Who gets services and who does not? Multi-level approach to the decision for ongoing child welfare or referral to specialized services A. Jud a, ⁎, B. Fallon b , N. Trocmé a a McGill University, Centre of Research on Children and Families, 3506 University St., Montreal, QC, Canada H3A 2A7 b University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor St. W., Toronto, ON, Canada M5S 1V4 abstract article info Article history: Received 11 November 2011 Received in revised form 25 January 2012 Accepted 29 January 2012 Available online xxxx Keywords: Service provision Decision-making Organizational context Surprisingly little is known on the decisions to provide services after a report is investigated. To fill this gap the study aims at identifying factors associated with the decision to provide ongoing child welfare services or to refer to specialized services following the investigation of the report. A multi-level analysis was applied to a representative sample of 15,980 investigations nested within 111 agencies throughout Canada. In almost 60% of cases some type of service was offered. Several case characteristics indicating a need for support such as having child or caregiver functioning issues, few social supports, teen parenting and low socioeco- nomic status were significantly associated with the odds of receiving services. Being identified with any type of substantiated or suspected maltreatment increased the likelihood of services compared to other types and unsubstantiated investigations. The impact of risk investigations on service referrals was striking. Caregiver and household concerns seem to drive decisions as much as if not more as substantiation status yielding further support for the implementation of an alternative response track beside the investigative track. Although there was remarkable variation in service referral rates between agencies, factors accounting for that difference remained largely unexplained. © 2012 Elsevier Ltd. All rights reserved. 1. Introduction North American child welfare authorities come into contact with a large number of children and families in difficulty: over 3 million chil- dren a year have an investigation response or an alternative response in the United States (U.S. Department of Health & Human Services, 2010); over 200,000 per year in Canada (Trocmé et al., 2010b). While mandatory reporting laws have been successfully used in North America to identify an important population of vulnerable chil- dren, surprisingly little is known about the services that are provided once a report is investigated and the factors associated with decisions to provide these services (DePanfilis & Zuravin, 2001; Gilbert et al., 2009). The two types of child welfare decisions that have received the most attention are decisions to substantiate an investigation and decisions to place children in out of home care. The following review focuses on placement decisions since they pertain to providing a ser- vice, although case and context factors found to be associated with the decision for placement might impact other service decisions dif- ferently. Case characteristics repeatedly associated with higher foster care placement are being an infant or an adolescent (e.g. Horwitz, Hurlburt, Cohen, Zhang, & Landsverk, 2011; Rivaux et al., 2008; Wulczyn, Hislop, & Harden, 2002), having child behavior or mental health issues (e.g. Burns et al., 2004; Hurlburt et al., 2004), low socio-economic status (e.g. Horwitz et al., 2011; Katz, Hampton, Newberger, Bowles, & Snyder, 1986; Rivaux et al., 2008; Zuravin & DePanfilis, 1997), household moves (e.g. Fluke, Chabot, Fallon, MacLaurin, & Blackstock, 2010), impaired caregiver functioning (e.g. Fluke et al., 2010), lacking social support (e.g. Runyan, Gould, Trost, & Loda, 1981) and having an adolescent parent or a single parent (e.g. Needell & Barth, 1998; Zuravin & DePanfilis, 1997). While stud- ies point at varying rates of out-of-home placement associated with different types of substantiated maltreatment (e.g. Fluke et al., 2010; Rivaux et al., 2008), evidence regarding the direction is less clear: Rivaux et al. (2008) reported that compared to neglect, sexual and physical abuse allegations were less likely to be placed in foster care; Fluke et al. (2010) found that cases of substantiated or sus- pected emotional maltreatment were less likely to be placed out-of- home than other forms of maltreatment. Zuravin and DePanfilis (1997) on the other hand found increased odds ratios for foster care placement of neglect and physical abuse cases compared to cases with the two forms combined. Differing results for maltreatment characteristics might partly be due to methodological and definitional issues, e.g. confounding alleged with substantiated maltreatment. Evidence is accumulating that children and families identified as being at risk of maltreatment present with as many household and caregiver concerns as investigations where specific incidents of maltreatment are substantiated (Fallon, Trocmé, & MacLaurin, 2011). Although placement studies usually do not report a gender Children and Youth Services Review xxx (2012) xxx–xxx ⁎ Corresponding author. E-mail addresses: andreas.jud@mail.mcgill.ca (A. Jud), barbarafallon@utoronto.ca (B. Fallon), nico.trocme@mcgill.ca (N. Trocmé). CYSR-01832; No of Pages 6 0190-7409/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2012.01.030 Contents lists available at SciVerse ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth Please cite this article as: Jud, A., et al., Who gets services and who does not? Multi-level approach to the decision for ongoing child welfare or referral to specialized services, Children and Youth Services Review (2012), doi:10.1016/j.childyouth.2012.01.030