After children enter the child welfare system, subsequent out-of-home
placement decisions and their impact on children’s well-being are
complex and under-researched. This study examined two placement decision-making
models: a multidisciplinary team approach, and a decision support algorithm
using a standardized assessment. Based on 3,911 placement records in the
Illinois child welfare system over 4 years, concordant (agreement) and
discordant (disagreement) decisions between the two models were compared.
Concordant decisions consistently predicted improvement in children’s
well-being regardless of placement type. Discordant decisions showed greater
variability. In general, placing children in settings less restrictive than the
algorithm suggested (“under-placing”) was associated with less
severe baseline functioning but also less improvement over time than placing
children according to the algorithm. “Over-placing” children in
settings more restrictive than the algorithm recommended was associated with
more severe baseline functioning but fewer significant results in rate of
improvement than predicted by concordant decisions. The importance of placement
decision-making on policy, restrictiveness of placement, and delivery of
treatments and services in child welfare are discussed.