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Substitute-care information systems under public law 96-272
Chddwn ad Youlh Smcr Rtmm. Vol. 8, pp. 349-361. Printed in the USA. AU nghts reserved.
,I,‘ll,-i4l,!liMi
1986 Copyright
0
1966 Pergamon
I:,
,,,I
Press
t
00
Ltd.
Substitute-Care Information Systems Under Public Law 96-272 Steven L. McMurtry Arizona
State
University
This paper reports on the results of a survey of state responses to the requirements of Public Law 96-272, including the use of permanency planning and periodic review techniques in substitutecare services, and, in particular, the nature and scope of information systems developed to monitor these services. Officials from 44 states and the District of Columbia completed the survey. All respondents reported having implemented statewide policies requiring permanency planning for and periodic review of all substitute-care cases. Those surveyed also indicated strongly favorable attitudes toward these policies among both administrators and direct-service personnel. A large majority (85%) of responding states had developed automated information systems for substitute care, most in the form of a central, statewide data base. Only four states reported depending solely on manual record keeping. The computer systems were most frequently used for administrative applications such as generating aggregate reports, monitoring case reviews, and coordinating caseloads. Applications least commonly reported included reducing narrative recording, determining placement availability, and linking clients to resources, activities more common to direct services. Finally, results of a set of attitudinal questions indicated support for the use of automated data management and the belief that it is a necessary technology, but many respondents also noted that automation has engendered complaints and opposition from staff members in field settings. This manuscript is a revised version of a paper presented at the meeting of the 1985 NASW Professional Symposium, Chicago, IL. Request for reprints should be addressed to Steven L. McMurtry, School of Social Work, Arizona State University, Tempe, AZ 85287. 349
350
McMurtry
PubIic Law 96-272, the Adoption Assistance and Child Welfare Act of 1980, requires all states to implement specific planning and review procedures for children in subst.itute care. Additionally, the law mandates the development of statewide information systems to allow cracking and reporting of data about each child’s status and progress. The rationale underlying the law and the nature of it.s requirements reflect a pair of important trends in substitute care services. First, strategies for serving children placed in out-of-home care have undergone a series of changes that began with research findings that many children were spending prolonged periods in presumably temporary placements (Bryce 8c Ehlert, 197 1; Fanshel, 197 1; Gruber, t978; Maas, 196s). The most widely accepted explanations for this problem were that chiidren were inadequately monitored while in care and that services were being provided in the absence of clear outcome goals. Attent.ion thus began to focus on permanency planning and periodic review, strategies for ensuring that services are organized around a basic plan designating the desired permanent placement outcome for each child and that current information is available for regular assessments of the child’s case. Though not uniformly favorable, research has tended to support the efficacy of both techniques in facilitating the movement of children through temporary care (Festinger, 1976; Jones, Neuman, & Shyne, 1975; Pike, 1976; Stein 8~ Gambrill, 1977). As a result, both permanency planning and periodic review were central among procedures advocated by the Children’s Defense Fund, the principal early proponents of the law (Knitzer, Allen, 8c McGowan, 1978). The second important trend has been the integration of computer technology into many areas of human services. The burgeoning array of experimental and established applications ranges from automation of disbursal procedures in public assistance to computerized diagnostics in clinical practice, but the most prevaient usage continues to be automated information management (Child Welfare League of America, 1978; Elkin, 1983; Fanshel, 1977; Poertner & Rapp, 1980; Richey, 1977). In substitute care, it was quickly recognized that computer capacities for recording, updating, and PI-Ocessing data could greatly facilitate the key decision-making and monitoring activities being advocated for substitute-care services. For example, in his analysis of a sample system in New York, Fanshel not,ed It is impossible to adequately administer a system caring for large numbers of children without modern methods of information storage and analytic
treatment
of the data.
It is pointless
to talk about
goal-oriented
Substitute-Care
Information
Systems
351
service systems and accountability when hand-sorting of index cards is the basis of statistical operations. The time is long overdue for computerized management information systems to be put into place to account for service delivery to children in foster care in all cities and states of the nation. (1976a, p. 44)
States did begin efforts to develop automated information systems for children’s services, and a pair of government studies have reviewed exemplary aspects of selected systems (U.S. Department of Health, Education, and Welfare, 1976; U.S. Department of Health and Human Services [DHHS], 1981). On the other hand, the reports also indicated that development of both new service techniques and supporting computer systems was extremely uneven across states, and it was not until the passage of PL 96-272 that general standards were made available. More than 5 years have elapsed since passage of the law, and presumably most states have made efforts to comply with its specifications. However, little information about the scope or nature of state efforts is available. Though permanency planning and periodic review techniques have been widely advocated in the literature and formalized in the law, it is not clear how widely or enthusiastically they have been implemented. More specifically, the degree to which automation information systems have been incorporated into states’ substitute-care services and management procedures remains unknown. Thus an exploratory examination of these questions is the subject of the research reported here. Method Data on state initiatives under PL 96-272 were gathered by means of a written questionnaire sent to the individual responsible for substitute care in the human services department of each state and the District of Columbia (hereafter treated as a state). The source of names and addresses was the National Directory of Children and Youth Services, 1983-84 (Howard, 1983). On the assumption that responsibilities might be shared among different staff members, a cover letter and two copies of the instrument were sent to each person. The instrument addressed two major issues: procedures and policies relating to permanency planning and periodic review and the nature of the automated system(s) designed around them. Also included were questions on respondents’ attitudes toward planning and review, toward the general issue of automation in human services, and toward the performance of their own substitute-care information systems.
