How an unwillingness to embrace technology is holding back our social services
Insight by Stephen Brock
Social care is a fundamental part of national healthcare, providing vital support to those who need it. Yet a complex and inadequate system means social care workers are often under immense pressure to do their jobs, affecting the mental health of all involved. Stephen Brock discusses the technological obstacles that hamper practitioners, and what needs to change.
Entering social work is entering a school of culture. The new social worker learns the cultural norms, customs, rituals, and expectations of practice. Practice including the quality of the conversations with those they are helping; the ability to record the information gained accurately and timely; the ability to make sense of this information and relate it to children’s and families' unique needs; and the ability to move information to the right people at the right time to affect change in lives. All while absorbing and holding in mind theoretical knowledge and ensuring professional duties are carried out in line with relevant legislation, policies, and procedures.
Thankfully, this entire process is facilitated by ever increasingly sophisticated technology. But therein lies a major problem: few practitioners ever get sufficient training or orientation in how to use this technology or manage information effectively, nor are the systems set up to support their practice. Rather, they are set up primarily for accountability, resulting in undue stress, frustration and disempowered practitioners, ultimately affecting their ability to work with families.
As technology has advanced, so too has bureaucracy – something social work is notorious for. In fact, this year bureaucracy was a key theme in a report by the care review summarising its engagement with practitioners. The report cited previous Department of Education research findings that 1 in 3 social workers do not work directly with children and those that did spend less than one third of their time in direct engagement with children and families.
In over our heads?
There is such a flow of information in the field of social work that it places extremely high cognitive demands upon practitioners. So much so that management of information has become a vital role in social work.
In 1994, In Over Our Heads: The mental demands of modern life by Robert Kegan was published. In this pre-app, pre-smartphone era, computers were becoming more commonplace in households and work. But at this point, computing was compartmentalised, it had its place. Computers and personal data assistants (PDAs) were mainly being used at work or home for specific purposes. Things like word processing and database management. It was easy to walk away from it. Portability remained limited too as laptops were expensive and not yet widely embraced in workplaces. Up until this time the Internet was in its infancy, truly mobile computing was just emerging, and social media was yet to come.
It was not until the development of hyperlinks and the launch of the world’s first web browser, Mosaic in 1993, that the world wide web opened. Suddenly, it was easier for people to share information via their own web pages. From 1993 to 1996, the number of websites grew from 130 to over 100,000.
Since then, the use of the Internet has exploded, providing innovations in computer languages, database management, software capabilities, user interface, and social media.
Doug Engelbart, who’s work greatly influenced the development of our ‘systems’ (computer mouse, bitmapped screens, hypertext) talked about making knowledge more accessible through computing to create, access, navigate, manipulate, and make sense of information. In fact, he and his teams were the first to demonstrate video presentations in ‘mother of all demos.’ As Engelbert put it, “we were not just building a tool, we were designing an entire system for working with knowledge.”
Managing information vs creating knowledge
Systems as we now know them are comprised of the servers that store the information or knowledge; the software programmes we use to access, add to, and make use of that information; and the different hardware (phones, laptops, tablets) that are used. All of this is designed for the purpose of managing information and/or creating knowledge.
This is an important distinction to make. In social work, as with other fields, the intent is to create knowledge – but the reality is more information management. For example, a practitioner will process information by reading what is on a file, and then using that information to plan to gather more information (from visits, emails, telephone calls, documents, meetings). They then put that information into a database via a form to make sense of it and act on it.
It all seems simple. Until you consider that the same information is often then reconfigured to fit other forms of the system to serve different purposes. Often, this results in a duplication of the original information presented in a different way for different audiences for specific purposes. This is mainly information management and very little knowledge creation.
Information overload
When the Internet was at a trickle in the early 1990s, Kegan was already talking about information overload. As a renowned educator, he was foretelling a time when the trickle would become a flood of information to be cognitively processed and acted upon.
In social work, the flood has happened. In practice, being overwhelmed manifests itself in the piling up of paperwork, large numbers of emails, frequent phone calls, and exposure to multiple sources of information. Being overloaded may lead to poorer judgment, losing track of things and losing focus.
Social workers are tasked with making sense of information and determining which to act on. This brings into question brain processing speed – something which is different for all of us. Some of us take longer, while others are very quick. This is not an indicator of intelligence; it is just one way our brains are different. Understanding how our brains process information can help social workers and those that create ‘the system.’
In 2014, a research report – Clinical Judgement and Decision-Making in Children’s Social Work: An analysis of the ‘front door’ system – found behavioural factors that impact social work decision making. Four were found to be most significant: 1) Time and workload pressures increase use of social workers’ intuition to make decisions; 2) Biases affect social workers’ ability to make objective judgements; 3) Decision fatigue as many sequential decisions have to be made through the course of a single day; and 4) Often relatively low quality information provided to social workers, resulting in significant energy spent on piecing together a full picture of the relevant information, leaving less time for analysis.
Similar findings have been found in another research. Where cyber-based overload predicted stress, poorer health, and less time devoted to contemplative activities. While in the disaster management field a correlation between higher levels of information overload form digital sources leading to increasing stress with lower levels of analytical think and greater use of intuition.
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The disempowerment of social service workers
In 1967 Ackoff wrote about management information systems (MIS) at a time when computers were in their infancy. His message is applicable today. If those using the system are involved in the design of it, this will ensure it suits their needs and, importantly, they will know how it works. However, most systems are designed by external designers in consultation with senior managers.
