The recent death of former Army medic, Joseph Patrick Dwyer, 31, provides an instructive lesson into the sort of difficulties faced by returning veterans. Unfortunately, the VA can't do it all and there is little evidence that state and local governments grasp the severity of the situation. Social services IT vendors must begin raising awareness behind the scenes.

Former Pfc. Joseph Patrick Dwyer's image was immortalized at the outset of the Iraq invasion. A post-9/11 volunteer, he survived the combat duty. But, it was a lack of adequate mental health support on the homefront that brought him down. Even as the nation debates if and when to begin bringing troops home from the Persian Gulf, the follow-on question as to how these veterans will be reintroduced into society has not garnered significant consideration.

Approximately 1.9 million soldiers will have served in the Persian Gulf since September 30, 2001. More than 308,000 veterans (from all conflicts) are being compensated for post-traumatic stress disorder (PTSD). Given the unique strain of multiple and extended deployments (as well as vastly improved medical care in the field that greatly reduced the mortality rate), a higher percentage of these returning veterans will have service-connected disabilities than those who served in the theatre between 1990 and 2001. As the troops (many of them guard and reservists) return home states will want to help them transition back into civilian society. Social services IT vendors, who are already engaged in discussions regarding how to integrate and streamline access to the continuum of health and human services should begin raising the issue of veterans' access to family-preservation, vocational rehabilitation, and mental health programs. At a minimum, this means that state veteran's departments and National Guard leadership will need to be at the table.

For those interested in more data on America's veterans, including their health, educational, and vocational concerns, see the U.S. Department of Veterans Affairs' National Center for Veterans Analysis and Statistics.

One of our recent posts highlighted that the Centers for Medicare and Medicaid Services (CMS) reported $10.8 billion in improper Medicare payments in FY07, or 3.5% of Medicare spending. Fortunately, CMS is fighting back with an innovative program.

According to a Wall Street Journal post, auditors have recovered over $700 million in overpayments to hospitals and other medical providers through a program that shares portions of the recovery with contractors who find the errors or fraud. This recovery was achieved in only a half dozen states, although CMS is pushing to move the program nation-wide.

Some may decry a "repo man" approach, but we should also point out that CMS has been using advanced statistical tools to analyze payments more thoroughly to identify potential errors and fraud, which likely supports the fact that only 14% of the cases in the program were appealed and only 4.6% were overturned. The program even found $38 million in payments that should have been made but weren't.

In a tightening government fiscal environment, this found money is well worth the effort, both for the Feds and the States, and these strategies (both technologies and processes) have applications across government. We also hope that CMS has completed the loop with feedback into how the overpayments were made in the first place.

In response to an upswing in food stamp usage, the state of Vermont is taking big strides toward modernizing its food stamp program by streamlining the application process to extend eligibility and increase benefits to include more of the state's most underserved groups who may be reluctant to apply for food stamps.

Earlier this week, members of Vermont's hunger councils met with legislators, heads of state agencies, and two national anti-hunger experts in a roundtable organized by the Vermont Campaign to End Childhood Hunger to find ways in which Vermonters' access to food stamps can be improved. According to the Campaign's food stamp policy specialist, the use of food stamps in Vermont is close to an all-time high.

In Vermont, the elderly and working families make up the state's most underserved groups. Since 2005, food stamp enrollment has increased by more than 55,000 people. Currently, about 80 percent of eligible Vermonters participate in the program. Among those who are 60 and older, the participation rate is only 32 percent; however, the elderly and the disabled in Vermont account for a greater share of food stamp recipients than they do nationally. More specifically, 27 percent of food stamp recipients in the state are the elderly or disabled, compared to the 16 percent nationwide.

Food stamps are an entitlement program. While Congress sets the eligibility procedures and the federal government pays for the benefits, the responsibility for administering the program is shared with the states, which can modify eligibility requirements. The income eligibility in Vermont is set at 130 percent of the federal poverty line, or less than $27,560 for a family of four. In an effort to ensure that eligible people take advantage of food stamps, the state plans to launch a three-year "modernization" project by streamlining the program's administration and implementing new technology within its food stamp program. According to Vermont's Food Stamp Program Director, some of the state's initiatives for expanding eligibility and increasing benefits include:

• Eliminating IRAs from the resource limit that keeps many senior citizens from applying for benefits.
• Removing the cap on child care costs, which would increase eligible families' allotments.
• Extending the certification period for reconfirming eligibility from six to 12 months, providing eligible Vermonters with more time to complete the recertification process prevent them from having to reapply for food stamps.

