Methods: For Stage 1, structured qualitative interviews were conducted with 3-5 staff from each tribal program (The Three Affiliated Tribes, the Turtle Mountain Band of Chippewa, and Osage Nation). The total number of staff in each tribal agency ranged from 6 to 9. Interview questions were developed to capture the congruence of the BPM map development process, facilitation and content delivery, and outputs with cultural/tribal cognitive, learning, communication, interpersonal and decision-making styles, and worldview/values orientation. Data were analyzed using thematic pattern analyses. Stage 2 involved developing a standardized quantitative BPM survey to be used with tribal programs using Business Process Mapping as a way to develop child welfare practice models.
Results: BPM is a highly structured and detailed process that involves staff working collaboratively to define and document each step of their practice. Findings from the qualitative data suggest that this process is challenging and unfamiliar to many child welfare workers who are accustomed to a less structured, more intuitive and relational approach to practice. However, while staff reported that BPM was unlike anything they had done before, it was not incongruent with tribal values. In fact, to the extent that the BPM process engaged stakeholders in working collaboratively toward a common goal, and documented cultural aspects of practice, it aligned well with tribal values. Having a facilitator who understood the cultural values and practices of the tribe was also a critical factor to success.
For Stage 2, the BPM survey instrument was designed to integrate implementation science concepts, in the form of items that measures Proctor, et al's (2004), implementation outcomes (acceptability, appropriateness, feasibility, adoption, fidelity, and implementation cost), with the topical domains identified in the interviews. This tool was developed and piloted with all three tribal sites. The majority of participants agreed that the process maps reflected cultural elements of their practice (88%) and represented their tribal program's vision and mission (86%), while 67% agreed that the values of the BPM process were similar to tribal values and that the process worked well in a tribal setting.
Conclusions: Gathering quantitative data through standardized assessments is challenging in Indian Country due to the low numbers of child welfare program staff in most agencies. BPM, with slight modifications and a facilitator with a deep understanding of tribal child welfare practice, values, vision and mission shows promise as an effective process for guiding tribal programs in the development of a practice model.