A family's entrance into the child welfare system begins once a report meets a jurisdiction's definition for child maltreatment. Alternative response (AR), a legislatively mandated policy in Maryland, is an approach to child protective services (CPS) where caseworkers are required to provide a family-centered, strengths-based approach as opposed to making a final determination of abuse/neglect. Once a family begins their trajectory into the child welfare system they are reliant on caseworkers to make the best decisions for them, but these decisions are influenced by multiple factors. This mixed-methods study examined caseworker decision making and the influence child, family, and organizational factors had on recurrence. The quantitative phase of this study used administrative data for 2,871 families from three jurisdictions in the state of Maryland. Using child and caregiver characteristics that are predictive of recurrence, differences were examined between families who received a traditional response (TR) versus an AR. These same characteristics were used to predict which families would receive a subsequent investigation, and among those, what predicted a substantiated recurrence. In the qualitative phase, AR caseworkers participated in focus groups where they were asked about the findings from the quantitative portion of the study as well as other organizational factors that influenced their overall decision making for families. County level differences were found among the TR and AR families for child and caregiver race, maltreatment allegation, Medicaid receipt, and re-investigation. These differences held when the counties were examined individually. The number of children, child gender, and Medicaid receipt predicted a subsequent investigation. Child age, maltreatment allegation, Medicaid receipt, previous investigative finding/response, and county predicted a substantiated recurrence. The findings from the focus groups revealed challenges specific to agency mandates and that caseworkers rarely differentiated their approach between a TR and AR. The results suggest that additional research is needed to fully understand the influence of case factors and organizational context and its impact on family outcomes. Also needed is additional training for caseworkers to fully understand the purpose of AR as well as the processes that place families on an AR track.