The Fen-Phen Phenomenon is Killing Our Children

Remember Fen-Phen? It was the miracle drug of the 1990s that promised to deliver on what every couch potato had been dreaming of: fitness in a pill. It was weight loss without the punishment of working out or the self-discipline needed to diet. It was everything we wanted, with the tiny side effect of destroying the heart and shortening the lifespan of those who took it. It was the rage that led to regret.

Despite the warnings, Fen-Phen is killing kids today. Well, not fenfluramine phentermine exactly, but rather the popular prescriptions for our ailments, sold to make us healthy, but that are, in reality, slowly eating away at our heart and putting children at risk. We all agree child welfare in our world is not as healthy as we would like it to be. No one wants to see vulnerable children at risk, but it seems like every attempt to get healthier isn’t working, and we are all clinging to the hope that the next thing we try will be the real deal.

Miracle Cure Number 1: The New IT System

Probably the most Fen-Phen-ish of them all, the new IT system promises huge results if you just buy the right pill. Unfortunately, these large system replacements typically miss some critical elements of overall health. First, they are built to manage to the deadlines we set. While this seems great on the surface, what we miss is the healthier strategy of ensuring work is constantly flowing with purpose so it never reaches the deadline. How can an arbitrary deadline tell us any more than a binary “met it or missed it” metric? Wouldn’t it be infinitely more valuable to know what’s open and why at any given time? Even if that took 100 days to complete.

Second, we build the system to meet the needs of the wrong people. Sure, we need the system to provide meaningful data and capture case information. But most systems are built for practice and policy, designed to ensure procedures are followed so we can justify decisions. They are built for CYA. Historically, the system has not been built with the customer in mind. Who really uses the information we enter into our systems? It’s not the child or the family (except for the safety plans specifically designed for the family). It’s us. Investigations uses what Intake produces, Ongoing uses what Investigations produces, and Courts use the products of Ongoing. But have we really explored what each customer needs and wants? No. Instead, we’re building deadline tracking CYA machines that will eventually rise up like Skynet robots and take over.

Miracle Cure Number 2: Hold the People Accountable

What made Fen-Phen so popular was that on the surface, the science made sense. The drug isolated the fat cells and kept them from being processed into the body where it would have been stored as love handles. In the same way, the science behind accountability makes sense. If we set performance targets for our employees, reward good behavior, and punish failure, then good employees stay good, mediocre ones can strive to get better, and the worst ones get isolated and discarded so they won’t weigh us down.

Unfortunately, the science is wrong. People in social services did not choose this career path to get rich. It is a calling to help families. Now, if you have a system to give us more money, we’d like some. We know these positions are notoriously undervalued, but a 2% bonus for closing 80% of cases on time isn’t going to get you the kind of effort it will take to make us healthy. As for fear, fear motivation is a tricky thing. Humans tend to react to fear motivation in two ways: we get away from it or we get used to it. Those used to it won’t be leaving anytime soon. They know you’re already short staffed and most likely bluffing. And those getting away from it? Well, check your turnover rates and ask, “are those the people we want leaving?” At best, fear needs to continually escalate to be effective, and that’s a horrible strategy for managing people who care enough about families that they already take case files home with them and on any vacation they can squeeze in.

The Problem with Miracle Cures

Like Fen-Phen, what we have turned to in order to get healthy is actually destroying our heart. Ever notice how after the new IT system rolls out things never got significantly better? We’re more mobile – that’s good. Our data is generally cleaner – also good. Our screens aren’t annoying shades of green on darker green anymore. But the work is the same. We’re still missing deadlines, the number of kids in care continues to grow, and foster placements still struggle. Technology alone doesn’t address these problems. For the price tag and the hassle, we got change, but we didn’t get radical improvements. And our hearts break over everything we put in for so few results.

Dan Pink wrote a wonderfully insightful book about motivation titled “Drive.” Turns out, we can’t really motivate behavior, and most our efforts to influence behavior actually demotivate people. Which is crazy because the people in this field already have the most powerful intrinsic motivation of all. They will knock on a stranger’s door in the middle of the night and risk their own safety to ensure the safety of a child. They are noble people and it breaks their hearts to be treated like they are the problem. When we break the heart of the people we need to be successful, we put children at risk.

If You Want to Get Healthy, You Gotta Work

So, what is the diet and exercise of child welfare? It’s worktime and workflow. These are the two lifestyle choices we have to make to get healthier.

Worktime is the measure of effort needed to do the job at hand. Currently, most assessments take around 20 hours to complete. Most workers get between three and seven new assessments per week. There is no way to keep up when 60 to 140 hours is continually coming in the door and we only have 40 hours to do it. We need to find time to be compliant with practice while cutting the worktime by almost half. By rebuilding our documentation to meet customer needs and finding those non-value added steps that rob us of capacity, we can do the hard work to reduce worktime.

Workflow is managing cases so that work is never “sitting” waiting on us. It’s making sure we have access to what we need to move a case forward, that the structure of the work allows for handoffs to be done quickly, and that the work and next steps are visible so we can always be moving with purpose. Workflow is managing the assembly line. It’s not social work-y by nature; it’s the hard work of making sure the widgets are getting made. It’s not natural to most of us, so we need to find ways to build it into our regular routines and our lifestyle. A lot like diet and exercise.

 

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