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RE: dumb question?
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Nicely put!<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
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<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
bounce-2242764-6840306@list.cornell.edu
[mailto:bounce-2242764-6840306@list.cornell.edu] <b>On Behalf Of </b>Raelene
Freitag<br>
<b>Sent:</b> Tuesday, January 15, 2008 11:00 AM<br>
<b>To:</b> Child Maltreatment Researchers <br>
<b>Subject:</b> RE: dumb question?<o:p></o:p></span></p>
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<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Sheri,<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It’s a good question. The term “risk” is often used quite
loosely, and is used rather impressionistically. Sometimes it has likert-type
scale definitions or anchor points so there is a relative increase or decrease.
Alternatively, there are actuarial risk instruments that have very specific
outcome data for families in various risk levels. For example, a recent study
of over 5500 California family risk assessments conducted by workers in the
field was used to construct a risk assessment instrument that creates 4 levels
of risk. The known rates of each outcome measured are presented below:<o:p></o:p></span></p>
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style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p>
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<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Raelene Freitag, MSW, Ph.D.</span><span style='color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Director</span><span style='color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Children's Research Center<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>So, when a worker in California describes a family as high risk,
they are saying that the family shares characteristics with families that are very
likely to be re-referred in the next two years (74.8%--and often this will
occur multiple times), have about a 50-50 chance of having at least one new
substantiation, and more than 1 in 5 (22.1%) will end up in foster care. In
contrast, low risk families are unlikely to be re-referred, more than 90% will
not be re-substantiated, and only about half a percent will end up in foster
care. It’s really important to note that risk assessment is good for
classification, but not prediction. It should not be used as a basis for
decisions about whether to remove a child (safety assessment should be used for
that). But a reliable and valid risk tool can be very effective at identifying
families who would benefit from services to prevent maltreatment. It’s also important
to note that we see virtually the same recurrence –by-risk distribution whether
or not the CURRENT referral is substantiated. It’s helpful to think about
serving higher risk families regardless of whether the current incident is
substantiated or not. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>You are completely right about the importance of balancing
statistical information with clinical judgment. It’s my argument that we can’t
ignore the evidence that for some things like estimating probability of future
events simple statistical models typically outperform human judgment. We also
can’t ignore that even the most robust risk tool can’t predict the future, or
take every variable into account. I encourage our profession to move past
“either/or” thinking about this and take a “both/and” approach. It’s important
to advance our skill at integrating data-driven information such as risk
assessments into the human relationships between worker and family.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>If you want to learn more about actuarial risk, you can get
several publications, including some of the risk studies, from our web-site
below. Follow the link to CRC, then publications, and look for risk-related
publications there. Best wishes.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'>Raelene Freitag, MSW, Ph.D.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>426 S. Yellowstone Dr. #250</span><span style='color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>Madison, WI 53719</span><span style='color:#1F497D'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>608-831-1180<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:#1F497D'>www.nccd-crc.org<o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:7.5pt;color:#1F497D'>Please do not
send any identifying or confidential information (such as names,
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an e-mail. Identification numbers (such as case or
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<p class=MsoNormal><span style='color:#1F497D'> </span><span
style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p>
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<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'> bounce-2239133-6833790@list.cornell.edu
[mailto:bounce-2239133-6833790@list.cornell.edu] <b>On Behalf Of </b>D F
MCMAHON<br>
<b>Sent:</b> Monday, January 14, 2008 5:10 PM<br>
<b>To:</b> Child Maltreatment Researchers<br>
<b>Subject:</b> dumb question?<o:p></o:p></span></p>
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<p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>I don't know if it is or it isn't. Child welfare--in
the legal system and in the child welfare system per se--is rife with
terms that indicate scale--degrees of risk (low, medium, high for
example); imminent risk of harm; etc etc.<br>
<br>
To what extent does either the child welfare system or the legal system
quantify these concepts? For example, if a risk assessment indicates high risk
for abuse/neglect (with abuse/neglect definitions including additional
quasi-quantitative concepts pertaining to likelihood of serious physical
or emotional harm as a consequence)--does this basically mean a reasonable
person would have the willies (scale) or that there is actually a range of
probability that can be applied to the risk (e.g. 1% risk of serious physical
or emotional harm)? <br>
<br>
I'm asking not to challenge, but to try to better understand the framework
here--yet it is also the case that 1) human beings are not very good at
assessing degree of risk--there may be consistency, but not necessarily
accuracy--e.g. if you ask people to state the likelihood that X will occur
given Y there are many examples in which groups of people pretty consistently
say the odds are Z even though the odds are actually far greater or less--and
2) perceived risk is affected by sociological factors (e.g. different attitudes
about the risk of germs depending on whether you are talking to a family
running a small dairy farm where the kids are in 4-H and raise rabbits and
chickens, vs. an affluent couple in the suburbs who have one child). <br>
<br>
It strikes me that child welfare in our society entails a pretty significant
tension between a statistical, sort of public-health aspect and an individual
aspect ("if just one life is saved" then all else is justified).
Since I am not a professional or a theoretician in this area are there things
one can read regarding this or are there observations anyone might have? Say,
someone who is knowledgeable (genuinely knowledgeable) about child welfare but
also able to identify underlying philosophical notions and, perhaps, conflicts?
<br>
<br>
(If you understand the question but can state it more clearly, please feel free
to do so)<br>
<br>
Sheri McMahon<br>
<br>
<br>
<br>
<o:p></o:p></span></p>
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