Family Matters

States struggle to upgrade child welfare information systems.

by / January 29, 2007 0
It's been 13 years since SACWIS entered the lexicon of administrators of state social services programs, yet a statewide automated child welfare information system that's fully compliant with federal standards still eludes many state governments.

Even with funding help from the federal government, states found themselves far behind estimated completion dates for building SACWIS-compliant systems -- some states reported eight-year delays, according to a 2003 SACWIS study from the then-General Accounting Office (GAO).

The GAO examined state child welfare information systems, at Congress' request, after a series of tragedies involving children under the supervision of state child welfare agencies across the country.

As of November 2006, three states had achieved SACWIS compliance, and two others were enhancing their systems to maintain compliance, according to the U.S. Department of Health and Human Services' (HHS) Administration for Children and Families (ACF), which oversees SACWIS compliance.

The 13-year implementation lag is perhaps not the timeframe the federal government envisioned for states making the SACWIS transition. States face significant barriers to executing a successful SACWIS, however, including the complexity of the giant information systems and the cultural shift to information sharing among social services agencies forced by a SACWIS rollout.

Finding Fault?
States' slow SACWIS pace can be traced to several intertwined causes.

Funding is always an issue in big IT modernization projects, and SACWIS funding presents additional headaches. System design is another common problem in large projects, and SACWIS design adds an additional layer of complexity. Finally, bringing cohesion to differing data definitions among local, state and federal governments is proving difficult.

The federal government has offered states funding since 1994 to support SACWIS compliance initiatives. Of course, federal dollars always come with strings attached, and SACWIS funding is no exception.

States must submit planning documents to the HHS that specify how their systems will be designed, built, deployed and maintained. Also, states must include performance goals in the planning documents. Furthermore, HHS examines states' information systems through formal SACWIS assessment reviews, and a separate federal review process to evaluate compliance with child welfare laws and outcome measurements set by the federal government.

Timing was one problem associated with the federal SACWIS funding, according to the GAO's report. In 1994, the federal government matched state funding for SACWIS at an enhanced rate of 75 percent, but the GAO discovered that many states didn't apply for federal funding or begin SACWIS development until 1996 and 1997 -- when the bulk of federal funds had already been allocated.

Also, the enhanced funding rate expired in 1997, dropping to 50 percent, which meant states had to come up with more of their own money. Forty-two of the 46 states surveyed told the GAO they experienced varying degrees of difficulty securing state funding for SACWIS development.

States have other worries tied to federal funding, including how much money they need to pay back if a project fails.

Citing figures from the HHS, the GAO's report said North Carolina received approximately $9.6 million in developmental funds for its SACWIS. North Dakota received approximately $2.4 million in developmental funds and $245,000 in operational funds for its SACWIS. Unfortunately both states ran into difficulties and did not complete their systems, the GAO's report said, forcing the states to negotiate with the HHS to determine how much money to return to the federal government.

Federal Satisfaction
Despite the setbacks, the ACF is pleased with states' progress, said Wade Horn, assistant secretary for Children and Families.

"We have 43 states and the District of Columbia that are in some stage of SACWIS planning, development or actual operations," Horn said. "For a system which is voluntary for the states, I think that's a pretty good measure of compliance."

Though rolling out a SACWIS is a complex undertaking for states, Horn said the HHS's overarching goal is straightforward -- to give state and local health and human services agencies the resources to build a tool that helps caseworkers manage their case loads. The HHS also stands to benefit from improved case-management practices.

Horn explained that more states successfully rolling out SACWIS means federal policy makers can rely on data from local, state, regional and national levels that's collected in nearly real time.

"We can make policy decisions based upon good information, rather than on mere supposition as to what's going on in the child welfare system," he said.

HHS officials aren't concerned about how long it has taken states to implement SACWIS, he said, partly because federal officials understand the process foists cultural change on agencies that may not welcome it.

"A truly integrated SACWIS can help to facilitate -- and maybe even force -- coordination across different silos of social services delivery systems," Horn said.

Historically HHS officials have focused on individual social programs, such as child welfare systems, the Temporary Assistance for Needy Families (TANF), child-care subsidies or even juvenile justice. This tunnel vision has led to information systems that only serve specific agencies with no capacity for information sharing.

"While they're not exactly the same population, they're overlapping populations," Horn said. "The TANF program doesn't coordinate with the child welfare program. The child welfare program doesn't coordinate with the child-care program. We act as if the only system that this child interacts with is the one we're involved in.

"The big, grand vision in social service delivery to children and families has always been integrated services. This technology has the ability to facilitate that integrated service delivery we've all been talking about for 30 years."

