Critical Decision Method Interviews to Understand the Initial Treatment Planning Process in Foster Care

Abstract

In foster care settings, the treatment plan captures goals and interventions for youth in care. The first version of this plan is typically due 30 days after the youth is enrolled in the foster care program, leading to a challenging month of assessing the case and developing the treatment plan. This study utilized Critical Decision Method interviews with care coordinators and clinicians to understand the decision-making involved in balancing assessment tasks, and the barriers to using assessment to inform treatment. The interviews were coded to identify major themes including information sources and constraints. These identified themes and general understanding of the problem space will drive future work developing interventions to improve the workflow process and drive better outcomes for youth in foster care.

The Context of Care: Abstraction Hierarchy Modeling of Therapeutic Foster Care Programs

“…We developed this abstraction hierarchy of Hillside’s therapeutic foster care program using our understanding of the domain that stemmed from a range of data sources. A previous interview study conducted with five care coordinators and clinicians at Hillside provided many useful insights about the first 30 days of the therapeutic foster care treatment planning process (Wurst et al, 2022). This study utilized the Critical Decision Method (Klein et al, 1989) to review particularly challenging instances of treatment planning resulting in a better understanding of process, constraints, and the general workplace ecology.…”

“…These criticisms are not meant to imply that technological solutions are unnecessary, as practitioner-driven decision-making also has some limitations. Practitioners are often overloaded with information of uncertain accuracy from a variety of sources (Wurst et al, 2022), which can lead to a lack of adherence to assessment protocol. For example, a think-aloud study examining foster family matchmaking found that analytical guidelines were underused in decision-making and that practitioners instead relied on heuristics to offset time and resource constraints (Zeijlmans et al, 2019).…”

“…Meeting the legislative requirements for any given case can be a demanding task by itself, and satisfying this abstract function may come at the expense of other values at this level. When asked about common mistakes in the assessment and treatment planning functions, many practitioners reported that the heavy administrative load of data entry and form filling required to meet legislative requirements can lead to a sort of "check-box" behavior (Wurst et al, 2022). This can include duplicating paperwork for siblings and assigning irrelevant goals to youth cases simply to speed up the data entry process.…”

“…In particular, greater emphasis on case history review would allow for better accounting of youth's previous trauma in assessment and further integration of care philosophy at the abstract function level. However, case history review is primarily achieved by accessing previous assessments through the Connections database, which practitioners have reported to be challenging to use under time pressure (Wurst et al, 2022). Alongside concerns regarding the agency EHR database, which are discussed below, this challenge presents a clear need for a data visualization tool that would better support the assessment and treatment planning functions.…”

“…At the micro level of child welfare, there are numerous challenges in the process of individual treatment planning and case management (Bosk, 2018; Wurst et al, 2022). These challenges largely motivate this study, as evidence-based practices and technological solutions need to be designed to facilitate optimal use of data and human-technology teaming.…”