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The Possibility of Human Service Informatics

A peculiarity of the human service sector: Everyone agrees that information is critically important, yet there is no unified discipline devoted to managing it.

The occasion for this epiphany: Stumbling upon a textbook in health informatics. (It happened to be Abdelhak’s Health Information: Management of a Strategic Resource.)

The various parts are impressive.

There was a chapter on electronic health records. There were chapters on health registries and evaluation and performance management. A dozen other chapters covered everything from privacy to the systems development life cycle, from statistics to clinical terminologies.

And the whole is even more impressive than the parts.

That’s the difference: In the human services, many of these elements exist too—but they do not add up to a unity.

In healthcare they do. This book was an introduction for people who might pursue health informatics as a profession—one with its own history, standards and research agenda. At the same time, it was designed for general students of health management. In those programs, a course in health informatics is a core requirement, not an elective.

What has made this level of development possible for the healthcare field but not for the human services?

One difference is simply size and money. Healthcare can devote more resources to managing information and to thinking about how to do it well. Healthcare is bigger, and naturally so—everyone has a body that is subject to disease, accident and time. Not everyone is poor or suffers from the ills that human service organizations address.

Another difference has to do with boundaries. It is relatively easy to draw a line around healthcare and explain—or debate within defined limits—why the boundary is where it is.

Not so with the human service sector. It looks more like some Balkan region upon which many surrounding countries have centuries of conflicting claims. In one corner are services that are also, to a large degree, part of the healthcare system—mental health and substance abuse. (In the United States, ordinary medical care for poor people is also lumped into the human services.) In another corner is income support; that is connected to a very distinct discipline, welfare economics. In the middle are child welfare, homelessness and domestic violence. Preventable health-related problems are there too, but they also fall into the public health field’s sphere of influence. Job training is in the mix, sometimes longing for reunification with education or economic development. And most of these regions are perilously close to the border with the criminal and juvenile justice systems.

And so there is, at this point, no such thing as human service informatics. Should there be? Is there justification for treating, developing, investing in—the management of human service information as a discipline in its own right?

Several people have floated ideas with similar names, but they’ve intended to slice off thinner pieces of the problem.

In 2006, Parker-Oliver and Demiris published an article proposing social work informatics. They imagined a sub-specialty of social workers who would act as interpreters among the culture of computer science, information science, and social services. They would research and address problems of social workers frustrated by information technology, of poor people having unequal access to it, and of the ethical, legal and clinical issues involved in doing therapy via the internet.

Those are certainly issues that need to be resolved. But they are a rather specialized set, framed from the unique perspective of social work—which is the discipline of a single stakeholder group.

The human service sector is a much broader collaboration. Its most pressing information management problems are at the borderlands where different stakeholder groups and world-views meet.

The sector’s resources flow to service providers through funding streams involving federal, state and local agencies and private philanthropy. Those resources depend on the advocacy, administration and acquiescence of everyone from the project officers at funding agencies to evaluators and politicians and the general public. That’s why there’s so much focus on measuring outcomes and on developing good and replicable practices.

In this blog’s first post I made an argument for what I believe are the sector’s four biggest information management problems: isolated agency silos, unsuccessful information system projects, barriers to producing performance measures, and uncoordinated demands on service providers. These are all problems that impede collaboration, are the result of imperfect collaboration, or both. And they are all problems that make it more difficult for human service organizations to effectively deploy their limited resources and defend them in a difficult fiscal environment.

My conclusion: The sector’s information management problems cannot be solved by treating them as the bailiwick of some sub-specialty of social work.

In 2007, Nguyen published a commentary proposing child welfare informatics and in 2010 Naccarato published a more detailed prospectus along similar lines.

Nguyen noted that of all the fields of social work, child welfare has the richest history of researchers and practitioners developing systems to capture large amounts of data to better understand ways to deliver services to clients. He particularly focused on the problems of completing that feedback loop: collecting client-level data, processing it for high-level analysis, and turning it back into information that is useful for front-line workers. Naccarato emphasized that agreement on the information stored and reported is challenging because of the diverse needs of the many groups that record and use child welfare information, including budget offices, administrators, researchers and voluntary agencies and that in the construction of statewide (SACWIS) systems, the users and builders of these systems were not always in consultation with each other.

If there were such a discipline as human service informatics, these articles would be required reading. They outline one of the fundamental problems that crops up in every kind of human service work—not just child welfare.

And for that reason, child welfare informatics is too fine a way to slice this. People are becoming more aware of the connections among issues. Solutions pioneered in one area of human service work can help solve problems in others. And at the same time, the sector’s resources are shrinking. Creating separate specialties around homelessness informatics, domestic violence informatics, workforce development informatics and all the rest would be neither effective nor efficient.

My conclusion: The different substantive specialties all need to be in a conversation together. And it must be an interdisciplinary conversation: public administration, social work and information systems must all be at the table together. (All of them may need to step beyond their current comfort zones.)

What might be a first step? I suggest that the sector needs to focus on a basic question: What’s different about managing human service information that makes it difficult? (I will float a few ideas in future posts on this blog.)

—Derek Coursen

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