Using risk adjustment approaches in child welfare performance measurement: Applications and insights from health and mental health settings

Abstract

Federal policymaking in the last decade has dramatically expanded performance measurement within child welfare systems, and states are currently being fiscally penalized for poor performance on defined outcomes. However, in contrast to performance measurement in health settings, current policy holds child welfare systems solely responsible for meeting outcomes, largely without taking into account the effects of factors at the level of the child, and his or her social ecology, that might undermine the performance of child welfare agencies. Appropriate measurement of performance is predicated upon the ability to disentangle individual, as opposed to organizational, determinants of outcomes, which is the goal of risk adjustment methodologies. This review briefly conceptualizes and examines risk adjustment approaches in health and child welfare, suggests approaches to expanding its use to appropriately measure the performance of child welfare agencies, and highlights research gaps that diminish the appropriate use of risk adjustment approaches – and which consequently suggest the need for caution – in policymaking around performance measurement of child welfare agencies.

Predicting therapist effectiveness from their own practice-based evidence.

“…Measures of risk adjustment for mental health populations have typically included sociodemographic data as well as baseline mental health severity (Rosen et al, 2010). Moreover, the inclusion of physical health data, stress indicators, and comorbid mental health disorders greatly increases the amount of variance explained in outcomes (Hermann, Rollins, & Chan, 2007; Jones et al, 2004; Raghavan, 2010). Risk adjustment is thus relevant to assessing therapist effectiveness, and the absence of this was a notable limitation of the Kraus et al (2011) study as well as other large, naturalistic studies of therapist effects.…”

Medicaid Expenditures on Psychotropic Medications for Maltreated Children: A Study of 36 States

“…The fiscal utility of instruments purporting to capture mental health need such as the Child Behavior Check List (CBCL; described below) (13, 14), and maltreatment status, is not well understood in large population-level data. Such a lack of data has been identified as one of the principal challenges facing Medicaid agencies in their attempts to contain costs of care for their child welfare beneficiaries (15). …”