Besides the technology solutions to eliminating information silos, the HHS is presenting a legislative solution to Congress to address a primary culprit in information-silo making -- federal funding by category.

"We have a proposal before Congress to break down the categorical walls of the funding streams within the child welfare system," Horn said. "One of our proposals is to provide federal money much more flexibly to states so they don't just spend it on child welfare, but they have a lot more flexibility in determining exactly how they spend the money."

Data Differences
States' struggles with designing a SACWIS don't fall into clear-cut categories, but one particular issue tends to plague large IT projects that impact multiple branches of government -- getting a diverse collection of state and local agencies to agree on system design.

The GAO studied New York state's SACWIS effort and found a cross-government bottleneck. The state's counties administer child welfare services, and the GAO learned that SACWIS development ground to a halt when commissioners from five large counties and New York City expressed frustration with the proposed SACWIS design.

That frustration led local government officials to ask the state to stop SACWIS development, according to the GAO, until the state reassessed the SACWIS design and implementation plans.

After that reassessment, state officials altered the project plan and created statewide work groups to bring all counties into agreement on the system design, the GAO said, and the state hired a contractor to monitor SACWIS development and ensure all users' requirements received serious consideration.

States also told the GAO that another design challenge is creating a SACWIS that reflects child welfare work processes and is user-friendly, a problem also identified in the HHS's reviews of states' systems.

In the federal SACWIS review, one state explained that it designed its SACWIS to meet caseworker needs and mirror child welfare work processes by developing a system that required events to be documented as they occurred, the GAO said. The state explained that caseworkers provide services to the children and families, and then record the information in the system.

Unfortunately the design limited the SACWIS's functionality because caseworkers could not enter information into the system after an event happened, the GAO said, and the state had to redesign the system to correct the design flaw.

Finally, designing a system that earns SACWIS compliance from the HHS entails overcoming troubling technical challenges. The GAO said 36 of the 50 states responding to its survey encountered technical issues, including matching state data element definitions to HHS's data categories.

North Carolina officials told the GAO that state policy requires every location where a child resides to be counted, including hospital stays, but one set of federal regulations stipulated that hospital stays and other short-term placements should not be included when counting foster care placements.

In cases where state and federal policies differ, states must carefully reformat their data to meet federal reporting requirements. Texas officials, for example, told the GAO that although a federal review of Texas' SACWIS instructed the state to modify its system to collect, map and extract data on guardianship placements, the state itself does not support guardianship arrangements.

This puts states in an awkward position, the GAO said. They must make sure they're reporting accurate data to the federal government but not contradicting state policies.

Short List
The dearth of states with a fully compliant SACWIS is somewhat surprising, said Lynda Arnold, director of the National Resource Center for Child Welfare Data and Technology (NRC-CWDT), but not completely unexpected because of the complicated nature of such systems.

"The issue with achieving tier-one status is just more complex than people had thought," said Arnold, who served as Child Welfare director in the Oklahoma Department of Human Services prior to joining the NRC-CWDT. During her tenure, Oklahoma became the first state to implement a federally compliant SACWIS.

The NRC-CWDT spends most of its time helping states with SACWIS data issues.

"Our main requests [from states] have been about converting data from their old system to their new system and not losing data quality in that process," she said. "A lot of our emphasis has been on mapping the data to meet federal requirements."

Perhaps the most misunderstood aspect of a SACWIS is that it's a child welfare management system, she said, not an information system.

"You've got to have that involvement from child welfare staff and from the leadership in child welfare," Arnold said. "Sometimes, getting the buy-in from the child welfare staff -- and getting that priority within the child welfare system when they're dealing with so many other issues -- is very difficult."

Early SACWIS development efforts appeared to be driven by the IT piece alone, she said, which is one reason why states ran into trouble designing systems that worked well while capturing and reporting data in ways that met federal guidelines.

One SACWIS development model that produced positive results and pleased the federal government was used by Dynamics Research Corp. (DRC) to design, develop and roll out a SACWIS for New Hampshire in 1997 and for Colorado in 2001.

DRC and New Hampshire rolled out New Hampshire Bridges, a system modeled on an earlier SACWIS originally developed in Oklahoma. DRC took the Oklahoma system from the public domain and adapted it to fit New Hampshire's organizational and operational needs, said Kathleen Perras, DRC's vice president and general manager of State and Local Programs.

"New Hampshire was one of the early states to adopt a SACWIS," Perras said. "The state wanted to take advantage of the 75 percent federal matching funds. A few states had gone after brand-new systems, but the federal government, at that time, was promoting reuse and transfer systems -- it was really encouraging states to take another state's system and adapt it, rather than paying for 50 brand-new systems."

