The Evolution of Worker Connect: A Case Study of a System of Systems

We discuss the rationale, development, deployment, and evolution of Worker Connect, a federation of agency systems that is used by authorized health and human services workers in New York City. We show how Worker Connect evolved with HHS-Connect, the organization that enables the integration and synergy of interagency health and human services systems. We show how the system of systems framework provides a way to understand issues encountered and lessons learned in developing and deploying Worker Connect and similar interagency human services systems. The first part of this article provides a history of the Worker Connect project in the context of a case study on achieving interoperability. The second part of this article introduces the framework of system of systems, and describes Worker Connect and HHS-Connect within this framework. The third part of the article describes future work, and offers some lessons for others wanting to implement a system of systems project for human services.     

Measuring changes in interagency collaboration: an examination of the Bridgeport Safe Start Initiative

This paper describes the evaluation of interagency collaboration in a network of child-serving providers as part of the evaluation of the Bridgeport Safe Start Initiative (BSSI). In line with the system of care approach, the objectives of BSSI included reducing fragmentation of efforts and delivering integrated services to families of young children exposed to or at risk of exposure to family violence. Interagency collaboration was examined via social network and focus group data collected at three time points starting at baseline. Network analysis findings suggest that over time the network structure became consistent with BSSI's vision of an ideal collaborative network structure. Focus group findings, however, present a more complex picture of the status of collaboration. This paper sheds light on approaches and challenges to measuring interagency collaboration in a service delivery system and communicating social network analysis findings to stakeholders in a way that is accessible and useful.     

Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system

While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.     

The role of interagency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of interagency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies - jurisdiction, shared information systems, and overall connectivity - and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems.     

Addressing the needs crossover youth: What key professionals are saying

Crossover youth have complex needs and can create difficulty for service providers who have to both provide effective services to the youth but also work with and navigate a system outside of their own. Professionals from the child welfare system and the juvenile justice system have recognized the need to work together to help crossover youth. A successful collaboration can be extremely beneficial to all those involved but certain barriers must be overcome. This study uses secondary qualitative analysis to examine the opinions of key professionals in both systems as they came together to create action plans to address issues facing crossover youth in their individual counties. Researchers identify common themes and discuss the importance of collaboration among systems and recognizing individual county's stages of change.     

Children with disabilities in out-of-home care: Perspectives on organisational collaborations

Many contemporary support services for children and young people (CYP) in out-of-home-care have adopted a collaborative approach to service provision in order to best meet the complex needs of clients. The purpose of this study was to gain a better understanding of the perceptions of Evolve Behaviour Support Services (EBSS) frontline and managerial staff delivering services to CYP in out-of-home-care with disability and complex behaviours regarding interagency/stakeholder collaboration. Views about the number and nature of collaborative partnerships, factors which facilitate or hinder effective relationships and advantages (including unintended benefits) of collaboration were sought. Qualitative interviews with 21 participants highlighted issues around: (1) general and agency/stakeholder specific issues and barriers, and (2) benefits of collaboration. The collaborative approach to service provision was seen as greatly enhancing the effectiveness of EBSS' response and ability to meet the range of CYP's complex needs, as well as having benefits for carers and service providers. Nevertheless, difficulties with collaboration were also encountered. Frequently identified challenges included reduced stakeholder engagement, differences in professional backgrounds and practice frameworks, unequal initiation of contact and follow-up, organisational disparities, communication and information sharing problems, frequent stakeholder turnover and geographical barriers in rural/remote areas.     

A therapeutic social work team in practice

In 1996, as a result of interagency collaboration between social services and health, Leeds Social Services Department brought together three groups of social workers undertaking therapeutic work into a centrally managed team. Continued inter-agency working together has ensured that the Therapeutic Social Work Team has become an established service for children and families. This paper describes the work of the team by focusing on four areas: the context of interagency collaboration, therapeutic work in the child protection process, managing different theoretical approaches in one team, and evaluating practice.     

Evaluating systems change in a juvenile justice reform initiative

Evaluating comprehensive, interagency initiatives to reform human services systems presents substantial challenges to traditional research models. Outcomes are observed at the system level rather than the individual level, and the validity of study results may be challenged on a variety of dimensions, particularly small sample sizes and measurement error. We report the results of a cross-site evaluation of the first phase of Reclaiming Futures, a five-year effort to improve services and interventions for justice-involved youth in 10 communities across the United States. We present the evaluation findings and discuss implications for similar research endeavors. The methods used in this study may be useful for other system-level evaluation efforts. A social network analysis analyzes changes in the size, density, and cohesiveness of stakeholder networks. Bivariate models test for associations between Reclaiming Futures implementation and key stakeholder perceptions of effective system change. Multivariate models are used to explore selection effects on item response. In general, we find positive correlations between successful implementation of Reclaiming Futures and indicators of effective and efficient system change.     

