November/December 2010 Issue

Data Driven, People Focused — Technology Takes on Social Work
By Christina Reardon, MSW
Social Work Today
Vol. 10 No. 6 P. 6

Successful information management systems require collaboration with frontline workers.

Imagine a world where you could access neatly organized data about your clients without rummaging through papers, where you could read case notes without struggling to decipher handwriting, where you could evaluate the effectiveness of services without digging through files.

Wouldn’t integrating computer technology into data collection and management make your job as a social worker so much easier? Then why, in many cases, doesn’t it?

Technology promises greater efficiency, less paperwork, and more time with clients. But many social workers’ perceptions—and realities—are of cumbersome and irrelevant systems that make them feel more like bureaucrats than helpers.

Let’s face it: Technology is transforming how people collect and share information and social workers who refuse to acknowledge this trend risk falling out of step with the profession. But organizations that impose data management technology without taking clinicians’ needs into account risk creating systems that bog down social work rather than enhance it.

“The technology is here. You’re going to have to use it, and it’s not going away,” says Mike Meikle, a Virginia-based IT consultant with experience serving the human services sector. “But managers can’t just implement this in a vacuum; they have to include their people in the process. You have to make sure that your users are on board and that they understand how it’s going to benefit them.”

Data Is Power
Keeping good tabs on data is key for any human services organization that wants to be successful, Meikle says. Funders, regulators, and members of the public are increasingly demanding evidence that organizations are accountable and that their services are producing the desired results. Data also help organizations evaluate employees, manage risk, and defend themselves against lawsuits.

And computer technology makes it easier for organizations to access the data they need when they need it, says Xiaoyan Zhang, PhD, president and CEO of KIT Solutions, a Pittsburgh-based company that provides Web-based information management services to health and human services organizations. “You have instant access to data, so you can submit it to researchers and evaluators and report it to government agencies. In one shot, [technology] can solve many problems.”

One organization that has experienced how technology can improve data collection and management is the Arapahoe/Douglas Mental Health Network, which provides mental health and substance abuse treatment services in Colorado. The network switched to an electronic medical record system several years ago in a bid to eliminate much of the inefficiency of its old paper-based system.

The electronic system allows workers to be more mobile in the services they provide because they can access client records using an Internet connection rather than carrying around paper files, says Eric Moore, Arapahoe/Douglas’ chief information officer. The technology means workers can spend less time searching for records and more time working with clients, a switch that has become especially important as the network finds itself serving more clients with fewer funding sources, Moore says.

Moore acknowledges that a significant number of his organization’s employees were opposed to switching to electronic records, but even those workers who were most opposed eventually came around once they started using the new system.

“I think the workforce has been able to adapt,” he says. “One of the biggest critics said a year later that he would never go back to the old paper way of doing things.”

A technological approach to managing data can be beneficial to clients, especially those who work with more than one person in an agency or who use services across multiple agencies, says Dale Fitch, PhD, MSW, an assistant professor at the University of Missouri School of Social Work. Fitch saw this firsthand when he was involved in a project that used technology to streamline referrals in a group of elder care agencies in Michigan. The technology expedited referrals in part because it reduced the need for clients to provide information to multiple service providers. That saved time for the providers and eased clients’ frustrations with the referral process, Fitch says.

“The reality of human services is that there is no single agency that deals with all of the issues people face,” he says. “The technology allows information to cut across agencies.”

Why Is There Resistance?
But for every success story, it seems there is at least one story of a data management system that is underutilized, seen by social workers as more of a burden than a benefit. And while it’s common for people to peg these failures on social workers labeled as stubborn and antitechnology, the truth is often far more complex.

“I think the idea that social workers are behind the times when it comes to technology is totally bogus,” says Dick Schoech, MSSW, PhD, a professor at the School of Social Work at the University of Texas at Arlington. “If the technology doesn’t do anything for them and they don’t get the information out of it that they need to use, they will resist it. If [the technology] is useful, they will adopt it in a second.”

Just because many industries in the corporate sector have embraced computerized records doesn’t mean such a switch is as easy in social work, Fitch says. For example, it is difficult to codify social work services in a way that can be easily entered and tracked in a computerized system. It’s one thing for Wal-Mart to use technology to track each jar of pickles it has in stock, Fitch says, but social work is something “you can’t put in a jar.”

In addition, many IT vendors are steeped in the corporate world, don’t understand the world of social work, and therefore create products that don’t adequately assist social workers or unintentionally make their lives harder, Fitch says.

And then there is the money issue. While some corporations may be flush with cash to spend on database systems, social work agencies are often dealing with dwindling resources that force them to set priorities that may not include new technology, says Stephen Kapp, MSW, PhD, an associate professor at the University of Kansas School of Social Welfare.

“When things get tight, [agencies] tend to invest more resources in services rather than support,” he says.

But the problem extends beyond differences in the operations, philosophies, and funding levels of the corporate and nonprofit sectors. It also involves the traditional tensions between management and frontline workers in human service organizations. Managers are often in charge of technology initiatives and therefore gravitate toward systems that reflect their needs when it comes to what data will be captured and how they will be used, Schoech says. He notes that it shouldn’t be a surprise that frontline workers often find these systems to be of limited value.