In addition to some of the initiatives mentioned above, the three-year project also involves integrating new technologies within the program, such as the development and implementation of an online food stamp application, an interactive voice response telephone hotline, and a document imaging system, in which all applications will be sent to a centralized in-take processing unit where images of them will be created. Also, indexing capabilities will be available in which applications will be given a bar code, get indexed, and downloaded into a database. The state intends to implement these technologies at all of the Economic Services Division (ESD) offices. Not only will these changes significantly reduce the time needed for application processing, but it will also provide applicants with access to benefits without having to visit a food stamp office. Currently, a person applying for food stamp benefits has to physically go to an office. Thus, as part of these modernization efforts, the the Vermont Agency of Human Services (AHS) intends to eliminate face-to-face interviews for determining eligibility so that Vermonters can apply at any time and in the privacy of their own homes. AHS has developed task force groups to survey service providers and recipients across the state within the next couple of months to determine the desired technological capabilities and to develop functional requirements.

The recent rise in food stamp applications in many states appears to be a reflection of the economic slowdown, with inflation in the prices of food and gas, as well as an increase in layoffs. According to public figures released by the U.S. Department of Agriculture (USDA) in June 2008, food stamp enrollment exceeded 27 million people in March 2008, up by 219,000 people from February and up 1.5 million from March 2007. The USDA estimates that enrollment will average 27.98 million people in fiscal year 2009, which begins on October 1, 2008, at a cost of $40.3 billion.

The California Child Support Automation System (CCSAS), or what many argue to be one of the biggest computer fiascos in the history of state government, that has not only wasted several billion dollars of taxpayer money, but also served as a contributor to the complex state budget deficit, has finally been certified, saving the state over $200 million in penalties in the new federal fiscal year beginning October 1, 2008.

The state of California's automated child support system has finally been approved by the federal government, 20 years after a law was passed requiring all states to establish a single automated child support system. Last Friday, officials from the Federal Office of Child Support Enforcement (OCSE) announced the certification of the nation's largest and one of the most complicated computer programs that has been under development since 2000. The state has more than 1.6 million child support cases that cover over 1.8 million children. California was next-to-the-last state to obtain federal certification, resulting in a $193 million rebate from the federal government. The only other state that remains out of compliance is South Carolina.

In 2006, California rolled out its new statewide system, but federal officials did not complete that certification until last week. The cost of the current system is approximately $1.6 billion with about a third paid by the state. The initial 90 percent federal share dropped down to 60 percent when the state missed a deadline extended to 1997 for completing the system. The state had paid $1.2 billion in fines to the federal government from 1998 to 2006 for not meeting a federal mandate issued in 1988 to create a centralized computer system. The 1988 Family Support Act, which amended the Social Security Act, mandated an automated tracking system in states to improve the accuracy and increase efficiency for child support recipients and employers.

The lack of unified leadership within the state's child support program in the past led to a reform in 2000, when the Governor passed legislation to create a separate department, moving the collection system from the Department of Social Services to a newly established Department of Child Support Services (DCSS). Under the guidance of the state Franchise Tax Board (FTB), which has expertise with large computer systems, the state entered into a contract in 2003 with a consortium led by IBM, who helped develop and design a system that meets federal requirements and integrates the separate county systems into a single, uniformed case management system.

The California Child Support Automation System (CCSAS), features a shared computer database and uniform reporting that provides county workers with quick access to shared information so that they can track non-custodial parents as they move to a new location in order to ensure that payments continue. The CCSAS also uses a biometric scanner to verify all county employees' fingerprints before they can sign on. Servers are housed at an IBM data center in San Jose. Additionally, CCSAS transmits information overnight to child support workers in other states, reducing the month-long response times to just a few days. The newly designed system is being rolled out on county-by-county bases. Currently, forty-one counties are using the CCSAS and the rest will be online by November 2008. The child support recipients can have their payments deposited electronically into their bank accounts or onto an electronic debit card that can be used like a check card at stores.