Which brings us to organisational culture. Research carried out in the financial sector found organisational climate was a factor that contributed to information overload. Specifically, a risk averse-oriented or ‘blame culture.’ This leads to informational behaviour that creates an overload on the individual themselves and/or on others.
These observations mirror the world of social work in the UK. It is the social worker who provides this information. The problem is that social workers do not have authority over how ‘the system’ works. Meaning they have little authority over the information they are tasked to collect and manage. They are in fact disempowered as they are consumed moving information to ‘all possible parties with a view’.
In social work part of promoting wellbeing is sharing knowledge with those we help. Knowledge is empowering. However, when it comes to information technology and information management systems, quite often the practitioner is left behind. Just as with families, the right knowledge will empower the practitioner. The more we can understand about how our brains work – especially when we accept that social work inevitably involves processing vast amounts of information – then it is possible both individually and organisationally to begin to use technology in a way that promotes practice and reduces practitioner distress to promote wellbeing.
Yet, this involves engaging practitioners in developing case management systems that support their practice. Simply relying on practitioners to understand how their brains process information so they can work more efficiently would be missing the point. There needs to be a fundamental shift in how systems are designed and for what purposes they serve.
Kegan pointed out that very few people working in organisations have jobs they have created for themselves. Social work is not an exception. He wrote that the modern workplace expects much of workers and listed six general expectations:
To invent or own our work
To be self-initiating, self-correcting, self-evaluating
To be guided by our own vision at work
To take responsibility for what happens to us at work externally and internally
To be accomplished experts in our roles, jobs, or careers
To conceive of the organisation from the outside in as a whole; to see our relation to the whole; to see the relation of the parts to the whole.
Social work practitioners are asked to fulfil all these expectations in some way. However, social workers are often sectored into different services. Assessment teams, Court teams, Children in Care Teams, etc., each creating siloed areas of practice tied together through ‘the system,’ with little autonomy over how case management systems are designed. This presents a contradiction in how they practice and understand how the system connects each service, resulting in the opposite of Kegan’s sixth listed expectation.
Workforce overwhelm and professional dilemmas
There is a large body of evidence regarding stress and the workplace. In social work, practitioners may experience distress when hearing and writing about the experiences of children and families. This secondary, or vicarious trauma, is widely acknowledged and practitioners are generally supported with this. The stress experienced working ‘the system’, the bureaucracy, is also acknowledged, as the Care Report reveals. Yet, there is little recognition of the mental strain placed on practitioners through the experience of using information management systems.
Recently a discussion with a team manager highlighted the frustration. They talked about a practitioner who had completed a piece of work in a Word format and uploaded this into the case management system. Then entering ‘see attached assessment’ in the appropriate template within the case management system. This was an effort to save time and avoid duplication.
Only, they were then directed to transfer the information into the case management template. This discussion occurred in the context of the manager expressing overwhelm at making their way through the numerous pieces of work to approve and not having the headspace to process the volume of information coming through to them on the system. This experience contradicts the first and fifth of Kegan’s listed expectations.
This is not an isolated story. I have heard stories expressing frustration, overwhelm and anxiety from both practitioners and managers around inputting information into the system. The time it takes to have discussion, write notes, and then rewrite them into the system. One practitioner explained finding the recording process so overwhelming, they had bought their own technology to help with this. The technology (at a personal cost of £600) is designed to cut out this duplication by digitising notes as they are written during visits and meetings. This experience is the practitioner trying to fulfil the second, fourth and fifth expectations on Kegan’s list.
In a further example highlighting knowledge of hardware occurred when speaking with a newly qualified practitioner who was struggling with keeping up with recording into the system. It was discovered that they were not aware of the capabilities of their work-issued laptop, specifically that it came with a digital pen and could be used to handwrite notes if they folded the laptop over. These could then be saved and put on the case management system.
Most workplaces will provide orientation training in the case management system as part of a standard orientation. Yet after this, there is little follow-up support. Most practitioners rely on support from their colleagues and managers to help them. This creates a dilemma for the new practitioner. In my work supporting practitioners, one of the challenges I often hear practitioners talk about is how to navigate and make ‘the system’ work. Inevitably, as part of such discussions, a practitioner will talk about feeling like a burden to their colleagues for continually asking for help with the system. However, I feel confident in saying their colleagues do not see it this way. Simply having the tools does not necessarily equate to enabling excellent quality practice. Without sufficient training and understanding, feelings of incompetence, anxiety and frustration will be experienced.
Where do we go?
As the discussion of bureaucracy in social work has increased over the years, there has been little, if any, change. Writing in 1980, Wilson and Mullings identified the need for effective information systems in social work, saying then that. “…those who work in this area are poorly serviced and communication in general is assumed to be something that happens rather than something that is designed.”
This is because there is little attention paid to technology; the information management systems which are driving the bureaucracy, and whose needs it is designed to meet. All the while technology is becoming more flexible and easier to use. Even so, the use of technology in social work has not kept pace to ease the demands of managing the flow of information and the mental demands placed upon practitioners.
The discussion of bureaucracy then shouldn’t be about discussing the bureaucracy itself. Instead, we need to be talking about the information management systems that underpins this, and how we can start embracing technology to ease the mental load social care workers are experiencing every day.