352
McMurtry
Questionnaires were mailed during the last week of August 1984, and follow-up requests to nonrespondents were made at 3-week intervals thereafter. A combination of written and telephone follow-ups was employed, continuing until responses from 45 of the 51 service systems (88.3%) were received by late October. Only one state returned more than one questionnaire, and responses of the two staff members from that state were averaged to form a single set. Permanency Planning and Periodic Review The results provide evidence of nearly uniform compliance with the law’s requirements for implementing permanency planning and periodic review procedures across states. All respondents reported requiring a written permanent plan for each case and a review of this plan within a specific interval after the initial placement. Administrative (or intra-agency) reviews were most often employed (42 states, 93%), but judicial reviews were also required by 39 states (87%). The overlap indicates that many states employed both means, often alternating between types from one review to the next. Only one of the respondent states reported having no policy regarding the type of review to be used. Following from the law, most states (80%) reported having increased the monitoring of workers by supervisors and administrators, and 39 (87%) had implemented policies requiring workers to visit children in substitute care at specific intervals. A sizable majority (71%) indicated that these changes had resulted in increased training of workers in direct services skills, and most (67%) also reported increased training in legal issues related to substitute care. Additional results indicate that the respondents generally favored the use of permanency planning and periodic review in substitute care. All either strongly agreed or agreed with the statement that “the nationwide emphasis on permanency planning is appropriate recognition of a necessary service strategy.” Almost all (96%) believed that workers and supervisors in the local offices shared this view. Contrary to some criticism of permanency planning (Claburn & Magura, 1978; Magura & Claburn, 1978), only one respondent agreed that permanency planning tends to divert attention from more serious problems in the system (e.g., insufficient funds to pay for care, too few foster and group homes). However, of importance to information-management issues is the fact that most respondents (69%) either agreed or strongly agreed
Substitute-Care Information Systems that permanency tute-care cases.
planning
tends to increase paperwork
353 for substi-
Automated Information Systems According to the respondents, by far the most common means of automating substitute-care records has been a single statewide computer information system (31 states, 69%). In some cases more than one system was used either on a statewide basis or in combination with city, county, or regional information systems (15 states, 33%). Three states (7%) reported that, instead of keeping individual case information, they recorded only summary data on their statewide systems. Four states (9%) noted that their present record keeping was principally manual, with automation still in the planning stages. For the descriptions of the systems to be discussed in the subsequent sections, 91% (39 states) are of a statewide substitute-care information system existing at the time, 7% (3) are of planned systems, and 2% (1) are of an advanced local system. System ~~e~o~~e~~ With respect to stages of implementation, 36% of the systems were replacements for a simple manual system the state’s initial effort at automation of (i.e., they represented substitute-care record keeping), another 36% replaced a less advanced substitute-care information system, and 24% were replacements for a system not specifically designed for substitute-care cases. Of the 43 state systems described, 35 (8 1%) were fully operational, with another 6 in pilot or partial-implementation phases. Despite the comparatively limited literature on automated information systems in human services, most writers have remarked on the necessity of involving the eventual users in the planning and development of systems (Poertner & Rapp, 1980; Schoech & Arangio, 1979; Schoech & Schkade, 1980). Results of the survey seem to indicate that this advice was taken, as two-thirds of the respondents reported that direct-service workers assisted in deciding on the objectives and general design of the systems. An even greater proportion (31 states, 74%) involved direct-service supervisors, and 25 (60%) sought input from local administrators. Not surprisingly, the persons most commonly involved in planning and development were state programming specialists (95%) and other state personnel (83%). State technical support staff (61%) and state social services planners and administrators (58%) were those principally involved in the ongoing operation of the systems.
McMurtry System Design The characteristics of the systems are best understood in terms of commonalities of intended uses and data elements. With respect to the former, respondents were provided a list of possible uses for substitute care information systems and asked to indicate whether each was carried out regularly, sporadically, or never by their own systems. Table 1 illustrates the most and least frequently reported uses. As can be seen from the first part of the table, the influence of PL 96-272 on the systems is reflected in the fact that the two most common applications were generating statistics to report to federal sources and monitoring the frequency of reviews, both mandated activities under the law. Another pattern is the distinct weighting of system uses toward administrative tasks such as generating aggregate data, monitoring direct services, and managing caseloads. The pattern is even clearer when one considers that uses such as reduction of case recording, * location of alternative resources, and pinpointing of available substitute care vacancies-applications more useful at the worker level than the administrative level-were those in which the
TABLE 1 Use of State Substitute Care Information Systems (N = 43)
Number Percent On a Rqgular Basis
To generate mandated federal reports To monitor the frequency of case reviews Check the average time cases are in care To determine which clients are attached to which worker To determine whether a child or family member has been previously served To look at changes in case characteristics and caseloads of the agency To track or identify cases in need of special attention Sporadically or Never
To reduce time spent doing narrative-style
recording To link families to needed resources To gather data to evaluate personnel To determine the availability of foster care placement To reduce worker paperwork
40 38 38
93 88 88
34
79
31
72
30
70
27
63
39 34 37
91 78 86
30 28
70 65
Substitute-Care
Information
Systems
355
were least commonly involved. Also noteworthy is the fact that most respondents did not claim to be using their systems for paperwork reduction, a benefit often promised but rarely provided by automated systems. Further patterns emerge with respect to data elements included in the systems. Respondents were provided a detailed list of possible information items and asked to check those tracked by their systems. Table 2 displays categories of data elements most and least commonly used. Most common was information relating to characteristics of the child, the permanent plan, periodic reviews, and the child’s placement. Consistent with patterns of use previously noted, these are the elements basic to conforming to the specifications of PL 96-272 and those most likely to be used for administrative tracking of cases as a group. Data elements least commonly included in the systems were those describing the actual course of services during the child’s stay systems
TABLE 2 Most and Least Common Data Categories in State Substitute Care Information Systems (N = 43) Number
Percent
