Heads in the Cloud: An Example of Practice-Based Information and Communication Technology in Child Welfare

Changes in information and communications technology (ICT) in human services have accelerated rapidly and have elicited academic concern about the impact on practice, changes in approaches to implementation, and a shift to user-led development. This article describes the development of ICT by a nongovernment child welfare agency over the past two decades. It is guided by a social constructionist view of technology in which technology is shaped by social factors, but in turn shapes the “social” implementation as requiring the integration of two distinct technologies: a standardized framework for practice and the computer. Both technologies had to be carefully aligned to workplace culture, but the interests of workers have not been allowed to dominate those of and children and families. The organization of work has had to change. This article explores the agency’s experience drawing on theories of implementation of ICT in human services.     

Who's on board? Child welfare worker reports of buy-in and readiness for organizational change

This study views the extent to which staff buy-in for an organizational innovation in child welfare (CW) relates to implementation progress. The study occurs during implementation of a statewide practice model that was supported with technical assistance from the Mountains and Plains Child Welfare Implementation Center (MPCWIC) and framed around the National Implementation Research Network model. Mixed methods were used to address three study questions: (1) what is the level and nature of buy-in related to the innovation? (2) does buy-in vary according to staff characteristics, and (3) what is the relationship between buy-in, local level agency readiness, and implementation status one year after project start? Survey data were collected from 568 CW staff in 13 local county agencies and 12 implementation specialists assigned as coaches. Focus groups and interviews were conducted with 52 staff in four agencies. Bivariate chi-square analyses and multivariate regression using a cumulative logit model showed that buy-in was related to gender and agency tenure. Implementation progress was higher among smaller agencies, and agencies with lower levels of job stress. Qualitative themes centered on staff inclusivity in project design, communication, and supervisor support. Findings highlight the need to adapt implementation strategies in urban and rural locales, and to attend strongly to staff selection, supervision, and inclusion during implementation. Addressing job stress may help bolster implementation.     

The context of program implementation and evaluation: A pilot study of interorganizational differences to improve child welfare reform efforts

This article contributes to the growing literature on evaluation and implementation science by examining the interaction between staff perceptions of organizational strength with perceptions and indicators of program fidelity. As part of a pilot project related to the evaluation of the Family to Family initiative, a survey was distributed to employees within two urban child welfare agencies with a total of 410 respondents across both sites, for a combined response rate of 72.2%. Survey results were analyzed both in terms or respondents' perception of their agency as well as in relation to measures of program performance and workload. Multivariate models show that organizational indicators are the most significant and positive predictors of perceived program implementation. Specifically, staff who positively perceived the availability of information within their agency also believed that the programs were well implemented in their agency. These findings suggest that as the value of program changes are articulated within an organization, the implementation of the initiative is perceived to improve.     

Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services

This study analyses the implementation and sustainability of evidence-based community mental health services in the form of publicly financed Individual Placement and Support programs. Critical implementation components and program fidelity were assessed after one year. After two years, program fidelity was assessed once again. After three years, the programs’ sustainability was assessed and semi-structured interviews performed, in order to deepen the understanding of implementation. Interviews and documents provided the quantitative and qualitative data, which were analyzed by the use of the Supported Employment Fidelity Scale, the Sustainable Implementation Scale (which was developed in a connecting study), and qualitative content analysis. Despite promising fidelity results after one year, eight out of 14 programs were terminated within three years. Implementation of integrated evidence-based programs in community-based settings is a delicate undertaking. Implementing agencies can benefit from rigorous preparation before program start, especially concerning the circumstances at the organizational level, such as making plans for collaboration, financing and assessments of program fidelity.     

Understanding Nurse Perceptions of a Newly Implemented Electronic Medical Record System

Nurses are the frontline of healthcare; however, there has been little theoretically-driven research on their acceptance of information technology use in care delivery. This research utilized the unified theory of acceptance and use of technology (UTAUT) model to understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system. This study used mix methods. The survey responses indicated that social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR. The interviews were utilized to better understand these results. The UTAUT model highlighted factors that are important to nurses during an EMR deployment and can help in future implementations of technology in healthcare.     

Systematically collected information at encounters with HIV-positive students: A review of 10 years of electronic medical records

Abstract

Objective: The objective of this study was to examine clinical and epidemiological information collected by Student Health Center (SHC) providers on HIV-positive students, and benchmark this information against Infectious Disease Society of America guidelines. Participants: Students who utilized the SHC and had an ICD-9 code indicating positive HIV status between 2005 and 2015 (3?=?7). Methods: In June 2016, we accessed the free-form provider notes of the SHC’s electronic medical records to identify specific, recorded epidemiological and clinical information. Results: Seven unique students sought care at the SHC during the study period. Current sexual risk taking and other known behavioral risk factors were absent from all records, along with CD4 count and viral load. ART status was only available for one patient, and he was not on ART. The information collected failed to meet IDSA benchmarks. Conclusion: Clinically- and epidemiologically-relevant information is not systematically collected from HIV-positive students at SHCs.     

