Families don't fit in boxes

Families don't fit in boxes

We are at the beginning of a big shift in child welfare information systems. As former child welfare workers, with more than 40 years of service (between the two of us), we are incredibly excited about the potential. However, as child welfare workers, throughout our careers, we often encountered systems of burdensome technology that focused more on reporting requirements than they did on supporting practice. The next generation of Comprehensive Child Welfare Information Systems (CCWIS) has an opportunity to do much better.


A major goal of CCWIS is to help child welfare agencies become more data driven. Identifying trends and understanding what practices are successful and which practices need attention can better inform decisions and services in a meaningful way. However, for data to have an impact, agencies must access all the data – both structured and unstructured data –such as the information in case notes and communications. This is where a worrisome trend seems to be emerging with some IT leaders determined to dramatically reduce unstructured data by creating more structured data e.g., check boxes. While there is indeed an opportunity to identify repetitive data currently in case notes and to create structured fields for that information, most case notes must remain as unstructured free-form text  because families do not fit in boxes and families have individualized needs.


Checking boxes simply cannot adequately tell the full story of a child or family’s unique lived experience. Two brief examples illustrate this:


A check in a box might allow a case worker to indicate that the child has their own bed. However, that box cannot begin to convey that the child will not sleep in the bed because they have nightmares from the trauma they have suffered. That story is about so much more than the bed!


Housing insecurity serves as another example. Checking a box for“eviction” might mean it occurred in the past, or that the family is currently evicted, or even more nuanced – that there is the risk that it might occur soon.There is a need for much more insight and detail, such as the reasons the family is not or cannot pay rent. Are they unemployed or underemployed, or misusing income on drugs or alcohol? 


Finally, there is also the opportunity for more errors or misinformation. For example, caseworkers could check a box for “pregnant,” but will they remember to go back and uncheck the box after the baby is born? And what about using a box or boxes for level of safety or risk - that is a very difficult assessment for all case workers particularly those with less experience. Risk assessment is seldom black or white and boxes or number scales often force a black and white decision. A simple mistake can dramatically change the status of the case. Case notes that include the case workers' observations and interactions with the family do not pose the same risk of error.


Innovations in technology such as natural language processing(NLP), federal funding, and ACF’s support for systems designed to support each State’s child welfare practice create an opportunity for this round of child welfare information systems to have meaningful impact. For that goal to be realized, systems must support child welfare practice and its complexity.


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