Critical factors in the design of a service delivery system for students-in-transition with severe disabilities

Although there has been tremendous growth in secondary school programs for students with severe disabilities, many of these students continue to “graduate” or “age out” without adequate preparation for community-integrated employment and increased independent living in the community. Competitive employment and independence will remain an illusion for many students with severe disabilities unless there is strong commitment by the public and private sectors to the development of post-secondary options and the establishment of effective processes to coordinate and integrate services and programs. The purpose of this article is to present some of the critical factors in the organization and delivery of services and programs for students-in-transition with severe to profound mental retardation. First, the extent of need for transition services and programs is briefly reviewed. Second, a framework for transition case management in Philadelphia is described. And last, three interrelated factors — communications, capability, and disposition — contributing to successful planned intervention are examined in relation to Philadelphia's initiative in establishing a service delivery system for students-in-transition with severe to profound mental retardation.     

A qualitative study of collaboration between guardians ad litem and caseworkers in the child welfare system

Various agencies and professionals in the child welfare system work together to prevent and treat child maltreatment. Prior research suggests their ability to collaborate is related to outcomes for children and families and agencies often implement strategies to improve collaboration. However, a review of the literature indicated a lack of research on collaboration between Guardians ad litem (GALs) and child protective services caseworkers. Examination of this relationship is warranted considering federal law mandates GALs be appointed for children in all court-involved child protection cases. This qualitative study begins to address this gap by exploring the GAL perspective on factors that promote or inhibit collaboration between themselves and caseworkers. Interviews were conducted with 12 GALs in a mountain region state. Participants emphasized five individual-level factors that impact the frequency and quality of collaboration with caseworkers. These include frequent and open communication, mutual respect, understanding the other's role and responsibilities, having an open mind, and valuing collaboration. Participants described in detail how these factors facilitate collaboration despite the organizational and systemic obstacles to working together. The findings may help explain why collaboration does not necessarily occur in frontline practice despite the presence of organizational policies and procedures intending to improve collaboration. These findings have several implications for improving GAL–caseworker collaboration in order to better serve children and families in the child welfare system.     

Transition strategies for youths with sensory impairments: Educational,vocational and independent living considerations

Students with sensory impairments comprise a heterogeneous group that is often underserved by rehabilitation and other social services. This underserved status has been attributed to poor interagency collaboration and eligibility issues, the low incidence nature of these disabilities, and the shortage of trained professionals to address the specialized needs of these individuals. This article examines important educational and vocational characteristics of this population to assist rehabilitation professionals in supporting more effective transitions into employment and other adult roles. Specific transition considerations include unique learning challenges, assessment issues, assistive technology, and accommodations. The article concludes with strategies for transition planning, community integration, and evaluating transition outcomes.     

A traumatised and traumatising system: Professionals' experiences in meeting the mental health needs of young people in the care and youth justice systems in Ireland

It is well recognised that children and young people in the care and youth justice systems typically present with significant and diverse mental health needs. Much has been written about this challenging area of professional practice but the focus has been primarily on the young people themselves rather than professionals' experiences of working in this challenging context. In this study, focus groups and individual interviews were conducted with 26 professionals working in the care and youth justice services in Ireland, representing a range of disciplines, to capture professionals' perspectives of working in this field. A thematic analysis was conducted on the transcribed data. Professionals described frustration and helplessness in the face of what they perceived as inadequate system responses and poor interagency working. Their experiences are conceptualised here as reflecting a traumatised and traumatising system. The implications for practice emphasise the need for staff support through training, collaboration between agencies, and addressing vicarious traumatisation.     

Early intervention services for very young children and their families under P.L. 99-457

This article addresses early intervention services for children, birth to kindergarten age, who experience developmental deficits and delays that may later be identified as learning disabilities. P.L. 99-457 is briefly reviewed with a focus on elements that emphasize family-centered practice. Vignettes are presented to illustrate interventive strategies that promote parent empowerment, and parent-professional and interagency collaboration.     

Integrating child welfare, juvenile justice, and other agencies in a continuum of services

This article presents a comprehensive strategy framework for integrating mental health, child welfare, education, substance abuse, and juvenile justice system services. It proposes an infrastructure of information exchange, cross-agency client referrals, a networking protocol, interagency councils, and service integration models. This infrastructure facilitates integrated service delivery.     

Predictors of High-Risk Sexual Behavior Among Individuals Living with HIV Disease and AIDS

An important focus of the 1996 World Aids Conference related to the extent of unprotected sex among gay men, particularly those in their twenties. This paper will use logistic analysis to explore the extent of unsafe sexual practices among individuals living in Bexar County, Texas, who are HIV+ assymptomatic, HIV+ symptomatic, or have AIDS. Using survey research data, we assess the significance and impact of various independent factors on whether respondents reported they did or did not engage in unprotected sex. The most striking finding is that unprotected sexual activity is prevalent regardless of demographic and/or status differences among respondents. Findings reinforce the use of community planning processes, which emphasize the importance of sound behavioral and social science combined with efforts to include the affected constituency to create effective HIV prevention programs.     

