Barriers and Facilitators to Collecting Vital Records in the Foster Care System

Background/Purpose: Keeping precise, up-to-date, and complete records is part of the role of child protective services (CPS) case managers (CMs) in the foster care system. However, this high standard is difficult to maintain given the constraints of a complex job. This study aimed to better understand foster care CMs’ experiences maintaining health and educational records and the barriers and facilitators to complete record-keeping.

Methods: Four focus groups were held with foster care CMs in different county-level CPS offices across one southeastern state. Focus groups were semi-structured. Participants were current public CPS employees with at least three months of experience with foster care case management, were at least 18 years old, and who reported that health and education records maintenance was part of their job responsibilities. Demographic survey results indicated participants (n=16) had a mean age of 29.94 years, racially/ethnically diverse (50.00% Caucasian, 37.50% African American, 6.25% Biracial, 6.25% Hispanic), and primarily female (93.75%). A codebook was developed through inductive thematic analysis using a qualitative team. The codebook was revised as new themes emerged with each new transcript. This iterative process continued until no new themes emerged from the data. Coding was conducted in NVIVO 10.

Results: Unique themes emerged from the data within the constructs of barriers and facilitators. Barriers that participants had to overcome in order to maintain complete records were broken down into six themes: 1) prioritizing amidst chaos, 2) training, 3) family participation, 4) discoordination, 5) right to access information, 6) insufficient time. Prioritizing amidst chaos detailed how the urgency of case management duties supersedes that of the paperwork during certain times. Training included statements where CMs’ experiences or perceptions could be addressed with additional training (e.g., never seen forms). Family participation included statements where the family-of-origin cannot or will not provide information. Discoordination focused on inability to obtain records due to a lack of coordination with other entities. Right to access information focused on entities requesting verification before sharing data. Insufficient time focused on time constraints in record retrieval. Facilitators to completing the records included four themes: 1) innovation, 2) networking, 3) teamwork, 4) streamlined processes. Innovation involved participants developing their own systems and strategies to completing records. Networking focused on establishing rapport and relationships with different partners (e.g., schools). Teamwork involved sources collaborating with others to share information. Finally, streamlined processes involved procedures that increased the ease with which participants can complete paperwork (e.g., self-populating forms).

Conclusions/Implications: In the midst of an already challenging, crisis-filled job, many case managers face additional barriers to maintaining accurate, up-to-date medical and educational records for the children they serve. However, CMs manage these challenges through innovation, networking, teamwork, and finding ways to streamline the process. This study indicates that CMs can be supported in their efforts to further streamline paperwork by minimizing duplication within their system and through the use of data extraction to populate the necessary medical and educational fields. More supportive processes have the potential to positively impact case managers and the children on their caseload.