When Home Visiting Meets Client Information System, but it Doesn’t Work: A Case Study

Overview: This paper describes a service-technology partnership in customizing and implementing a client information system (CIS) and explores the factors influencing its failure to last. Factors we found important included translating between service and technology languages, clarifying the service flow, the cost for customization, emotions aroused while using, and support provided.Proposal text:

Background:
Client information systems (CIS) are widely used in social work practice (Huuskonen & Vakkari, 2010). They are expected to support the workflow by reducing the documentation burdens, easing the data monitoring process, and facilitating evidence-based practice and evaluation (Huuskonen, 2014). Healthy Start is a federally funded home visiting program that aims to "improve health outcomes before, during, and after pregnancy" (HRSA, 2016). In 2019, a new Healthy Start program in a Southern metropolitan area partnered with local agency "A" to customize a CIS. However, this service-technology partnership eventually ended because the CIS did not meet the original expectations. This paper explores the factors influencing this partnership's failure to last.

Method:
This study used a case study approach (Stake, 2005). The case studied here was the partnership between a home visiting program and a technology provider for three years. The research question is: in the context of a federally funded maternal and infant health home visiting service, what influenced the viability of the success-technology partnership? The research team comprises the PI of the local Healthy start program and members of its data team. We used participatory observations to collect data, including documents, meeting memos, emails, support tickets, and notes of in-person communications. Thematic analysis (Braun & Clarke, 2006) was used to analyze the data.
Result:
Five themes emerged from the analysis -- First, translation of languages. The process of customization CIS is a process of translating back and forth between the service and the technology teams. Second, a matching design. It is essential to let the structure and flow on the platform mimic the service, not the other way around. Maternal home visiting services have unique characteristics. For example, they work with the mother, child, and father simultaneously, and the data structure of the CIS needs to reflect that. Relatedly, the third theme is the cost of customization, including both financial, time, and human resource costs. The fourth theme is emotions around the platform. Social workers felt disappointed, skeptical, and frustrated when they kept running into missing data and unstable access. Last, training and support facilitate trust. Step by step training and timely support, especially when there are problems, helped build the service team's confidence in the CIS.

Discussion:
Several contextual factors also impacted the process of this partnership, such as the pandemic and the funder factors (heavy emphasis on reporting and mid-year changes in reporting requirements). Similar to a recent study in Finland (Salovaara & Ylönen, 2021), we also found that CIS might not provide sufficient support for social workers if not designed or implemented well. Difficulties in managing service data essentially create barriers to helping our clients achieve health equity. This paper will lead a critical conversation on how CISs should be incorporated to help social workers protect mothers' and babies' health rights. We will also discuss how our program administration could improve to balance accountability and better address clients' needs (Burton & van den Broek, 2009; Räsänen, 2015).