While the economy is suffering from a steady rise in food and gas prices, many states are relying heavily on the federal Food Stamp Program and putting forth the extra effort to obtain federally funded food stamps for those who are eligible. In fact, most states are reaching out to millions more who may not realize they are eligible or are reluctant to participate. However, that does not seem to be the case for the state of Texas as they continue to delay and deteriorate their eligibility and benefits enrollment services during these tough financial times, leaving their food stamp recipients hungry and frustrated.

Last week, the state of Texas received final approval from the U.S. Department of Agriculture (USDA) officials to expand the use of their divisive public assistance enrollment system, known as the Texas Integrated Eligibility Redesign System, or TIERS. Nonetheless, the state's Health and Human Services Commissioner, Albert Hawkins, has denied the expansion. In the past, Hawkins has ignored the feds, such as in 2006 when he linked the launch of the Accenture call center network with an expansion of TIERS, and in early 2007 when the Health and Human Services Commission (HHSC) moved forward with an expansion of TIERS despite the glitches in the system. Moreover, on March 23, 2007, the feds denied HHSC's approval to expand the system after learning about their plans. However, now that the feds have given permission to the state to expand, Hawkins has decided to comply with a legislative request that the HHSC first establish and meet a series of goals before expanding the web-based computer system that is responsible for food stamp enrollment.

Texas has struggled to process food stamp cases as quickly as the 30-day time frame required by the federal government. Just in May 2008, the USDA's Food and Nutrition Services (FNS) approved an expansion of TIERS, but only to 22 percent of food stamp cases attributable to a series of application backlogs and too many approvals taking too long. Currently, 9 percent of cases are in TIERS. A month prior to that, in April 2008, only 49.2 percent of the state's food stamp applications processed were completed on time using TIERS as opposed to the 92.6 percent processed using the old computer system in the same period. In addition to the technical complexities with TIERS, the state has also been struggling with staff turnovers.

As a result of a new law requiring legislators to vigilantly inspect the state's work enrolling Texans in programs such as food stamps, the state legislation has created an oversight committee to retain supervision, hold HHSC accountable, and to guarantee a practical approach toward expanding TIERS. Thus, Hawkins has been asked to propose benchmarks later this summer to the oversight committee, such as ensuring that there is adequate staff trained in TIERS. Consequently, the state will not begin rollout in July 2008.

In 2003, the state set out to privatize enrollment in social services in an effort to improve access to state benefits by reducing operation and maintenance costs, and improving the accuracy and timeliness of eligibility and benefits. The intended goal of the web-based system and call centers was to bring efficiency to state benefit programs and make it easier for eligible Texans to get their food stamps and other benefits by submitting their applications by phone, fax, internet, and mail, rather than having to do them in person at HHSC local branch offices. Yet, five years have gone by and the results have been quite different as TIERS remains in the same debacle, manifested by technical difficulties, staffing shortages, and inadequate training of the private call center staff. Most importantly, the consequences of HHSC's mismanagement are causing needless hardships on Texans who are in desperate need of food stamps. As recently stated, about 2.3 million Texans are on food stamps. Nevertheless, given the history of TIERS, with continuous delays and its inability to maintain case records and/or process applications in a timely manner, many food stamp recipients are probably left hanging, wondering if they will ever receive their benefits. Not only have the poorly managed call center and computer system projects failed to perform as promised, but they have also wasted half a billion of taxpayers' dollars.

Consistent with the high volume of weekly news articles and as indicated by the USDA, a record number of people have been entering the Food Stamp Program as the economy weakens due to the high food and gas prices and lost jobs. This has been more than any other year since the program began in 1964. According to the Congressional Budget Office (CBO), the Food Stamp Program is expected to spend $36 billion on 28 million recipients nationwide in the fiscal year starting October 1, 2008, an 8 percent increase in participation over the year before. On the same note, there are individual states that are experiencing a much larger increase, such as New Hampshire, reporting an 18 percent rise in food stamp applications compared to last year. Furthermore, Maine and Michigan have indicated that one in eight residents now relies on the food subsidy, compared to about one in 11 nationwide. West Virginia is another example, reporting an even higher rate of one in six.

According to the USDA, there are currently 15 states that offer online Food Stamps applications, with Texas being one of them:

• Delaware
• Florida
• Iowa
• Kansas
• New Jersey
• Maryland
• Massachusetts
• Pennsylvania
• Rhode Island
• Tennessee
• Texas
• Virginia
• Washington
• West Virginia
• Wisconsin

The following six states are testing programs accept electronic applications in specific cities and counties before going statewide:

• California
• Idaho
• Indiana
• New Hampshire
• New York
• Utah

As indicated by the USDA, nearly 36 million Americans go hungry every year, including 12 million children, and the numbers are rising.

