Child Welfare Workers' Adoption of Decision Support Technology

Abstract

Child welfare workers must process complex information in deciding to refer clients to appropriate mental health services. Decision support systems (DSS) have been demonstrated in other fields to be an important tool, yet little research has been done in child welfare. This study focused on the adoption of a specific DSS into child welfare practice. Quantitative analysis was used to demonstrate the diffusion of innovation process among a sample of state child welfare workers, while qualitative analysis was used to explain the facilitators and barriers to DSS adoption. Results indicate that for DSSs to be widely adopted in child welfare practice, they should be integrated into the referral system and include workers' knowledge and experiences with referral resources. For successful adoption, DSSs need to respect the natural logic and flow of worker interaction, as well as organizational constraints.Keywords decision support technology; child welfare; diffusion of innovations Child welfare workers must process complex information in deciding whether to provide services or to refer clients to appropriate mental health services. Many frontline workers are ill-trained to make adequate mental health assessments and therefore they either fail to identify mental health and substance abuse concerns or they refer clients to services that are inappropriate for their particular needs (McDonald & Marks, 1991). Yet such workers often serve as the "gateway" to mental health services (Stiffman, et al., 2000;Stiffman, Pescosolido, & Cabassa, 2004), as do physicians, counselors, teachers, etc. Decision support systems have been shown to assist physicians in processing varied and complex bits of information (Chen et al., 2004;Kawamoto, Houlihan, Balas, & Lobach, 2005;Pluye & Grad, 2004). These systems might also help child welfare workers as they navigate practice and referral decisions requiring the integration of complex information.In essence, child welfare workers are important providers of mental health services. Decision support technology has been demonstrated in other fields to be an important tool for evidencebased practice, and the few extant studies about social workers' use of these systems indicate they have the potential to change the way services are delivered (Giffords, 2003;Monnickendam, 2000;Monnickendam, Savaya, & Waysman, 2004 Savaya, Monnickendam, & Waysman, 2000;Schuerman & Vogel, 1986;Schwab, Bruce, & McRoy, 1986;Stiffman, Foster, Hamburg, & Doré, 2004). Developing technology that assists child welfare workers to better meet client needs is insufficient without a thorough understanding of the factors impacting the integration of technology into practice. It is therefore imperative that we gain a better understanding of the adoption process of DSS in child welfare practice. This paper examines the process of and reaction by child welfare workers' to the adoption of a new decision support system specifically designed to enhance their assessment and referral capacity.

Dissemination and Implementation of Evidence-Based Practices for Child and Adolescent Mental Health: A Systematic Review

“…Rohrbach et al 33 found that the training of the school principal, but not the intensity of teacher training, increased the likelihood of adoption of a school-based intervention. Foster and Stiffman 34 found that the addition of a personal digital assistant version of a desktop decision support system for social service workers increased EBP use. Epstein et al found that (1) providing pre-packaged medications to enable practitioners to conduct n of 1 double-blind placebo-controlled trials of different stimulant doses for use with individual patients, along with (2) specialist support for its interpretation to pediatric practices increased the use of such trials, though it did not increase the frequency of monitoring of ADHD symptoms over time.…”

“…Aarons et al 37 found that fidelity monitoring resulted in lower levels of staff emotional exhaustion when such monitoring took place in the context of sustainment of an EBP (in this case SafeCare) compared to fidelity monitoring for providers providing usual care services. In their small clinical trial comparing desktop computer only versus desktop computer plus personal digital assistant access to the a decision making support system, Foster and Stiffman 34 found that use of the system declined during the sustainment phase of their trial, though use of the decision support system remained higher in the desktop computer plus personal digital assistant condition during the sustainment phase.…”

Can Predictive Algorithms Assist Decision‐Making in Social Work with Children and Families?

“…() explored the potential of what they refer to as ‘artificial intelligence’ to develop ‘expert systems’ to support professional decision‐making. Research‐based development of DSS continued in the 21 st century and identified particular challenges in their design and implementation such as making them useful in the contexts in which they are implemented (Fitch, , ; Foster and Stiffman, ), getting practitioners to use them (Fitch, , ; Foster and Stiffman, ) and accounting for the importance of emotion and bias in human decision‐making (MacFadden and Schoech, ).…”

Child Welfare Workers’ Connectivity to Resources and Youth’s Receipt of Services

“…Other factors not included in this study may influence assessment, referral practices and service provision for youth. Studies conducted with the St. Louis Children’s Division (Fedoravicius, McMillen, Rowe, Kagotho & Ware, 2008; Foster & Stiffman, 2009; McMillen, Fedoravicius, Rowe, Zima & Ware, 2007) show that mental health services for youth in the child welfare system are frequently court ordered. The pressure to comply with court demands for documentation and time constraints influence workers’ assessment and referral practices (Fedoravicius et al, 2008; Foster & Stiffman, 2009; Smith & Donovan, 2003).…”

“…If training, experience and education were not associated with connectivity, other factors that were not included in these analyses must be important. Focus groups revealed that interactions at the office shaped workers’ familiarity with other providers and their referral patterns (Foster & Stiffman, 2009). Constructive organizational culture and positive perceptions of organizational climate influence work-place interactions and may have a role in the transfer of practice knowledge (Glisson & Green, 2006; Uzzi & Lancaster, 2003).…”