Most Common Basic demographic information about each child Date of initial placement Type of initial placement (e.g., foster home, group, home, etc.) Legal status Information on special characteristics of the child Nature of permanent plan Date child removed from substitute care Number of placements experienced by child Reason for placement of child Date of next required review of plan Date permanent plan established
43 43
100 100
43 43 42 41 40 38 37 35 35
100 100 98 95 93 88 86 81 81
4
9
7 9
16 21
10 11
23 26
Least Common Frequency of parental visitation with child Number or dates of worker contacts with substitute caregiver Barriers to achievement of permanent plan Number or dates of worker contacts with biological parents Number or dates of worker contacts with child
356
McMurtry
in care. For example, three of the most rarely employed elements were the number or dates of contact between the worker and the child, the biological parents, and the substitute care givers. This lack of information might have negative implications for monitoring effectiveness in view of results documenting a significant relationship between increased caseworker contacts (especially with the biological parents) and reduced lengths of time in care (Bryce & Ehlert, 197 1; Fanshel, 1976b; Maas, 1969). Similarly, a major demonstration project illustrating the efficacy of permanency planning organized its entire model around the identi~cation of barriers to achievement of the permanent plan, (e.g., legal difficulties, problems of biological parents, lack of particular resources); yet only nine states (2 1%) recorded data on these barriers (Emlen, Lahti, Downs, McKay, & Downs, 1976; Pike, 1976). Finally, one group of studies found that the single most important predictor of discharge of children from care was visitation by the biological parents with the child; yet this was the element least often recorded by state systems (Fanshel, 1976b, 1977; Mech, 1985). Of course not all information of use in substitute-care cases needs to be recorded by a statewide computer network, nor can such a system be made to serve all possible needs. One means of keeping a given system’s size in check while expanding its utifity and informational capability is to enable it to share information with other data. bases. Thirty-two (74%) of the respondents reported that their states’ systems had this capability. Other informational sources able to interface with the substitute-care systems were public-assistance client record systems (59%), general social services client record systems (59%), and adoption information systems (59%). Of course, a danger in using multiple systems is that duplication of information will overburden staff with recording demands and negate the benefits of intersystem access. Some respondents indicated evidence of such problems, reporting that as much as 100% of the information on their substitute-care systems was duplicated on other data bases. On the average, though, the respondents reported that roughly 19% of the substitute-care information was duplicated elsewhere. System Operation A 1981 federal review of foster-care tracking efforts in six states argued that an important aspect of a good system is on-line access to the computer via remote terminals in local offices (DHHS, 1981). A majority of systems (38 states, 88%) had this capability, but they varied in terms of how information was initially recorded. For the most part, the systems depended on handwritten forms as the basic means of recording data for input.
Substitute-Care
Information
Systems
In 29 of the 38 states with on-line capabilities, some or all of the workers recorded information on written forms, which were then given to local clerical staff for entry. In 18 of the 38, at least a portion of the workers were forced to mail the written forms to state or regional offices for entry. Only six states (16%) reported facilities for direct entry of data by workers into visual display terminals. On the other end of the communications loop, all but one of the states with automated systems produced hard-copy output for use at the local level. In most (35 states, 83%), such documentation is generated at a central location and mailed to local personnel. Twelve states (29%) reported some capabilities for producing output at printers in the local offices. All but one of the systems produced summary or aggregated data reports. Most commonly these were provided for state and regional personnel (93%) or local administrators (86%) and workers (84%). A large number of the systems generated reminders of impending or overdue case actions (80%), most often for upcoming administrative reviews or those already overdue. Reminders were usually sent to direct-service supervisors (80%) or workers (77%). Finally, a large majority (84%) used their states’ automated systems to conduct annual inventories of substitute-care cases in the state. Patterns in practices for training staff to use the systems are difficult to identify. All states offered some type of training, but the range of reported lengths of time required for service workers to become familiar with a system varied widely. Roughly one-third of the respondents reported that this required from one hour to one day; another third reported that it took from one day to one month; and a third responded that a working familiarity required more than a month (up to maximum of 6 months). In terms of internal monitoring of the success of users in learning the system and employing it correctly, slightly more than a third (15 states, 36%) reported collecting information on rates of errors in data entry. Of these, 60% used this information in evaluation or revision of the system or both. Perhaps as an indication of the youth and evolving nature of these systems, 23 (55%) noted that they planned to revise or replace their systems in the near future. Attitudes Toward Automation Respondents in each state were asked a series of attitudinal questions about automation in substitute care and human services overall and about the efforts in their own states. With respect to the former, the respondents showed little of the reluctance or direct antagonism toward automation often thought to characterize human service personnel. Almost all
358
McMurtry
(91%) agreed or strongly agreed that automated information systems were essential to tracking children in substitute care. Another 75% agreed that the use of automation had facilitated planning for substitute-care cases. A large majority (87%) disagreed or strongly disagreed with the statement that “computer technology is not yet sufficiently sophisticated to be of real use to human services.” Finally, two-thirds also disagreed that automated systems tended to cost more than they save in service efficiency. The respondents’ attitudes toward their own states’ substitutecare information systems were a good deal more mixed, however. Most (75%) agreed or strongly agreed that the system had been effective in meeting federal requirements for .monitoring substitute-care cases, and two-thirds also indicated that the system had helped ensure the regularity of case reviews. On the other hand, there was a clear pattern of equivocal or negative responses concerning the feelings of service-level users toward the state systems. A roughly equal split (40% versus 34%) occurred between respondents who believed that workers and supervisors viewed the system favorably and those who thought the staffers disliked the system. A majority (54%) reported that local users complained of the system’s being too time consuming. Another 54% noted that local staff members were usually antagonistic to automation initiatives originating at the state office level, and fully 8 1% expressed a belief that the system had been more helpful at the administrative level than for direct services. Again, most (66%) believed that the system did not reduce paperwork, but a plurality (43%) thought that users did not devote the time needed to learn the system properly.