As every state is beginning to push toward collecting child outcome data, trainers, faculty and program administrators in early childhood education are relying on a host of new technology tools and evaluation options to serve as catalysts for dynamic learning and for also better understanding the impact of their training efforts.

The National Association for the Education of Young Children (NAEYC) held its 17th National Institute for Early Childhood Professional Development from June 8 through June 11, 2008 in New Orleans, Louisiana. The theme of this year's professional development event, Technology and Early Childhood Education, focused on the uses of technology in early childhood settings for children and families. The Institute featured over 200 sessions that addressed one or more of the following areas: Technology in the Classroom and Family Child Care Home; Technology for Teacher Preparation and Ongoing Professional Development; Technology for Program Management; and the Influence of the Media on Children. Additionally, the Institute also included other non-technology related sessions, such as current research and topics in higher education, training programs, program administration, and public policy advocacy.

Throughout the sessions, several experienced educators, policymakers, and program managers discussed how they are leveraging technology to support their existing public school, child care, Head Start, early intervention, and preschool programs, as well as ways in which they are assessing each program's needs and challenges. Some of the effective tools that were mentioned include:

Tablet PCs

• Using Tablet PCs to facilitate better assessment of children and to support effective communication with families.

• Using Tablet PC technology, digital media capturing equipment, and web-based child development screening tools to increase the accuracy, efficiency, and effectiveness of assessment practices of infant and toddler caregivers in a center-based care and education program.

Handheld Computers

• Using handheld computers and web-based data reporting applications to improve efficiency and effectiveness of site visits; enhance the ongoing accountability and mentoring relationship between early childhood agencies and the programs they serve; and to efficiently record standards-aligned observations of children in an early childhood classroom.

E-portfolios

• Using technology to create an electronic version of the traditional portfolios on every child.

• Using electronic portfolios to showcase program and student outcomes and to assist programs in achieving accreditation.

• Developing classroom and program portfolios through a variety of technological tools, including the use of digital still and video photography, as well as web-based documentation.

Web 2.0

• Integrating Web 2.0 tools into program management for administrators. Web 2.0 tools that are widely used today, such as blogs and wikis, allows administrators to write on the web with little technical knowledge and help improve the services provided to children, families, and staff.

Web-based "Cube" Technology

During one of the Technology for Program Management sessions, representatives from the South Carolina Department of Social Services (DSS), Clemson University, and the South Carolina Budget and Control Board's Office of Research and Statistics, discussed the state's Data Bridge Project, which consists of a lined data infrastructure for child care policy making using a unique web-based "cube" technology that bridges information on child care providers and children in their care. Funded by the U.S. Department of Health and Human Services (DHHS), Administration for Children and Families (ACF), Office of Planning, Research and Evaluation's (OPRE) Child Care State Research Capacity Grant, the project links this information to child level indicators from the state's human services data warehouse by using a child roster.

According to the Director of Child Care Services from DSS, there was a need to rebuild and/or create new systems in order to better track South Carolina's children and their families. Thus, the state aimed at:

• Creating a child-based database for the Child Care Licensing Operating System to house data on children in child care;
• Developing a system of linked data sets from multiple service providers to capture key data about families and children under the age of 6; and
• Investigating the impact of the Child Care and Development Fund (CCDF) on improving the quality of child care available to, and utilized by, low-income working parents and at-risk families.

Accordingly, the state began designing a web-based licensing system and turning to the Tablet PC technology in the field. The licensing staff now utilizes Verizon wireless cards and has access to remote printers. DSS is currently ordering cameras for the staff. Parallel with the licensing system, the state also created a web-based system for their ABC Quality reviews, getting rid of their previous paper-only method and manual data collection for quality monitoring activities. The ABC Quality review staff is also provided with Tablet PCs. Furthermore, the state's voucher system for ABC providers has been converted from the old DOS system to an online voucher payment system, which is integrated with common identifiers:

• System is integrated and shares information
• Reduces the burden and repetition in the collection of information
• Locates discrepancies in information
• Alerts staff to critical key information quickly

Additionally, the Child Care Services public website has been re-designed, making it more user-friendly to the public. DSS is currently in the process of creating a more unified and in-depth public website for child care providers, which is intended to be up within the next three months.

