What is the meaning of “meaningful change”? Helping social workers assess clinical change in the well-being of children in care

Research has documented a gap between young adults with out-of-home care (OHC) experience and their peers on a range of long-term outcomes. This gap is persistent and must be narrowed. One explanation is the lack of systematic routines in OHC by social care authorities. In this article, we introduce the concept of “clinically meaningful change” (CMC) indicators to systematize social care routines, point out their importance for social workers for assessing change in individual clients, and describe some of the challenges in implementing such indicators in social work practice. CMC refers to changes in an individual’s outcome measures that are reliable (i.e., not due to chance or measurement error) or that are large enough to be considered “important.” We present five indicators to analyze CMC in a child’s well-being and illustrate their use with two examples. Our main point is that to assess change at the individual level it is imperative to address questions of reliability of measurement and the yardstick for judging when a change is large enough to be considered “important.” The use of CMC indicators is as a vital complement to the typical unstructured clinical conversation between practitioners and their clients. Combining the strengths of the former – the ability to make reliable and valid comparisons across individuals and time – with those of the former – its adaptability to a specific situation – will raise the chances of giving appropriate help, thereby narrowing the gap, foster child by foster child.
Key words: clinically meaningful change, children in care, Strengths and Difficulties Questionnaire
Subject categories: Out of home care, social work practice