The shaping of electronic service delivery

This paper considers the current literature on electronic service delivery in the light of the findings of a qualitative research project examining the implementation of online services in British social housing. The paper adds to existing evidence that the nature of electronic service delivery is heavily influenced by the agencies that introduce it and by the context in which it occurs. The shape of electronic service delivery in social housing was found to be heavily influenced by the high complexity of transactions between social landlords and tenants, and by the ethos of some social landlords. The research also suggested there was a broad consensus between social landlords and tenants with regard to the practical limits of online services. However, the development of this form of electronic service delivery was occurring in a situation in which influence was unevenly divided between the various parties involved.     

Is implementation fidelity associated with improved access to care in a School-based Child and Family Team model?

Effective child and family centered service planning is crucial to addressing vulnerable children's needs. However, there is limited evidence about what facets of these processes improve service use and outcomes. The current study used a Poisson random effects hazard model to test correlations between fidelity to NC's Child and Family Support Team model and time to service receipt, using case management data for 3396 children served by that program during the 2008–2009 school year. Students were more likely to receive recommended services more quickly when caregivers and the students attended planning meetings, when their plans included services for caregivers, and when child and family team leaders followed up after meetings to verify service receipt. Contrary to the Child and Family Support Team theory of change, match between student needs and the lead agency of the meeting was not associated with the odds of quicker service receipt, nor was attendance by natural supports. Findings from this study demonstrate the potential effectiveness of using case management systems to measure service planning process fidelity, as well as how results thereof can both inform process improvement and potential refinements to models’ theories of change.     

Exploring social work students’ attitudes towards feminism: opening up conversations

This paper reports on findings from a 2013 study of UK social work students’ attitudes towards feminism and the perceived relevance of feminist theory to social work practice. Building on an earlier, single-university exploration of students’ views, the study made use of social media (Twitter) to access opinions of students from seven universities across the UK using an online survey tool. Whilst it is not possible to make generalising claims based on ‘opt in’ research of this nature, the findings are nevertheless suggestive of some important issues for those working with social work students today. Principally, they showed that understandings of feminism in the student cohort were diverse and may be very different to the feminism that an older generation of academic and fieldwork educators may have grown up with. The article argues that it is important, in the light of this, to interrogate what we mean by feminism in our work with students. This will then allow us to open up wider conversations about power, agency and structure, thus bringing greater criticality and reflexivity to our teaching and learning.     

Tactics for successful organizational change in a youth and family services agency

There is a vast body of literature on organizational change, but much of it includes only case studies or surveys with a limited number of variables. Organizational change tactics, key aspects of planned change, are not often studied. One purpose of this study was to add to this literature by assessing the use of a questionnaire regarding the use of organizational change tactics as seen by staff who had experienced an organizational change initiative. This study is particularly notable in that it uses perceptions of staff in assessing the success of the change intervention. A second purpose was to learn about specific tactics which were associated with the success of change processes in a youth and family service agency. Findings showed that eighteen of the tactics were observed and seen as helpful in goal accomplishment. These findings can help change leaders choose appropriate change tactics. This method, including a survey of all levels of staff regarding generic change tactics, an interview with an executive, and a focus group, shows promise for further study.     

The National Family Caregiver Support Program: A Multivariate Examination of State-Level Implementation

Research on caregiver support policy implementation has offered valuable insights but has not incorporated theoretical frameworks or multivariate analysis. This article describes how the communications model for intergovernmental policy implementation was used as a framework to examine predictors of successful statewide implementation of the National Family Caregiver Support Program (NFCSP). Using data from the National Center on Caregiving State of the States survey, U.S. Census, Administration on Aging, and historical records, implementation (extent of service delivery) was examined in 50 states and the District of Columbia. State-level characteristics (demographic, historical, political, and organizational) were tested for their ability to explain more or less successful implementation. Bivariate and multivariate findings suggest that historical characteristics predict the likelihood of delivering more counseling, support group, and training. States that recognize caregivers as both service recipients (through counseling and support groups) and service providers (through training) may demonstrate more effective implementation.     