As quoted by Daniel Boorstin, Librarian of Congress (1975-87), "Technology is so much fun, but we can drown in our technology. The fog of information can drive out knowledge." As indicated by the Associate Research Professor from Clemson University, Institute on Family and Neighborhood Life, we often tend to focus on the word "data" a lot, yet our job as program administrators is to bring our knowledge to the data. In an effort to achieve this concept, South Carolina has been spending what feels like an eternity building their integrated human services data warehouse system that consists of linked data sets from multiple service providers to capture key data. The integrated system was built using existing legacy systems from state agencies and the private sector, in which a unique tracking number has been created. Once these tracking numbers are assigned to identifiers, the system gets rid of the identifiers so that only the statistical data will be used. The data is always owned by the originating agency and every agency must obtain permission to use and/or link any data. Furthermore, HIPPA Best Practices have been employed for extensive security measures. In linking the data sets, the records are linked for the same individual using the assigned unique tracking number, which is random and therefore cannot be unencrypted to identify the individual. The data is used for evaluation of interventions and programs by: assessing outcomes; understanding interaction with other programs and providers; analyzing aggregate data; assessing analytic data cubes; managing client care; and creating a research capacity.

So what exactly is an "analytic cube"? According to the Senior Consultant from the South Carolina Office of Research and Statistics, an analytic cube is a secure web-based system that allows users to access large databases from their desks, or in other words, a way to "slice and dice" through large amounts of data. The "slicers" are defined as characteristics that are important to analyzing the subject population. Moreover, the linked data is pre-aggregated by all possible combination of "slicers." So far, analytic cubes have been created for injuries, behavioral health, Medicaid, seniors, dental services, and mother-baby. The state has proposed analytic cubes for Child Care Services and intends to build two types of cubes:

• Cubes based on Provider Data
  • Licensing
  • ABC Quality Review
  • Information on ABC Voucher Providers
• Cubes based on Child Level Data
  • With agency permission, use the Integrated Data Warehouse
  • Medicaid, DSS TANF and Food Stamp children, ABC Voucher children
  • Mental health, disabilities and other issues
  • Eventually would like to link to Education

South Carolina's vision is to bridge the gap between the provider and the all the children served by the provider.

More and more state and local child welfare agencies are turning to disconnected computing and other new technology tools as a way to save time and increase worker productivity. It is critical for vendors who are crafting these solutions to implement a training methodology to support case workers with the information they need to respond positively to changes resulting from the new products. Also, keep in mind the generational differences --while the younger case workers entering the workforce are tech savvy, they are not experienced as far as practices. Thus, business practices and policy changes need to be aligned with the technology.

The State Information Technology Consortium (SITC) held its 7th Annual National Child Welfare IT Managers' Meeting, Increasing Productivity and Managing Change for Caseworkers, IT, and Management, from May 19 through May 22, 2008, in Reston, Virginia. One emerging theme at this year's event, sponsored by the Administration for Children and Families (ACF), Children's Bureau, was how to reduce workload using technology. Many states are beginning to make improvements by using a variety of new, innovative automation and technology tools within their child welfare programs to increase worker productivity. Several of the sessions explored states' experience with technological tools, including challenges, benefits and lessons learned.

Digital Pen Technology

In one of the sessions on the Underpinnings of Digital Pen Technology, the Chief Technologist and the IT Program Manager of Health and Human Services, from Northrop Grumman's Commercial, State and Local Group, discussed how the digital pen bridges the gap between paper documentation and electronic record keeping. The digital pen, which consists of ink, camera, Bluetooth, CPU, and battery, combines the portability of a traditional pen and paper with computer processing. A hard copy of document is printed on special paper and an electronic image is also stored. The users then write with the digital pen on a document and the writing is recorded to the pen memory. Furthermore, the data stored is transmitted and matched with the image of the original document and an exact copy of the handwritten document is created in PDF form. The pens run from $400 to $500 due to their licensing for data enterprise applications and the brands include Maxell, Logitech IO, Nokia, Sony Ericsson, and LiveScribe, which records audio and digital ink. Northrop Grumman is currently working with the state of Montana on a pilot using this technology.