Summary Results of this study would suggest that all states appear to be making extensive use of permanency planning and periodic review. Whether because of PL 96-272 or concurrent with it, the two procedures seem to have become integral to substitute-care services across the country. Persons responsible for administering these services in the states overwhelmingly favored using such techniques, and they believed that this favorable viewpoint was shared by the service staff actually responsible for employing them. What remains for future research is confirmation that the effectiveness of the strategies can be maintained in the many large systems in which they are being employed. Though not yet universal, automated information management in substitute care has also begun in many substitute-care service systems throughout the country. It seems, however, to have a
Substitute-Care Information Systems
359
much more uneasy marriage with services than is the case for permanency planning and periodic review. Most respondents appeared to think that automation efforts had not achieved their full potential, but they also appeared to be optimistic about the future. These views were reinforced by the fact that most of the systems described were less than 3 years old and that a high percentage of respondents reported plans to revise or replace their systems. However, the attitudes expressed by the respondents, themselves state-level staffers, also imply that they believed many of the problems in their systems arose from the line level. For example, most noted that locai personnel were antagonistic to state initiatives, and there was a common view that workers did not devote enough time to learning each system. This could indeed be true, but much of the evidence of the survey suggests that resistance by direct-services staff to automated systems results from the fact that the systems tend not to serve their needs. As was illustrated in Tables 1 and 2, a distinct slant toward collecting management-related data characterizes most states’ systems. This is underscored by the respondents’ own opinions that the systems were more helpful at the administrative level than in service delivery, Other data suggest that the systems tend not to serve technical support functions such as research and evaluation, because they are seldom used in activities such as defining and tracking units of service or monitoring activities other than planning and review. Interestingly, these limitations appear despite the fact that service and service-support personnel, especially workers and supervisors, were included in the planning of most systems. It could be that outside pressures such as federal mandates and the greater power of state staff members are the most important factors in determining the systems’ design and mission. The input of other personnel might simply be used as a means of ensuring that the design is of sufficient line-level relevance and ease to prevent misuse from undermining the system’s ability to serve even administrative purposes. Although it is unfortunate that the substitute-care information systems developed by the states were not yet meeting the aims of all their users, this should not necessarily be construed as a failure of the movement toward automation. On the contrary, perhaps the most important finding of the survey is that most states were able to automate their record-keeping fnnctions in this area very rapidly, and the process appears to have been generally successful in meeting the direct specifications of PL 96-272. Serving a greater variety of applications across all organizational levels is an appropriate goal for future development, but within the specific range of
McMurtry uses around which most systems are designed, evidence of their initial success.
there is reasonable
References Bryce, M. E., 8c Ehlert, R. C. (1971). 144 foster children. Child Welfare, 50, 499503. Child Welfare League of America. (1978). CYCZS: A child and youth centered information system. New York: Child Welfare League of America. Claburn, W. E., & Magura, S. (1978). Administrative review for foster children. Social Work Research
and Abstracts,
14, 34-40.
Elkin, R. (1983). Child welfare information systems: Potent new tools coming into hands of service providers. In W. E. Howard (Ed.), National directory of children and youth services, 1983-84 (pp. l-6). Washington, DC: CPR Directory Services. Emlen, A., Lahti, J., Downs, G., McKay, A., & Downs, S. (1976). Overcoming barriers to planning for children in foster cure. Portland, OR: Portland State University, Regional Research Institute for Human Services. Fanshel, D. (1971). The exit of children from foster care: An interim research report. Child Welfare, 50, 499-503. Fanshel, D. (1976a). Computerized information systems and foster care. Children Today, 5, 14-18,
44.
Fanshel, D. (1976b). Status changes of children in foster care: Final results of the Columbia University longitudinal study. Child Welfare, 55, 143- 17 1. Fanshel, D. (1977). Parental visiting of foster children: A computerized study. Social Work Research and Abstracts, 13, 2- 10. Festinger, T. B. (1976). The impact of the New York court review of children in foster care: A follow-up report. Child Welfare, 55, 515-544. Gruber, A. R. (1978). Children in foster care: Destitute, Neglected, Betrayed. New York: Human Science Press. Howard, W. E. (Ed.) (1983). National directory of children and youth services, 198384. Washington, DC: CPR Directory Services. Jones, M. A., Neuman, R., & Shyne, A. W. (1976). A second chance for families. New York: Child Welfare League of America. Knitzer, J., Allen, M. L., & McGowan, B. (1978). Children without homes. Washington, DC: Children’s Defense Fund. Maas, H. S. (1969). Children in long-term foster care. Child Welfare, 48, 321-333. Magma, S., & Claburn, W. E. (1978). Foster care case review: A critique of concept and method. Journal of Social Welfare, 5, 25-34. Mech, E. (1985). Parental visiting and foster placement. Child Welfare, 64, 67-72. Pike, V. (1976). Permanent planning for foster children: The Oregon project. Children
Toduy, 5, 22-25,
41.
Poertner,
J., & Rapp, C. A. (1980). Information system design in foster care. Social Work, 25, 114-l 19. Richey, B. B. (1977). The computer in a child care agency. Child Welfare, 56, 259270.
Schoech, D., & Arangio, 24, 96-102.
T. (1979).
Computers
in the human services. Social Work,
Substitute-Care
Information
Systems
361
Schoech, D., & Schkade, L. L. (1980). What human services can learn from business about computerization. Public Welfare., 38, 18-27. Stein, T. J., & Gambrill, E. D. (1977). Facilitating decision making in foster care: The Alameda project. Social Service Review, 51, 502-513. US. Department of Health, Education, and Welfare. (1976). ChiM welfare in 25 states: An oven&w (DHEW Publication No. OHD 76-30090). Washington, DC: U. S. Government Printing Office. U. S. Department of Health and Human Services. (1981). ChiM use&are in~o~~~~ system projles. (Contract No. GUS-105-78-7404). Washington, DC: Lawrence Johnson & Associates.