Perras said New Hampshire officials had seen Oklahoma's system in operation, liked it and wanted it for their state. In an odd twist, Perras said DRC wound up competing against the company that produced Okalahoma's system for the New Hampshire SACWIS contract.

"We chose to go to the federal government to take it up on its word that the Oklahoma system was part of the public domain, that we could get a copy of it and compete against the original developer in a fair competition," Perras recalled.

A few years later, New Hampshire Bridges was adapted to fit Colorado's needs, Perras said, adding that Colorado officials liked New Hampshire Bridges due to the two states' similarity in business processes for child welfare services. The Colorado Trails SACWIS went live in 2001.

DRC is now busy in Ohio. The company won a contract, and after a two-year development effort, a SACWIS pilot kicked off in Ohio's Muskingum County in August 2006. Perras said the target date for rolling out the SACWIS to Ohio's remaining 87 counties is mid-2007.

Other SACWIS Success
In 1998, Oklahoma was the first state to achieve full federal tier-one compliance with its SACWIS, according to the GAO. Other states have since followed Oklahoma's lead.

Kentucky started its SACWIS -- called The Worker's Information SysTem (TWIST) -- in the early '90s, said Lorna Jones, CIO of the Kentucky Cabinet for Health and Family Services.

TWIST went live in 1996 and serves 129 locations throughout the state. In 1997, Kentucky won an award for TWIST from the then-National Association of State Information Resource Executives for "Innovative Use of Technology."

"TWIST was one of the first client/server applications that Kentucky rolled out," Jones said, noting that the state attempted to adhere to federal SACWIS guidelines from TWIST's beginning. "Our first federal review came in 1999, and we worked closely with the feds over the years. It wasn't until July 2005 that we received tier-one SACWIS compliance. It's been a long, evolving process focused mainly on meeting those many SACWIS requirements, as well as trying to get a system in place for workers to use in the field."

Besides the burden of meeting various federal requirements, Jones said the health and human services setting itself makes it hard for states to build a SACWIS.

"Health and human services is a very dynamic environment to try to automate. When you're dealing with human services, every day is a different day," she said. "It's like changing a tire on the bus as you're driving down the road. Once you're operational, from a technology standpoint, you've got to focus on maintaining the system, making sure the payments go out the door, and at the same time, making those changes toward meeting all the federal requirements."

It's a huge challenge, Jones said, and one that states seem slow to respond to. But there's a reason for the slow pace, Jones said: States realize there's no room for error; people depend on human services agencies to be on time with benefit payments and related assistance.

"We are dealing with human services," she said. "What we roll out has to be right because you're dealing with people's lives."

Kentucky is now moving TWIST to a new, Web-based platform to create a second-generation SACWIS. Jones said the state is planning a two- to three-year transition, and the hope is that the conversion will be easier, since Kentucky already built its SACWIS.

Still, moving to a second-generation SACWIS presents its own challenges.

"We have to make sure we stay SACWIS-compliant," she said. "We still have to meet all those requirements, but we're also going to focus on improving some of the functionality in the system -- making the system a little more user-friendly."

Viola Miller is also quite familiar with Kentucky's SACWIS experience.

Miller served as secretary of Families and Children in Kentucky prior to being appointed commissioner of the Tennessee Department of Children's Services in late 2003. Tennessee plans to release an RFP in early 2007 to upgrade its existing SACWIS to a second-generation SACWIS built on Web services.

Miller said she remembers well the difficulty Kentucky encountered during its search for the technology to create the state's SACWIS.

"As I began to search, it just didn't seem to me that this should be as hard as it was --that there ought to be some product, market or base to build around," Miller recalled. "But the market is too small. There are only 50 states, so there's not enough market there for private industry to really develop a product that's going to help states."

States fended for themselves in solving the SACWIS puzzle, she said, and those individual efforts did little to create critical mass for a SACWIS market. Those efforts had to be individual because every state administers health and human services differently, Miller continued, forcing states to reinvent the SACWIS wheel.

Miller cites such individuality as the chief barrier to creating an off-the-shelf SACWIS application that any state can purchase and simply plug into its health and human services technology architecture. The nature of a SACWIS makes it completely different from, say, a business system such as an enterprise resource planning application.

"If this was a business application, writ large, there would then be a market for it," she said.

Along with the decidedly nonbusiness nature of social services agencies' work, the culture of these agencies creates another complication when building IT systems such as SACWIS. Social services agencies take a humanistic approach to their work, Miller explained, instead of an organizational, management-driven perspective -- which makes building a SACWIS that much slower.

"It's not a good/bad judgment. It's just the nature of the work we do," she said. "Social workers would rather spend their time with [client] families and kids, instead of entering information into a case-management system."
Shane Peterson Associate Editor