The state of West Virginia is currently using the Logitech digital pen with their Safety First Protection Plans, completed by Child Protective Service Workers. The state is also currently working to transfer information entered on forms via digital pen directly into their SACWIS system, referred to as the Families and Children Tracking System (FACTS). The maintenance work for the application and on updates is currently performed by the state rather than a vendor. West Virginia has not had any security issues with the digital pen as of yet.

With this technology, states can automate workflows within their SACWIS systems without actually replacing their systems. Additionally, the digital pen has the following benefits:

• Portable and cost effective
• Low maintenance (less vulnerable to viruses, no software versioning issues)
• Secure and encrypted
• Reduces dual entry
• Built-in data contingency (paper backup, original signatures)
• Reduces training costs
• Supports working in disconnected mode
• Supports multiple digital ink options (digital pen, tablet PC)

Tablet PCs

Most child welfare case workers complete a lot of their functions away from their desk/desktop computer, such as interviews, assessments, home visits, and court hearings. Thus, there's an increasing need for mobile workforce to provide workers in the field with real time data and to increase productivity.

In the state of West Virginia for example, due to forested mountains and narrow valleys, electronic communication is difficult. As a consequence, there was a strong business need to provide workers with off-line access to the state's FACT system while they were working in a client's home, a school, or elsewhere in the community. To overcome the communication limitations, the state developed several disconnected computing methods that allow workers off-line access, such as Tablet PCs using a mobile FACTS application and digital pen. The same FACTS application that runs on the central database also resides on the Tablet. As a result of using the Tablet PC technology, case workers saved an average of 30-45 minutes of work time entering contact information and two hours of work time entering initial assessment information into the client record. The Tablet PC also reduces the need to retype handwritten notes when workers return to the office, thus, eliminating duplication of effort.

Although the state of Oklahoma elected not to use the digital pen technology for their SACWIS, known as KIDS, the state chose the Tablet PC technology in turn to fulfill their workers' request for mobility and to address many of the staff complaints about not wanting to duplicate efforts and wanting 24/7 anywhere access to the KIDS application. Oklahoma's initial Tablet rollout occurred over several months in the spring of 2007. The Director of the Oklahoma Department of Human Services (OKDHS) used one-time money that was available to purchase Tablets for employees when unable to provide raises in order to address the employee satisfaction and retention issues. Since last spring, the state has distributed over 3,200 Tablets to increase the productivity of the child welfare and family support staff, who are now provided with off line work capability and greater flexibility with work schedules.

Similar to Oklahoma and West Virginia, the state of Indiana also chose to utilize the Tablet technology. After piloting several technology tools, such as the quick pad, PDA, web application via cell phone, handheld voice recorder, and transcription services, the state felt that none of the solutions really met their needs. Therefore, the state re-evaluated their business needs and decided to go with a solution that provides their family case workers with a user friendly tool, security of the data, an independent internet connection, and reduces the risk of adding barriers between the client and family. For that reason, Indiana chose the Smart Client, developed by Oracle, which allows the user to disconnect from the state network and work off-line in the field and the case information is downloaded to a Tablet. The state felt that the Tablet was less intrusive when working with clients and could be used both in the field, as well as in the office. Furthermore, the staff's work stations in the office have been replaced with the Tablets.

In an effort to assist case workers in delivering high quality work that facilitates child safety, the state of Texas worked with Accenture to develop a mobile version of SACWIS for staff to use while offline. The Mobile Protective Services (MPS), is a disconnected mobile application that simplifies note-taking by allowing case workers to "check out" cases for remote use and later synchronize with the online system. The MPS initiative resulted from Executive Order 33, issued by Governor Rick Perry in 2004, calling for an increased use of technology. Thus, beginning in 2005, the Texas Department of Family and Protective Services (DFPS) deployed Tablet PCs to their Adult Protective Services (APS) and Child Protective Services (CPS) case workers. Since then, over 3,000 case workers use Tablet PCs in Texas and it is anticipated that by the end of this year, that number will increase to 5,000. According to the Operations Support Officer from DFPS, the state has plans to add testing and voice recognition software to the Tablets in the near future.

Dictation Services, Audio Capture and Voice Recognition

While several states shared the different types of technology tools they are utilizing within their SACWIS to promote greater worker productivity, the state of Utah discussed their examination of worker productivity in terms of how the information is actually being entered into a SACWIS system. In recognizing that a need exists to provide case workers with more than the traditional keyboarding as the means to data entry, the state explored three alternative data entry methods: dictation services, audio capture, and voice recognition.

