Wendy Cole can really concentrate on what children tell her these days because of technology used by child welfare workers in Utah Department of Human Services--she doesn't have to spend a lot of time writing in long hand.

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"We carry audio digital recorders, so I don't have to take notes anymore. I just turn it on, enter the date and time and focus on the child," Cole said. She gets an exact recording and can quickly download the interview onto her computer.

The Utah Department of Human Services has invested a significant amount of resources--both human and financial--in technology solutions for better data generation and analysis leading to enhanced capacity to monitor and manage its programs. A comprehensive approach has been used in various program areas with four major components:

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* Case Management System

* Services Review--Quantitative and Qualitative

* Data Warehouse Capacity Across State Systems

* Enterprise Systems

These components allow data to be generated and used on a continuum from line workers like Wendy Cole through department management. At the caseworker level, technology results in more efficient case documentation and individual case management. Supervisors and office/region management receive ongoing and current information to assess each worker, team and office's performance and to look at the case status related to desired process and quality outcomes. Division and department management study data to assess performance at all levels. Data also are integrated to allow for workload management and forecasting, fiscal forecasting, and outcome tracking and reporting.

Investment Paying Off

Utah's technology investments are producing returns. The results are most evident in child welfare. During the mid-1990s, human services focused on developing and implementing a State Automated Child Welfare Information System known as SAFE to provide caseworkers with tools to make their jobs more doable and improve case activity documentation.

Coinciding with this development, the state began re-negotiating its agreement with the federal court as a result of a class-action lawsuit covering all children in the child welfare system. The result was the Performance Milestone Plan, which provided specific milestones to achieve, outlined steps to be taken, and described methods for measuring performance. Accurate performance measurement required a new approach to case review. It would no longer be sufficient to simply determine whether workers had "crossed the t's" and "dotted the i's." The department, through its Office of Services Review and jointly with the court monitor, developed a performance and outcome measurement system.

Two major components are included in the services review system. The quantitative component or case process review (CPR) is conducted annually on a statistically significant number of cases. It relies on documentation in SAFE and the case file and tests for performance with key statutes and practice guidelines that policymakers and professionals agree are important to meet the goals of child protection, permanency and stability.

The qualitative case review (QSR) component is also conducted annually on a representative sample and is designed to assess the status of children and families related to safety, stability, appropriateness of placement, permanence, health/physical well being, emotional/behavioral well being, learning development, caregiver functioning, family functioning, resourcefulness, and satisfaction. Overall system performance also is measured based on factors of child and family participation, child and family teams, functional assessment, long-term view, child and family planning process, plan implementation, formal and informal supports, successful transitions, effective results, tracking, adaptation, and caregiver support. QSR reviews rely on information from a variety of sources, including interviews with all key stakeholders.

CPR results are available for multiple levels of analysis from individual case and caseworker results to any number of possible aggregated results by worker, team, office, or region. Trend data also are available comparing results from year to year. A database containing all these analyses is compiled and reviewed by Office of Services Review staff, who, in turn, report the information, as well as recommendations for performance improvement, to both division and department management.

QSR results are similarly available at multiple levels of analysis as well as from a trend perspective. OSR staff again report on areas of strength and areas of need with recommended solutions. These are reported to division and department management as well as to regional qualitative improvement committees.

The CPR and QSR databases also allow for comparative and correlational analysis. Comparisons can be made between state measures and the federal child and family services review measures to predict performance and inform practice. Data from the CPR can be correlated to QSR outcome data to show which case process elements are most directly related to achieving desired child and family outcomes as well as system outcomes.

Coinciding with implementation of the performance and outcome measurement system, the department invested in a comprehensive data warehouse capacity. This incorporates both programmatic and administrative data across all areas of human services--child welfare, child support, juvenile justice, including the juvenile court, adult services, and disability services. At the same time, other state departments, including Workforce Services, which is responsible for TANF, Food Stamps, Child Care and Wages and Health, which handles Medicaid and Public Health, also developed similar capacity. Interfaces among the data warehouses allow clients to be tracked individually across systems and across time.

This capacity has proved extremely valuable in assessing performance trends and in developing baseline data for program development. An example is Utah's Transition to Adult Living (TAL) Initiative, designed to help youths who age out of foster care live successfully as adults. While several national studies have reported on the status of youths after they age out of foster care, no comprehensive Utah data had been compiled. As the TAL Implementation Team sought to establish goals and desired outcomes, it needed to establish baseline data from which progress could be measured.

Using the data warehouse capacity of various state agencies, data on youths who left the foster care system between 1999 and 2004 were obtained to gather a picture of their experience since leaving care. Aggregate data were compiled on outcome variables, including wages, criminal activity, utilization of public assistance, child bearing, death, including suicides, child-support obligations, access to driver's licenses, health and mental health needs, and child welfare follow-up services. Data have been integrated into a single database that allows analysis across multiple dimensions and for ongoing updating. The ability to generate this baseline data not only allows for ongoing performance measurement but allows us to target interventions based on individual and aggregate case characteristics.

The final and newest component of Utah's comprehensive approach is an enterprise system development that serves multiple related departments and clients. Utah's Electronic Resource and Eligibility Product, e-REP, serves the Departments of Human Services, Workforce Services, and Health, and is due for completion in 2006. The first component, an interactive information and referral system called Utah CARES, is operational and accessible at http://www.utahcares.utah.gov. Additional components either developed or in process include Integrated Income Support Service Screening and Integrated Eligibility Modules for TANF, Child Care, Food Stamps, Medicaid, IV-E, the State Children's Health Insurance Program and others. The e-REP system also will interface with program case management systems in all departments to provide even greater capacity to track service delivery and outcomes as well as provide management data to inform practice and policy.

SAFE System

Case               Supervisor/Team               Division
Worker             Office/Region                 Department

* Case                         * Program Review
  Documentation                  and Planning
* Case                         * Management
  Management                     Data
                               * Fiscal
                                 Forecasting
                               * Workload        * Outcome
                 * Caseload      Management and    Tracking and
                   Management    Forecasting       Reporting

Example: Performance by Worker and Supervisor Over Time

Supv  Supv   Worker  Worker
Last  First  Last    First
Name  Name   Name    Name    Program      FY2004  FY2003  FY2002  FY2001

A.    C.     C.      M.      CPS           83%
A.    C.     J.      D.      Home Base     70%     67%    92%
A.    C.     L.      W.      Home Base     27%     54%    83%
A.    C.     W.      G.      CPS          100%
A.    N.     F.      R.      CPS           86%
A.    N.     M.      D.      Foster Care                  83%
A.    N.     M.      D.      Home Base                             75%
B.    G.     G.      S.      Foster Care                           76%
B.    C.     A.      T.      Foster Care                  80%
B.    C.     A.      T.      Home Base            100%    88%
B.    C.     A.      M.      Home Base     20%
B.    C.     B.      R.      Home Base                             73%
B.    C.     G.      C.      Foster Care           67%
B.    C.     G.      C.      Home Base     46%                    100%
B.    C.     L.      S.      Foster Care           84%    91%
B.    C.     M.      K.      CPS                          92%      96%
B.    C.     S.      H.      Home Base     27%            50%      68%
B.    C.     W.      C.      Foster Care                  97%

Robin Arnold-Williams was the executive director of the Utah Department of Human Services.