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System Failure to Address Complex Cases

What are complex cases?


In recent years, our systems of care for dependent and delinquent youth have been struggling with how to manage and meet the needs of what seems to be a growing population of “complex cases”. While the definition of a complex case varies, one thing that remains constant is that these cases rarely start out as complex. They become more and more complex as youth enter and fail in multiple programs and placements.  Providers are reluctant to accept and treat these youth for a number of reasons.  As a result, the youth becomes more and more difficult to place. When no provider is willing to accept the youth for treatment, the case is labeled complex.

person in red sweater holding babys hand


A recent analysis of system reentry data suggests that:


66% of youth in out-of-home residential placement are entering their second such placement and 44% are entering their third placement.  

Overall, 88% of all youth that enters an out-of-home placement were in a prior in-home program. 

Similar data is available on the in-home service side of our system: 64% of all youth were enrolled in their second in-home program.   

Historically our child-serving systems respond to these less than desirable outcomes by redoubling efforts to improve the quality of available programming.  This approach is critically important – but it’s only one part of the equation.  What our system has historically failed to do is to employ strategies that help identify the most appropriate program match the first time.  When only 34% of youth exit the system after their first program, we should all be more focused on making sure we are matching the youth with a program that is not only rooted in quality but also suits their individual needs. 

The good news here is that a growing number of professionals in our field are starting to recognize that the match is really important.  The historical and archaic drivers behind placement decisions are starting to yield to a more data-driven approach.


One such approach is FirstMatch.



FirstMatch is a research-based predictive analytics model that uses a provider’s historical outcomes compared against multiple child-specific predictive factors to better inform program selection decisions. 



This structured decision-making tool ensures that youth are matched with the right program for them, decreasing the rates of reentry and reducing the number of youth that become labeled as complex.   

Want to learn more about FirstMatch?  Contact us at or call 724-804-7011.  In the meantime, we’ll continue to keep you updated through this blog. Visit us for trends within the juvenile justice, child welfare, and behavioral health systems. 

Source: Juvenile Court Judges Commission Disposition Report for 2018 

Mark Mortimer