Once the state's SACWIS system was released in 1998, many of the case workers struggled with using the system due to their unfamiliarity with computers, lack of keyboarding skills, and their reliance on the traditional pen and paper process. According to the SACWIS Project Manager from the Utah Department of Human Services, Division of Child and Family Services, the state is still facing difficulties with workers not knowing how to use computers. Thus, the state implemented dictation services to support workers' transition to the new system. The service is available 24/7 and does not require the workers to be connected to the system. In addition, the state also purchased approximately 200 high quality audio recorders for every worker who had to interview a child victim. The audio capture was introduced as a result of the 2004 Utah state legislature, which wanted to ensure that the child interviews were accurately documented. The recordings are integrated with the SACWIS system, allowing the worker to download the audio recording and index it for easy retrieval. Once indexed, the audio recordings can be easily shared by workers like supervisors and the Assistant Attorney General.

In addition to the dictation services and audio captures, the state of Utah also provides workers with voice recognition software that gives them the ability to dictate text into the SACWIS system, as well as other applications (i.e. word processors or emails).

Challenges and Lessons Learned

Several of the state and vendor representatives discussed the issues and challenges associated with investing in new technology products. One theme that appeared to be common across the board was the recognition that not every worker will like working with the new technology and that there is not a single solution that is going to fit everything. Let's face it, resistance to change is a natural reaction and some people are terrified of change. Most case workers are used to the traditional, paper-based systems and are computer illiterate or phobic. According to the Families and Children Tracking System (FACTS) Program Manager, the state of West Virginia continues to struggle with staff who do not know how to use a computer or prefer using the pen and paper method versus the Tablet PC. Oklahoma and several other states faced similar challenges with their case workers who have been using the pen and paper method for years. Other issues and challenges discussed included:

• Security – preventing theft of the Tablet and of confidential client data
• Planning for staff turnovers
• Increase in help desk tickets and user support needs
• Maintaining system capabilities when newer technologies are introduced
• Need to rigorously monitor, control, and improve security (threats)
• Users adjusting their basic computer habits and incorporating them into existing business practices

Future Tools

Although many states have already adopted or are in the process of investing in innovative technology tools within their child welfare programs to support increased worker productivity, there will be newer ground-breaking products to come in the near future.

During a session on Usability Features and Services, the head of the CGI SACWIS Development Center discussed some revolutionary tools on the horizon:

Geographical Information System or Geospatial Information System (GIS)

This technology can be utilized for placement process and provider searches by providing easy and transparent access to explore and analyze geo-data with interactive, direct manipulation tools.

Multi Touch

This is a newer technology that goes beyond the traditional keyboard and mouse and it is currently in the experimental phase. Some of the features include:

• iPhone
• Perceptive Pixel
• Microsoft
• Enables user(s) to work collaboratively
• Image manipulation
• Ability to work with large data sets
• Collaborative case work

Haptics

This is another technology tool that goes beyond the traditional keyboard and mouse by applying sense feedback of information that has been entered into the system to human interaction with computers. The objects can be captured, manipulated, modified and rescaled.

Neural Interface (Head Set)

This product is currently in the developmental phase. With this technology, the user interface is controlled and influenced by the user's mind and the sensors tune into electric signals that are naturally produced by the brain to detect user thoughts.

On May 22, legislation was signed to help veterans returning home from Afghanistan and Iraq, get the adequate mental health care they need. Governor Martin O'Malley signed the legislation based on concerns that the mental health needs of many returning veterans has been slipping through the cracks within the federal system.

The program will aid Maryland veterans in acquiring mental health assistance from the Department of Veterans Affairs. When situations arise where the services are either being performed too slow, or not at all, the state will hire private mental health professionals to assist the veterans. The initiative, costing $2.8 million, is aimed at assisting veterans with what many see as insufficient help from the VA and the Federal Government to provide such services.

In an effort to provide veterans with mental issues, such as post-traumatic stress disorder, access to information about overall mental health, Maryland's Department of Health and Mental Hygiene will hire coordinators to serve as intermediaries between returning veterans and the Federal Government. The coordinators will, in essence, assist the veterans to make sure they are signed up for care with the VA. If and when the care may slip, the state will be notified and take the necessary steps to get aid for the veteran.