,I,‘ll,-i4l,!liMi
1986 Copyright
0
1966 Pergamon
I:,
,,,I
Press
t
00
Ltd.
Substitute-Care Information Systems Under Public Law 96-272 Steven L. McMurtry Arizona
State
University
This paper reports on the results of a survey of state responses to the requirements of Public Law 96-272, including the use of permanency planning and periodic review techniques in substitutecare services, and, in particular, the nature and scope of information systems developed to monitor these services. Officials from 44 states and the District of Columbia completed the survey. All respondents reported having implemented statewide policies requiring permanency planning for and periodic review of all substitute-care cases. Those surveyed also indicated strongly favorable attitudes toward these policies among both administrators and direct-service personnel. A large majority (85%) of responding states had developed automated information systems for substitute care, most in the form of a central, statewide data base. Only four states reported depending solely on manual record keeping. The computer systems were most frequently used for administrative applications such as generating aggregate reports, monitoring case reviews, and coordinating caseloads. Applications least commonly reported included reducing narrative recording, determining placement availability, and linking clients to resources, activities more common to direct services. Finally, results of a set of attitudinal questions indicated support for the use of automated data management and the belief that it is a necessary technology, but many respondents also noted that automation has engendered complaints and opposition from staff members in field settings. This manuscript is a revised version of a paper presented at the meeting of the 1985 NASW Professional Symposium, Chicago, IL. Request for reprints should be addressed to Steven L. McMurtry, School of Social Work, Arizona State University, Tempe, AZ 85287. 349
350
McMurtry
PubIic Law 96-272, the Adoption Assistance and Child Welfare Act of 1980, requires all states to implement specific planning and review procedures for children in subst.itute care. Additionally, the law mandates the development of statewide information systems to allow cracking and reporting of data about each child’s status and progress. The rationale underlying the law and the nature of it.s requirements reflect a pair of important trends in substitute care services. First, strategies for serving children placed in out-of-home care have undergone a series of changes that began with research findings that many children were spending prolonged periods in presumably temporary placements (Bryce 8c Ehlert, 197 1; Fanshel, 197 1; Gruber, t978; Maas, 196s). The most widely accepted explanations for this problem were that chiidren were inadequately monitored while in care and that services were being provided in the absence of clear outcome goals. Attent.ion thus began to focus on permanency planning and periodic review, strategies for ensuring that services are organized around a basic plan designating the desired permanent placement outcome for each child and that current information is available for regular assessments of the child’s case. Though not uniformly favorable, research has tended to support the efficacy of both techniques in facilitating the movement of children through temporary care (Festinger, 1976; Jones, Neuman, & Shyne, 1975; Pike, 1976; Stein 8~ Gambrill, 1977). As a result, both permanency planning and periodic review were central among procedures advocated by the Children’s Defense Fund, the principal early proponents of the law (Knitzer, Allen, 8c McGowan, 1978). The second important trend has been the integration of computer technology into many areas of human services. The burgeoning array of experimental and established applications ranges from automation of disbursal procedures in public assistance to computerized diagnostics in clinical practice, but the most prevaient usage continues to be automated information management (Child Welfare League of America, 1978; Elkin, 1983; Fanshel, 1977; Poertner & Rapp, 1980; Richey, 1977). In substitute care, it was quickly recognized that computer capacities for recording, updating, and PI-Ocessing data could greatly facilitate the key decision-making and monitoring activities being advocated for substitute-care services. For example, in his analysis of a sample system in New York, Fanshel not,ed It is impossible to adequately administer a system caring for large numbers of children without modern methods of information storage and analytic
treatment
of the data.
It is pointless
to talk about
goal-oriented
Substitute-Care
Information
Systems
351
service systems and accountability when hand-sorting of index cards is the basis of statistical operations. The time is long overdue for computerized management information systems to be put into place to account for service delivery to children in foster care in all cities and states of the nation. (1976a, p. 44)
States did begin efforts to develop automated information systems for children’s services, and a pair of government studies have reviewed exemplary aspects of selected systems (U.S. Department of Health, Education, and Welfare, 1976; U.S. Department of Health and Human Services [DHHS], 1981). On the other hand, the reports also indicated that development of both new service techniques and supporting computer systems was extremely uneven across states, and it was not until the passage of PL 96-272 that general standards were made available. More than 5 years have elapsed since passage of the law, and presumably most states have made efforts to comply with its specifications. However, little information about the scope or nature of state efforts is available. Though permanency planning and periodic review techniques have been widely advocated in the literature and formalized in the law, it is not clear how widely or enthusiastically they have been implemented. More specifically, the degree to which automation information systems have been incorporated into states’ substitute-care services and management procedures remains unknown. Thus an exploratory examination of these questions is the subject of the research reported here. Method Data on state initiatives under PL 96-272 were gathered by means of a written questionnaire sent to the individual responsible for substitute care in the human services department of each state and the District of Columbia (hereafter treated as a state). The source of names and addresses was the National Directory of Children and Youth Services, 1983-84 (Howard, 1983). On the assumption that responsibilities might be shared among different staff members, a cover letter and two copies of the instrument were sent to each person. The instrument addressed two major issues: procedures and policies relating to permanency planning and periodic review and the nature of the automated system(s) designed around them. Also included were questions on respondents’ attitudes toward planning and review, toward the general issue of automation in human services, and toward the performance of their own substitute-care information systems.