Kapp has witnessed the effects of such a disconnect. While researching how mental health managers in Kansas use information, Kapp and Karen Stipp, MSW, LSCSW, a doctoral candidate and research assistant at the University of Kansas School of Social Welfare, discovered that a statewide automated information management system was designed in such a way that it prevented the workers who were required to enter data from reaping direct benefits from their efforts. That’s because workers could not access the client-level data they entered into the system and instead had access only to quarterly reports of aggregated data.

“Once [the workers] hit send, they no longer had the data at their centers. For years they were sending all of this stuff out, and they wouldn’t get it back for up to six months later and then the information was aggregated,” Stipp says. “People understood why data was being collected, but they couldn’t see how it was useful to them.”

The involvement of frontline workers in the design of data management systems is vital if human services organizations want to end up with systems that workers will actually use and benefit from, Kapp says.

“The design is really important to the usefulness of the data,” he says. “It has to be designed in a way that complements the user and allows the user to integrate data into practice.”

Moore believes part of the success of Arapahoe/Douglas Mental Health Network’s electronic record system lies in the network’s decision to actively include employees in the selection of software and vendors. The organization arranged for internal focus groups so employees could interact with vendors and get a sense of how each vendor’s software worked. The network also sent questionnaires to other agencies that had purchased systems to gauge their satisfaction with their choices.

“It’s about knowing exactly what it is you want to have and then finding the right fit,” Moore says.

Training and services tailored to social workers also are important. Organizations must understand that workers will not latch onto a new system overnight and may require lengthy periods of support, Zhang says.

“Like any new thing that’s introduced, there is resistance. Many people are used to pen and paper,” he says. “It’s part of the reality of this sector, and you have to take the time to get them comfortable with the technology.”

Finding Middle Ground
Fitch believes a change of attitudes is needed for computerized data management tools to become more accepted—and used—in social work. Social workers need to become more open to the benefits of technology and technology companies need to become more sensitive to the concerns of social workers, he says.

Some technology companies are trying to bridge this gap by putting people with experience in the human services sector into leadership roles. For example, Zhang has a doctorate in sociology. And Keith Gray, LCSW, heads up Groupware Technologies Inc.’s training and support efforts. The Wisconsin-based company markets a care-management tool used in a variety of social services settings.

“My experience as a social worker has helped me as a trainer,” Gray says. “I’ve been a case manager, I’ve been in mental health. And when I say, ‘Hey, I’m a social worker,’ it takes a lot of the stress away and makes people more comfortable with the technology.”

The tension between social work and technology may ease as younger, more computer-savvy people come into the profession. But many schools of social work still lag behind when it comes to teaching students about the positive ways technology can improve the delivery of human services, Fitch says. In addition to traditional dual majors such as social work and public health or social work and law, universities should consider how social work can be integrated with studies in computer science and engineering, he says.

“We need a cadre of talented students and young researchers interested in designing information systems that reflect the values of social work,” Fitch says. “We don’t have that discourse enough in our profession. If social workers are not part of the discussion of design, then other people are going to do it.”

— Christina Reardon, MSW, is a freelance writer based in Harrisburg, PA, and contributing editor at Social Work Today.

Views on Data Management Technology in the Workplace
The issue of how computerized data management systems affect social work organizations and their employees has been widely discussed in the academic literature. Among recent articles on the topic are the following:

• Burton and van den Broek (2009) studied how new technology contributes to the bureaucratization of social work. Many of the Australian social workers participating in the study reported that data collection technology made them feel less connected with clients and shifted their priorities from quality of output to quantity of output. Workers also felt that organizations did not appreciate the amount of time it took to produce reports for funders demanding an ever-increasing amount of data about programs.

• Carrilio (2007) surveyed 245 community social workers to examine which factors affected their willingness to use client information systems. The study found that workers’ skill and experience with computers and workers’ perceptions about the user friendliness of the systems and usefulness of data affected utilization. However, attitudes about data use did not have a strong effect on system utilization.

• In a case study of how a social service organization in Hong Kong practiced knowledge management, Leung (2009) observed that different types of knowledge have varying degrees of usefulness in a digital format. IT is useful for the storing of and access to items such as meeting minutes and presentation handouts. However, other forms of knowledge sharing, such as stories, are harder to digitize because certain aspects of the experience are lost when shared electronically.

• The debate over the acceptance of electronic data is not limited to social work. In a study of an electronic health record system in use at a VA medical center, Saleem and colleagues (2009) discovered that many workers still chose to rely on paper to complete certain tasks. Workers reported that they turned to paper for various reasons, including the perception that it was efficient in certain cases, easier to use, and more useful in helping them remember important information.

— CR

References
Burton, J. & van den Broek, D. (2009). Accountable and countable: Information management systems and the bureaucratization of social work. British Journal of Social Work, 39(7), 1326-1342.

Carrilio, T. E. (2007). Using client information systems in practice settings: Factors affecting social workers’ use of information systems. Journal of Technology in Human Services, 25(4), 41-62.

Leung, Z. C. S. (2009). Knowledge management in social work: Types and processes of knowledge sharing in social service organizations. British Journal of Social Work, 39(4), 693-709.

Saleem, J. J., Russ, A. L., Justice, C. F., et. al. (2009). Exploring the persistence of paper with the electronic health record. International Journal of Medical Informatics, 78(9), 618-628.