While the program is available for all returning vets from Afghanistan and Iraq, it is aimed at those living in rural areas. The initiative is broadened by the fact that it introduces the Veterans Behavioral Health Advisory Board, which will identify gaps in services. Board members, who have yet to be chosen, will travel across the state and conduct open meetings discussing issues related to mental health of returning veterans, which will then be addressed by the General Assembly before the years end.

The recent history of social services outsourcing in places like Indiana, Texas, and Colorado has not been a success. Projects are initiated with intent to reduce costs and improve service. However, at the end of the day it mostly ends up looking like automation and outsourcing were used to boot recipients off the rolls. Now, many of the stakeholders in these systems (i.e., beneficiaries, state/county caseworkers, and welfare advocates) would like to exploit these failures and put the very idea of social services outsourcing on trial.

Here at INPUT, we've blogged about Indiana's welfare outsourcing effort several times going all the way back to its inception. (Just search this blog for: "Indiana".) As Gov. Mitch Daniel's re-election effort heats up, it looks like the state's deal with IBM-ACS will be a political football. Most recently, the state's chapter of the American Civil Liberties Union (ACLU) is suing the state for the shortcomings of the system. The ACLU claims that new Internet/fax/call center-based eligibility determination process has created barriers for some of the state's welfare population and wrongfully terminated benefits in some instances.

Of course, much of the case will hinge on whether the problems are related to...

1. client "failure to cooperate,"
2. automated procedures, or
3. third-party caseworkers.

Vendors interested in social services outsourcing should keep a close eye on this case (Gibson v. Roob) as it has ramifications beyond the state of Indiana. INPUT will be following it and chiming in here as events merit.

Food stamps outsourcing has survived its near-death experience, but vendors looking to pick up outsourcing work in social services should heed Congress's shot across the bow.

As you might have heard, the $289 billion 2007 "Farm Bill" has recently been passed out of the Senate Committee Agriculture, Nutrition, and Forestry and is headed for the President's desk. President Bush has promised to veto it (with the encouragement of GOP Presidential nominee Sen. John McCain) and Congress has promised to override that veto, setting up one of the most dramatic legislative battles of recent years.

While the larger battle over the Farm Bill is related to subsidies for farmers, government IT vendors will be most interested in the bill's impact on outsourcing of social services functions--primarily eligibility determination for the Food Stamps program. (Food Stamps enjoys a $7.8 billion funding increase in the current bill.) The House version of the bill (H.R. 2419) contained language in section 4006 ("REVIEW OF MAJOR CHANGES IN PROGRAM DESIGN"), which explicitly forbid vendors from performing eligibility-determination functions. This was a direct shot at Indiana's recent outsourcing of such functions to an IBM-ACS consortium.

The version that passed out of the Senate committee did not include this language. However, the same "major changes in program design" section of the Senate version (Sec. 4211) attacks this issue from a different angle. Rather than prohibit outsourcing directly, it significantly discourages "closing county food stamp offices and requiring households to contact a central call center by mail, telephone, fax, or over the web to apply for benefits, provide documentation, and report changes." It does so by requiring extensive review of program performance data to prove the effectiveness of such an approach. These sorts of program changes are essential to any savings from outsourcing. So, while this is not an out-and-out ban on outsourcing, it puts a a definite chill on it.

Vendors should recognize that the Democratic Congressional majority, which is likely to become veto-proof in both chambers, is cool (at best) to the idea of outsourcing. Past outsourcing efforts--despite the best spin of the governors--has been more about reducing per-transaction costs than program effectiveness. But, outsourcing will not go away. Those who want to thrive in this space should begin thinking about third-party strategies that include buy-in from state/county workers and have performance metrics baked in from the start.

The Campaign to Protect Children's Nutrition, a coalition which includes the American Federation of State, County and Municipal Employees (AFSCME), has been actively opposing food stamps outsourcing and has a website dedicated to the cause. However, civil servants are not all of one mind. They know they are swamped with caseloads and could use some help. But, like anyone else, they do not want to pay the full price for the system's long-standing inefficiencies--many of which are the result of bad program design by Congress.

Oh, and by the way, the bill also renames the Food Stamps Program the "Supplemental Nutrition Assistance Program" (SNAP). Supplemental nutrition assistance is now dispensed via EBT, not stamp booklets.