Drug-endangered children need a collaborative community response

The United States is facing an epidemic of the use of methamphetamine drugs. Child welfare has not yet addressed the needs of the children living in so-called "meth homes." These children are endangered not only from the chemicals involved, but also from parental abuse and neglect. Communities are recognizing the need for interagency collaboration to address the consequences of this epidemic. Spokane, Washington, has created a Drug-Endangered Children Project, whose mission is to implement a collaborative response among law enforcement, prosecutorial, medical, and social service professionals to the needs of drug-endangered children. This article presents the findings from the evaluation of the first year of the project, including a baseline assessment of the needs of drug-endangered children and the extent of community-based collaboration achieved. This article makes recommendations for future community-based partnerships to improve the well-being of drug-endangered children.     

Collaboration Between Community Mental Health and Juvenile Justice Systems: Barriers and Facilitators

Recent studies have confirmed a high prevalence of youth with diagnosable mental health disorders within the juvenile justice system, as well as the vulnerability of youth in the mental health system who enter the juvenile justice system. This high prevalence of dual system involvement has spawned challenges of collaboration between the mental health and juvenile justice systems to provide needed services to youth and their families. Seventy-two in-depth interviews were conducted with 18 youth and their parents/guardians, mental health professionals from five different community mental health centers, and juvenile justice professionals in urban and rural communities in a Midwest state in the United States. Professionals, youth and parents identified several important factors that facilitated collaboration, as well as a myriad of barriers that needed to be overcome. Findings suggest ways to improve partnerships between the two systems and the development of supportive policies and procedures.     

‘Changing the way we do child protection’: The implementation of Signs of Safety® within the Western Australia Department for Child Protection and Family Support

ObjectiveThis paper describes a six-year large scale implementation of the Signs of Safety practise framework in a complex statutory child protection context in Western Australia. The case study documents both the practitioner-led and organisational-led implementation journey as part of the State's child protection system reform drawing on Roger's diffusion of innovation theory and Fixsen's five stage implementation model as conceptual frameworks, and highlighting the key facilitators and barriers.MethodsThe study is a collaboration between researchers investigating the impact and use of Signs of Safety in Western Australia who contributed the theoretical perspectives and analysis; and key personnel from the Department responsible for implementation who contributed documents, manuals, records and personal accounts to form the narrative of the implementation. A naturalist, intrinsic and multiple case study design utilising semi-structured interviews was used to consult with 27 Departmental staff and practitioners. Thematic analysis was utilised to identify key themes and patterns of experiences with the Signs of Safety framework implementation.FindingsMuch can be learned from the journey of the Department and their long term commitment and systematic implementation strategy of Signs of Safety including the significance of leadership, learning and developing initiatives, effective communication, instituting continuous improvement processes and the provision of feedback for individual practitioners. Signs of Safety appealed to natural champions of systemic social work practise within the Department whose organisational culture adapted to align with the principles of the framework in building partnerships and understanding with families, being solution-focused, maintaining an open stance of inquiry and balancing strengths and safety around children whilst concurrently working to solve dangers and harm. As a learning organisation, the Department also utilised case practise implementation teams to be able to move through more successfully the different stages of implementation. In utilising Fixsen's implementation framework, the challenges and gaps to implementation strategies were also highlighted, including a problematic data system and an internal focus compromising the success of interagency collaboration.ConclusionThis discussion paper has provided an overview of the key concepts of the diffusion and implementation literature, and highlighted the importance of utilising theoretical frameworks in guiding implementation of practise models especially in complex statutory child protection contexts. Findings will be of particular interest to child welfare leaders and supporters of organisational change, providing concrete examples of implementation strategies and demonstrates the systemic benefits of a theoretical framework for guiding implementation efforts.     

Young People Transitioning from Out-of-home Care in Victoria: Strengthening Support Services for Dual Clients of Child Protection and Youth Justice

Abstract

A significant proportion of young people leaving out-of-home care make their transition to independence via the youth justice system, exposing them to further risks and reducing their likelihood of full social and economic engagement in mainstream society. This article presents the initial findings of a research project based on a partnership between Monash University and seven nongovernment child and youth welfare agencies in Victoria, Australia. Seventy-seven key stakeholders participated in interviews and focus groups with a view to identifying practices and policies that could reduce the over-representation of young people leaving out-of-home care in the youth justice system. Factors that contributed to offending included varied responses by the child protection and youth justice systems, limited utility of leaving care plans, and the availability of a range of preventative and diversionary programs. The findings point to a need for more formalised interagency collaboration, and intensification of the interventions and supports offered both in custodial settings and post discharge from custody or care.