In covering state and local government, I've noticed that certain ideas seem to cycle in and out. Sometimes they're simply renamed; total quality management became six sigma which became kaizen which, in turn, became lean. But there's one idea that started taking root in human services in the 1980s that is still hanging on in various forms and at various levels of fidelity, and that's team decision making (TDM).
When it was started by John Mattingly at the Toledo Department of Health & Human Services, TDM seemed on the verge of taking off and taking hold. The essential idea was that instead of having one caseworker make decisions about child removal and placements, those decisions were made with as much family involvement as possible, along with the input of other crucial players, including teachers, parole officers, friends, extended family, guardians ad litem and providers.
Having that many minds focused on what's best for a kid -- and what options exist for the most therapeutic and least disruptive placement (especially the option of keeping a child in their home) -- is a good idea and ought to be the way that children and family services systems operate. But the problem with TDM, as TDM pioneer Pat Rideout succinctly states it, is that implementing it and sustaining it "is a bear." The logistical difference between one person sitting in a cubicle making a decision about a child's fate versus the process of trying to bring four or five or six or eight people together at one time in one room is vast. Training entire children and families services departments in the model, and trying to ensure model fidelity is also a bear. Invariably systems that have implemented TDM begin to experience what those in the business call "drift." Says Rideout: "It takes a manager who is pretty bullheaded because there a million barriers and a million moving parts."
The value of TDM was driven home for me last month when I visited Cuyahoga County to interview a variety of folks about the practice, how it's going there, and what's necessary to keep it on track and true to its original spirit. The TDM meeting that I sat in on involved a young mother of two, and strategies for how to return custody of her kids to her.
As her caseworker, case supervisor, a community advocate and the TDM facilitator worked through a variety of options, it quickly became clear that the one key person who should have been in the room wasn't: the mother's parole officer, who could have quickly answered key questions about the conditions of parole and when it might be lifted. That the parole officer wasn't there drove home the importance -- and difficulty -- of being faithful to the model: Every individual key to a case needs to be at the TDM meeting for it to go smoothly and successfully. Had that missing parole officer been at the meeting I attended, it was clear that a now sober and clean, eager young mother could have made significant strides right then and there toward getting her kids back with her where they belong.
Limited studies confirm that TDM improves outcomes for kids, although admittedly data collection around the practice still isn't great. But those who have worked in agencies both pre- and post-adoption of TDM swear by it. One children and families supervisor I recently interviewed notes that besides better outcomes for children and families, the practice pays broader dividends, including much better community relations. "It's been kind of neat to be able to watch our progression from when our agency was perceived as 'baby snatchers,' to one that really engages with parents." One other key dividend: It means a lot less pressure on individual caseworkers and supervisors when they're making decisions about removal and placements.
TDM, of course, is just one of a host of family-centered practices being bandied about in the human services world these days. But Rideout argues that there needs to be a single, tightly focused, tightly adhered to model for family engagement, lest drift become a built-in component of family-centered strategies. One standard, effective model to which systems can hew is a good idea.
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