352
McMurtry
Questionnaires were mailed during the last week of August 1984, and follow-up requests to nonrespondents were made at 3-week intervals thereafter. A combination of written and telephone follow-ups was employed, continuing until responses from 45 of the 51 service systems (88.3%) were received by late October. Only one state returned more than one questionnaire, and responses of the two staff members from that state were averaged to form a single set. Permanency Planning and Periodic Review The results provide evidence of nearly uniform compliance with the law’s requirements for implementing permanency planning and periodic review procedures across states. All respondents reported requiring a written permanent plan for each case and a review of this plan within a specific interval after the initial placement. Administrative (or intra-agency) reviews were most often employed (42 states, 93%), but judicial reviews were also required by 39 states (87%). The overlap indicates that many states employed both means, often alternating between types from one review to the next. Only one of the respondent states reported having no policy regarding the type of review to be used. Following from the law, most states (80%) reported having increased the monitoring of workers by supervisors and administrators, and 39 (87%) had implemented policies requiring workers to visit children in substitute care at specific intervals. A sizable majority (71%) indicated that these changes had resulted in increased training of workers in direct services skills, and most (67%) also reported increased training in legal issues related to substitute care. Additional results indicate that the respondents generally favored the use of permanency planning and periodic review in substitute care. All either strongly agreed or agreed with the statement that “the nationwide emphasis on permanency planning is appropriate recognition of a necessary service strategy.” Almost all (96%) believed that workers and supervisors in the local offices shared this view. Contrary to some criticism of permanency planning (Claburn & Magura, 1978; Magura & Claburn, 1978), only one respondent agreed that permanency planning tends to divert attention from more serious problems in the system (e.g., insufficient funds to pay for care, too few foster and group homes). However, of importance to information-management issues is the fact that most respondents (69%) either agreed or strongly agreed
Substitute-Care Information Systems that permanency tute-care cases.
planning
tends to increase paperwork
353 for substi-
Automated Information Systems According to the respondents, by far the most common means of automating substitute-care records has been a single statewide computer information system (31 states, 69%). In some cases more than one system was used either on a statewide basis or in combination with city, county, or regional information systems (15 states, 33%). Three states (7%) reported that, instead of keeping individual case information, they recorded only summary data on their statewide systems. Four states (9%) noted that their present record keeping was principally manual, with automation still in the planning stages. For the descriptions of the systems to be discussed in the subsequent sections, 91% (39 states) are of a statewide substitute-care information system existing at the time, 7% (3) are of planned systems, and 2% (1) are of an advanced local system. System ~~e~o~~e~~ With respect to stages of implementation, 36% of the systems were replacements for a simple manual system the state’s initial effort at automation of (i.e., they represented substitute-care record keeping), another 36% replaced a less advanced substitute-care information system, and 24% were replacements for a system not specifically designed for substitute-care cases. Of the 43 state systems described, 35 (8 1%) were fully operational, with another 6 in pilot or partial-implementation phases. Despite the comparatively limited literature on automated information systems in human services, most writers have remarked on the necessity of involving the eventual users in the planning and development of systems (Poertner & Rapp, 1980; Schoech & Arangio, 1979; Schoech & Schkade, 1980). Results of the survey seem to indicate that this advice was taken, as two-thirds of the respondents reported that direct-service workers assisted in deciding on the objectives and general design of the systems. An even greater proportion (31 states, 74%) involved direct-service supervisors, and 25 (60%) sought input from local administrators. Not surprisingly, the persons most commonly involved in planning and development were state programming specialists (95%) and other state personnel (83%). State technical support staff (61%) and state social services planners and administrators (58%) were those principally involved in the ongoing operation of the systems.
McMurtry System Design The characteristics of the systems are best understood in terms of commonalities of intended uses and data elements. With respect to the former, respondents were provided a list of possible uses for substitute care information systems and asked to indicate whether each was carried out regularly, sporadically, or never by their own systems. Table 1 illustrates the most and least frequently reported uses. As can be seen from the first part of the table, the influence of PL 96-272 on the systems is reflected in the fact that the two most common applications were generating statistics to report to federal sources and monitoring the frequency of reviews, both mandated activities under the law. Another pattern is the distinct weighting of system uses toward administrative tasks such as generating aggregate data, monitoring direct services, and managing caseloads. The pattern is even clearer when one considers that uses such as reduction of case recording, * location of alternative resources, and pinpointing of available substitute care vacancies-applications more useful at the worker level than the administrative level-were those in which the
TABLE 1 Use of State Substitute Care Information Systems (N = 43)
Number Percent On a Rqgular Basis
To generate mandated federal reports To monitor the frequency of case reviews Check the average time cases are in care To determine which clients are attached to which worker To determine whether a child or family member has been previously served To look at changes in case characteristics and caseloads of the agency To track or identify cases in need of special attention Sporadically or Never
To reduce time spent doing narrative-style
recording To link families to needed resources To gather data to evaluate personnel To determine the availability of foster care placement To reduce worker paperwork
40 38 38
93 88 88
34
79
31
72
30
70
27
63
39 34 37
91 78 86
30 28
70 65
Substitute-Care
Information
Systems
355
were least commonly involved. Also noteworthy is the fact that most respondents did not claim to be using their systems for paperwork reduction, a benefit often promised but rarely provided by automated systems. Further patterns emerge with respect to data elements included in the systems. Respondents were provided a detailed list of possible information items and asked to check those tracked by their systems. Table 2 displays categories of data elements most and least commonly used. Most common was information relating to characteristics of the child, the permanent plan, periodic reviews, and the child’s placement. Consistent with patterns of use previously noted, these are the elements basic to conforming to the specifications of PL 96-272 and those most likely to be used for administrative tracking of cases as a group. Data elements least commonly included in the systems were those describing the actual course of services during the child’s stay systems
TABLE 2 Most and Least Common Data Categories in State Substitute Care Information Systems (N = 43) Number
Percent
