Critical Decision Method Interviews to Understand the Initial Treatment Planning Process in Foster Care

Background and Purpose: Efforts to overcome significant time, staff, and resource constraints inherent in the foster care system have been met with calls for assistance from technological, data-driven, and evidence-based interventions. Decision support tools, including technology prompts and supports for using data, can also help. However, these supports must be responsive to the needs of those working in the foster care system. This paper reports an effort to understand current decision-making practices by staff in foster care programs, particularly in the first 30 day treatment planning period, via a series of interviews. Findings provide crucial context for the design and implementation of any technology-based decision support tools to inform treatment planning and alignment of appropriate services- ultimately to improve outcomes for youth in foster care.

Methods:

We conducted interviews with five care coordinators and clinicians from a Western New York foster care program, focusing on the initial treatment planning process. These interviews utilized the Critical Decision Method (CDM) interview technique, an approach from the field of human factors engineering, which asks practitioners to recall challenging cases in order to understand their decision making process, strategies, constraints, and resources related to the treatment planning process. Staff were asked to remember a case in which the initial treatment planning period was exceptionally difficult. After the staff relayed an initial case narrative, the researchers worked with them to create a timeline, identify decision points, and solidify a shared understanding of the case. Finally, a series of probing questions eliciting clarification regarding decision-making processes.

The interviews were transcribed and thematically coded, focusing on identifying the treatment planning process, constraints, and assessment strategies used by staff. These codes were reviewed by internal and external subject matter experts.

Results:

A key product of these interviews was a structured timeline of the treatment planning process that identifies the sources of information, roles and responsibilities, and time constraints. This novel framing of the treatment planning process captures work as it is currently done and allows for comparisons with existing protocols. The thematic analysis revealed important constraints on treatment planning: multiple time constraints, divergent goals, and a lack of information coupled with multiple sources, all of which have complex interactions. The interviewees discussed the need for linkages and alignment between identified needs and services, which we call “The Golden Thread.”

Conclusions and Implications:

This study provided context for the design of technology-based decision support tools to aid in treatment planning, by pointing to challenges and constraints that must be resolved before instituting a new “support” tool for staff. The interviews represent a novel domain application of CDM, and the findings serve as an example of the sort of process, strategy, and constraint insights that can be ascertained via this approach. This technique bridges workplace strategies necessary to improve decision-making. Further work is needed to understand team dynamics and data use, and eventually to design work and technology that may aid staff so they can improve outcomes in collaboration with youth and families served by these systems.