The Structured Decision-Making Model’s risk assessment (RA) is a prominent feature of front-end child protection work. Examining how two different states have set policy to implement the RA, we analyze their distinct choices and unintended consequences. We propose that variation in implementation originates not from individual workers but from two nested sources. First, the RA embeds an implicit epistemological conflict between actuarially based and clinical decision making, with very little guidance on how to reconcile these different approaches into its design. Second, without explicit guidance on how to address divergence between scores and clinical judgment, states are free to set different policies, which, in turn, creates the conditions for variation in implementation. Examining these relationships advances our understanding of the conditions under which the RA is able to achieve a standardizing function.

中文翻译：

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金发姑娘问题：儿童福利决策中基于精算的判断和临床判断之间的紧张关系

结构化决策模型的风险评估（RA）是前端儿童保护工作的一个突出特点。检查两个不同的州如何制定政策来实施 RA，我们分析了他们不同的选择和意想不到的后果。我们建议实施的变化不是来自单个工人，而是来自两个嵌套的来源。首先，RA 在基于精算的决策和临床决策之间嵌入了一种隐含的认识论冲突，几乎没有关于如何在其设计中协调这些不同方法的指导。其次，如果没有明确指导如何解决评分和临床判断之间的分歧，各州可以自由制定不同的政策，这反过来又为实施的变化创造了条件。