Most Common Basic demographic information about each child Date of initial placement Type of initial placement (e.g., foster home, group, home, etc.) Legal status Information on special characteristics of the child Nature of permanent plan Date child removed from substitute care Number of placements experienced by child Reason for placement of child Date of next required review of plan Date permanent plan established
43 43
100 100
43 43 42 41 40 38 37 35 35
100 100 98 95 93 88 86 81 81
4
9
7 9
16 21
10 11
23 26
Least Common Frequency of parental visitation with child Number or dates of worker contacts with substitute caregiver Barriers to achievement of permanent plan Number or dates of worker contacts with biological parents Number or dates of worker contacts with child
356
McMurtry
in care. For example, three of the most rarely employed elements were the number or dates of contact between the worker and the child, the biological parents, and the substitute care givers. This lack of information might have negative implications for monitoring effectiveness in view of results documenting a significant relationship between increased caseworker contacts (especially with the biological parents) and reduced lengths of time in care (Bryce & Ehlert, 197 1; Fanshel, 1976b; Maas, 1969). Similarly, a major demonstration project illustrating the efficacy of permanency planning organized its entire model around the identi~cation of barriers to achievement of the permanent plan, (e.g., legal difficulties, problems of biological parents, lack of particular resources); yet only nine states (2 1%) recorded data on these barriers (Emlen, Lahti, Downs, McKay, & Downs, 1976; Pike, 1976). Finally, one group of studies found that the single most important predictor of discharge of children from care was visitation by the biological parents with the child; yet this was the element least often recorded by state systems (Fanshel, 1976b, 1977; Mech, 1985). Of course not all information of use in substitute-care cases needs to be recorded by a statewide computer network, nor can such a system be made to serve all possible needs. One means of keeping a given system’s size in check while expanding its utifity and informational capability is to enable it to share information with other data. bases. Thirty-two (74%) of the respondents reported that their states’ systems had this capability. Other informational sources able to interface with the substitute-care systems were public-assistance client record systems (59%), general social services client record systems (59%), and adoption information systems (59%). Of course, a danger in using multiple systems is that duplication of information will overburden staff with recording demands and negate the benefits of intersystem access. Some respondents indicated evidence of such problems, reporting that as much as 100% of the information on their substitute-care systems was duplicated on other data bases. On the average, though, the respondents reported that roughly 19% of the substitute-care information was duplicated elsewhere. System Operation A 1981 federal review of foster-care tracking efforts in six states argued that an important aspect of a good system is on-line access to the computer via remote terminals in local offices (DHHS, 1981). A majority of systems (38 states, 88%) had this capability, but they varied in terms of how information was initially recorded. For the most part, the systems depended on handwritten forms as the basic means of recording data for input.
Substitute-Care
Information
Systems
In 29 of the 38 states with on-line capabilities, some or all of the workers recorded information on written forms, which were then given to local clerical staff for entry. In 18 of the 38, at least a portion of the workers were forced to mail the written forms to state or regional offices for entry. Only six states (16%) reported facilities for direct entry of data by workers into visual display terminals. On the other end of the communications loop, all but one of the states with automated systems produced hard-copy output for use at the local level. In most (35 states, 83%), such documentation is generated at a central location and mailed to local personnel. Twelve states (29%) reported some capabilities for producing output at printers in the local offices. All but one of the systems produced summary or aggregated data reports. Most commonly these were provided for state and regional personnel (93%) or local administrators (86%) and workers (84%). A large number of the systems generated reminders of impending or overdue case actions (80%), most often for upcoming administrative reviews or those already overdue. Reminders were usually sent to direct-service supervisors (80%) or workers (77%). Finally, a large majority (84%) used their states’ automated systems to conduct annual inventories of substitute-care cases in the state. Patterns in practices for training staff to use the systems are difficult to identify. All states offered some type of training, but the range of reported lengths of time required for service workers to become familiar with a system varied widely. Roughly one-third of the respondents reported that this required from one hour to one day; another third reported that it took from one day to one month; and a third responded that a working familiarity required more than a month (up to maximum of 6 months). In terms of internal monitoring of the success of users in learning the system and employing it correctly, slightly more than a third (15 states, 36%) reported collecting information on rates of errors in data entry. Of these, 60% used this information in evaluation or revision of the system or both. Perhaps as an indication of the youth and evolving nature of these systems, 23 (55%) noted that they planned to revise or replace their systems in the near future. Attitudes Toward Automation Respondents in each state were asked a series of attitudinal questions about automation in substitute care and human services overall and about the efforts in their own states. With respect to the former, the respondents showed little of the reluctance or direct antagonism toward automation often thought to characterize human service personnel. Almost all
358
McMurtry
(91%) agreed or strongly agreed that automated information systems were essential to tracking children in substitute care. Another 75% agreed that the use of automation had facilitated planning for substitute-care cases. A large majority (87%) disagreed or strongly disagreed with the statement that “computer technology is not yet sufficiently sophisticated to be of real use to human services.” Finally, two-thirds also disagreed that automated systems tended to cost more than they save in service efficiency. The respondents’ attitudes toward their own states’ substitutecare information systems were a good deal more mixed, however. Most (75%) agreed or strongly agreed that the system had been effective in meeting federal requirements for .monitoring substitute-care cases, and two-thirds also indicated that the system had helped ensure the regularity of case reviews. On the other hand, there was a clear pattern of equivocal or negative responses concerning the feelings of service-level users toward the state systems. A roughly equal split (40% versus 34%) occurred between respondents who believed that workers and supervisors viewed the system favorably and those who thought the staffers disliked the system. A majority (54%) reported that local users complained of the system’s being too time consuming. Another 54% noted that local staff members were usually antagonistic to automation initiatives originating at the state office level, and fully 8 1% expressed a belief that the system had been more helpful at the administrative level than for direct services. Again, most (66%) believed that the system did not reduce paperwork, but a plurality (43%) thought that users did not devote the time needed to learn the system properly.