Changing social responsibilities: the role of advocacy organisations in the construction of the Social Support Act in the Netherlands

This paper describes a study on civic participation in legislative processes. In January 2007 a new law on health and social care in the Netherlands was implemented: the Social Support Act (SSA). This law specifically aims at greater civic participation in the implementation of the law, in the provision of health and social care and in the social policy making process. This study focuses on civic participation in policy making, more specifically on civic participation in the legislative process of the Social Support Act. It examines whether national advocacy organisations were successful in their efforts to influence the legislative process and the final construction of the Social Support Act. The main conclusion is that the client and patient organisations were indeed successful in obtaining important changes in the law both through a well informed and professional individual lobby as well as by means of collective action. Yet questions concerning the justification of high expectations for successful local civic participation in the local policy-making process remain.     

Agency among young people in marginalised positions: towards a better understanding of mental health problems

ABSTRACT

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister’s four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today.     

Language matters: effects of linguistic agency assignment on HPV prevention advocacy in Chinese public health education materials

This study was conducted to examine the effects of linguistic agency assignment on human papillomavirus (HPV) prevention advocacy in Chinese public health education materials. The participants (N?=?481) were asked to read one of four versions of an article about the HPV infection. The results indicated that the linguistic agency assignment of threat used in the context of health education in the English language functioned similarly in the Chinese context with only minor differences. In the Chinese language context, the respondents tended to report higher levels of personal susceptibility when the linguistic agency was assigned to the HPV vaccine and not human factors. Minor cross-cultural issues are discussed. The findings of this study contribute to the health communication literature by explicating the persuasive power of language and demonstrating that the concept of linguistic agency assignment is applicable across cultures for the effective promotion of public health education.     

Examining the equivalence of fidelity over two generations of KEEP implementation: A preliminary analysis

Problem

In order to obtain and maintain positive outcomes garnered from evidence-based practice (EBP) models, it is necessary to implement them effectively in “real world” settings, to continually monitor intervention fidelity to prevent drift, and to train new staff due to turnover. The fidelity monitoring processes that are commonly employed in research settings are labor intensive and probably unrealistic to employ in community agencies given the additional burden and cost that they represent over and above the cost of implementing the EBP. Efficient strategies for implementing fidelity monitoring and staff training procedures within the inner context of agency settings are needed to promote agency self-sufficiency and program sustainability.

Method

A cascading implementation model was used whereby agencies who achieved proficiency in KEEP, an EBP designed to prevent placement disruptions in foster and kinship child welfare homes, were trained to take on fidelity management roles to improve the likelihood of program sustainability. Agency staff were trained to self-monitor fidelity and to train internal staff to achieve model fidelity. A web-based system for conducting fidelity assessments and for onsite/internal and remote program quality monitoring was utilized.

Results

Scores on fidelity ratings from streamed observations of intervention sessions showed no differences for foster parents treated by first generation interventionists trained by model developers compared to a second generation of interventionists trained by the first generation.

Conclusion and relevance to child welfare

Development of the local intra-agency capacity to manage quality intervention delivery is an important feature of successful EBP implementation. Use of the cascading implementation model appears to support the development of methods for effective monitoring of fidelity of the KEEP intervention, for training new staff, and ultimately for the development of internal methods for maintaining program sustainability and effectiveness.     

Use of a Parent Management Training Intervention with Urban Foster Parents: A Pilot Study

The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (ages 4-12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.     

Comparing Varieties of Agency Theory in Economics, Political Science, and Sociology: An Illustration from State Policy Implementation

As rational choice theory has moved from economics into political science and sociology, it has been dramatically transformed. The intellectual diffusion of agency theory illustrates this process. Agency theory is a general model of social relations involving the delegation of authority, and generally resulting in problems of control, which has been applied to a broad range of substantive contexts. This paper analyzes applications of agency theory to state policy implementation in economics, political science, and sociology. After documenting variations in the theory across disciplinary contexts, the strengths and weaknesses of these different varieties of agency theory are assessed. Sociological versions of agency theory, incorporating both broader microfoundations and richer models of social structure, are in many respects the most promising. This type of agency theory illustrates the potential of an emerging sociological version of rational choice theory.     

Automated patient linking for electronic health record and child welfare databases

Abstract

There are 427,000 children in protective custody in the United States. A lack of integration between the child welfare data system and electronic health record systems complicates the communication of critical health history details to caregivers. We created and evaluated automated 10 custom algorithms linking these data. Deterministic matching was performed using combinations of first and last name, date of birth, and gender. If unmatched, a nondeterministic algorithm allowed for punctuation differences and letter transpositions. Of the children linked deterministically, 91.3% were linked. Of the ones undergoing nondeterministic matching, 71.3% were linked. Sharing integrated data is the first step in systematically improving health outcomes for children in protective custody. This approach represents an automatable and scalable solution that could help merge data from two disparate sources.