addictions, in its effort to reduce stigma and self-blame, may have unintended downstream consequences for parents’ mental models about their children’s risks for future addiction. Parents receiving SUD treatment, and the staff who deliver it, may benefit from psychoeducation about the intergenerational transmission of SUD as part of treatment