Summary Results of this study would suggest that all states appear to be making extensive use of permanency planning and periodic review. Whether because of PL 96-272 or concurrent with it, the two procedures seem to have become integral to substitute-care services across the country. Persons responsible for administering these services in the states overwhelmingly favored using such techniques, and they believed that this favorable viewpoint was shared by the service staff actually responsible for employing them. What remains for future research is confirmation that the effectiveness of the strategies can be maintained in the many large systems in which they are being employed. Though not yet universal, automated information management in substitute care has also begun in many substitute-care service systems throughout the country. It seems, however, to have a
Substitute-Care Information Systems
359
much more uneasy marriage with services than is the case for permanency planning and periodic review. Most respondents appeared to think that automation efforts had not achieved their full potential, but they also appeared to be optimistic about the future. These views were reinforced by the fact that most of the systems described were less than 3 years old and that a high percentage of respondents reported plans to revise or replace their systems. However, the attitudes expressed by the respondents, themselves state-level staffers, also imply that they believed many of the problems in their systems arose from the line level. For example, most noted that locai personnel were antagonistic to state initiatives, and there was a common view that workers did not devote enough time to learning each system. This could indeed be true, but much of the evidence of the survey suggests that resistance by direct-services staff to automated systems results from the fact that the systems tend not to serve their needs. As was illustrated in Tables 1 and 2, a distinct slant toward collecting management-related data characterizes most states’ systems. This is underscored by the respondents’ own opinions that the systems were more helpful at the administrative level than in service delivery, Other data suggest that the systems tend not to serve technical support functions such as research and evaluation, because they are seldom used in activities such as defining and tracking units of service or monitoring activities other than planning and review. Interestingly, these limitations appear despite the fact that service and service-support personnel, especially workers and supervisors, were included in the planning of most systems. It could be that outside pressures such as federal mandates and the greater power of state staff members are the most important factors in determining the systems’ design and mission. The input of other personnel might simply be used as a means of ensuring that the design is of sufficient line-level relevance and ease to prevent misuse from undermining the system’s ability to serve even administrative purposes. Although it is unfortunate that the substitute-care information systems developed by the states were not yet meeting the aims of all their users, this should not necessarily be construed as a failure of the movement toward automation. On the contrary, perhaps the most important finding of the survey is that most states were able to automate their record-keeping fnnctions in this area very rapidly, and the process appears to have been generally successful in meeting the direct specifications of PL 96-272. Serving a greater variety of applications across all organizational levels is an appropriate goal for future development, but within the specific range of
McMurtry uses around which most systems are designed, evidence of their initial success.
there is reasonable
References Bryce, M. E., 8c Ehlert, R. C. (1971). 144 foster children. Child Welfare, 50, 499503. Child Welfare League of America. (1978). CYCZS: A child and youth centered information system. New York: Child Welfare League of America. Claburn, W. E., & Magura, S. (1978). Administrative review for foster children. Social Work Research
and Abstracts,
14, 34-40.
Elkin, R. (1983). Child welfare information systems: Potent new tools coming into hands of service providers. In W. E. Howard (Ed.), National directory of children and youth services, 1983-84 (pp. l-6). Washington, DC: CPR Directory Services. Emlen, A., Lahti, J., Downs, G., McKay, A., & Downs, S. (1976). Overcoming barriers to planning for children in foster cure. Portland, OR: Portland State University, Regional Research Institute for Human Services. Fanshel, D. (1971). The exit of children from foster care: An interim research report. Child Welfare, 50, 499-503. Fanshel, D. (1976a). Computerized information systems and foster care. Children Today, 5, 14-18,
44.
Fanshel, D. (1976b). Status changes of children in foster care: Final results of the Columbia University longitudinal study. Child Welfare, 55, 143- 17 1. Fanshel, D. (1977). Parental visiting of foster children: A computerized study. Social Work Research and Abstracts, 13, 2- 10. Festinger, T. B. (1976). The impact of the New York court review of children in foster care: A follow-up report. Child Welfare, 55, 515-544. Gruber, A. R. (1978). Children in foster care: Destitute, Neglected, Betrayed. New York: Human Science Press. Howard, W. E. (Ed.) (1983). National directory of children and youth services, 198384. Washington, DC: CPR Directory Services. Jones, M. A., Neuman, R., & Shyne, A. W. (1976). A second chance for families. New York: Child Welfare League of America. Knitzer, J., Allen, M. L., & McGowan, B. (1978). Children without homes. Washington, DC: Children’s Defense Fund. Maas, H. S. (1969). Children in long-term foster care. Child Welfare, 48, 321-333. Magma, S., & Claburn, W. E. (1978). Foster care case review: A critique of concept and method. Journal of Social Welfare, 5, 25-34. Mech, E. (1985). Parental visiting and foster placement. Child Welfare, 64, 67-72. Pike, V. (1976). Permanent planning for foster children: The Oregon project. Children
Toduy, 5, 22-25,
41.
Poertner,
J., & Rapp, C. A. (1980). Information system design in foster care. Social Work, 25, 114-l 19. Richey, B. B. (1977). The computer in a child care agency. Child Welfare, 56, 259270.
Schoech, D., & Arangio, 24, 96-102.
T. (1979).
Computers
in the human services. Social Work,
Substitute-Care
Information
Systems
361
Schoech, D., & Schkade, L. L. (1980). What human services can learn from business about computerization. Public Welfare., 38, 18-27. Stein, T. J., & Gambrill, E. D. (1977). Facilitating decision making in foster care: The Alameda project. Social Service Review, 51, 502-513. US. Department of Health, Education, and Welfare. (1976). ChiM welfare in 25 states: An oven&w (DHEW Publication No. OHD 76-30090). Washington, DC: U. S. Government Printing Office. U. S. Department of Health and Human Services. (1981). ChiM use&are in~o~~~~ system projles. (Contract No. GUS-105-78-7404). Washington, DC: Lawrence Johnson & Associates.